Michigan medicine : the journal of the Michigan State Medical Society

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EPIGRAMS

E NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

January 12, 1972, Volume 71, Number 1
Michigan State Medical Society
Save this Issue for Reference

MSMS Testifies before
National Democratic Council

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JAN 2 8 1872

MSMS Lists Michigan Medical Meeds;
Describes Steps toward Solutions

I appreciate the invitation extended to the
Michigan State Medical Society to appear today
before the Democratic Policy Council of the
Democratic National Committee. I am Doctor
Brooker L. Masters, a family physician at Fremont,
Michigan, a rural community of 3,400 in western
Michigan. I appear here in my capacity as chair-
man of the board of directors (Council) of the
Michigan State Medical Society, the professional
association of 8,101 doctors of medicine in Michi-
gan.

With me today is Doctor Donald N. Sweeny,
Jr., a surgeon in group practice here in Detroit.
Doctor Sweeny is a member of our board of
directors; and long has been active in the Wayne
County Medical Society. Should you have any
questions today or in the future, we are available
to provide the views of both the rural and urban
doctor of medicine.

We are pleased that you have invited providers
of health care so that you can obtain first-hand
the views and suggestions of the doctors, nurses,
dentists.

We accepted because it is our strong contention
that the political parties, candidates, and the
elected representatives have not generally sought
views of the physicians in practice. Those doctors
who actually see patients every day can accurately
evaluate the problems and suggest possible work-
able solutions.

Our Michigan State Medical Society member-
ship spans the whole spectrum of medical doctors
—from the medical school professor to the medi-
cal researcher to the salaried physician to the fee-
for-service solo practitioner. But it is only through
the Michigan State Medical Society that the pri-
vate practitioner has a voice in Michigan.

* * #

As the prime providers of medical care in
Michigan, doctors are deeply concerned about the
health and medical needs of the people in Michi-
gan. We have 40 active committees which study

various medical concerns and we are activists in
attacking these problems.

Our presentation today is developed in accord-
ance with the request made in your invitational
letter. Your letter said— “These hearings will give

EDITOR’S NOTE:

Here is the complete testimony offered by
the Michigan State Medical Society before
the national Democratic Policy Council in
Detroit, Jan. 12. The Democratic Policy
Council invited MSMS to discuss Michigan
medical needs. Brooker L. Masters, MD,
Chairman, MSMS Council, who presented
the testimony, explains that the statement
was developed to establish MSMS as a
leader in working on Michigan health needs,
and to report steps being taken by MSMS
to help solve these problems.

The testimony was based on resolutions
adopted by the MSMS House of Delegates
in recent years. The statement. Doctor
Masters adds, also pointed out several weak-
nesses in current governmental health care
programs without implying that any new
revolutionary approach is needed. The state-
ment also stressed the need to continue the
pluralistic approach to the practice of medi-
cine.

Members of the MSMS Council over-
whelmingly indicated to Doctor Masters that
this Democratic Party invitation should be
accepted. The Party plans four such hear-
ings across the nation, the first being the
one in Detroit.

The AMA will testify before the Demo-
cratic Platform Committee on national issues
and advised MSMS to make its presentation
deal with Michigan needs and projects.

the Democratic Party an opportunity to develop
proposals which respond appropriately to the
needs of the country.”

We have studied the 1968 platform of the
National Democratic Party. We share your con-
cerns about medical research, the physician short-
age, maternal and perinatal health care, drug edu-
cation, and others.

Your 1968 platform also called for “new co-
ordinated approaches through a partnership of
government and private enterprise.” Again, the
Michigan State Medical Society is at work to bring
about stronger cooperative programs between the
private practice of medicine and government.

Doctors agree with your 1968 health statement
that— and I quote— “The best of modern medical
care should be made available to every American.”

* * *

We will discuss some of the specific needs that
the Michigan State Medical Society has identified
and urge that your Democratic Policy Council
consider our approaches toward solutions.

These needs have been officially recognized
by the Medical Society House of Delegates, which
supervises ongoing study and action to solve these
problems. Our House of Delegates is a truly rep
resentative body, consisting of one delegate elected
in each county medical society to represent each
50 physicians.

Time forces me to select what 1 feel are six
major medical needs facing doctors and everyone
in Michigan.

Need #1:

Michigan medical schools should be enlarged

Michigan issues an average of 650 permanent
licenses each year to doctors of medicine. In order
to better meet our own needs in Michigan, our
Medical Society was a prime proponent of the
new medical school at Michigan State University.
We have worked for many years to convince the
State legislature to increase appropriations to ex-
pand the medical school enrollments at the Uni-
versity of Michigan and Wayne State University—
and now also at Michigan State University. We
are pleased that the number of medical students
in Michigan has increased from 1,342 in 1966
to 1,710 in 1971. This is an increase of 368 in
just five years.

Last June there were 343 young men and
women graduated from Michigan medical schools.
This figure will soon surpass 400; but still leaves
us considerably short. In addition to the 650 doc-
tors who receive permanent licenses in Michigan
each year, there are 200 graduates of foreign medi-

“MSMS has worked many years
to convince the legislature
to increase appropriations
to the medical schools ”

cal schools who receive temporary Michigan li-
censes.

We feel that every qualified applicant for medi-
cal schools in Michigan and the nation should
be admitted. Medical school officials report that
at present only 60 per cent of the qualified stu-
dents can be accepted.

I believe many Michigan doctors will utilize the
newly-emerging physician assistants to help pro-
vide more care for more people. In 1965 the Mich-
igan State Medical Society was the first such society
in the nation to support this new kind of medical
personnel. HEW reports that the developing phy-
sician assistant program at Western Michigan
University is the only one in the nation with the
endorsement of a state medical society.

# * #

Need #2:

Michigan needs more family physicians

Michigan residents— and I am sure those in other
states too— need and want more family physicians.
Doctors do too. During the ’60s, more and more
doctors chose to specialize and fewer went into
general practice. The Michigan State Medical
Society has had active committees since 1967 work-
ing to help turn this situation around.

Dedicated GPs are spearheading real progress
here— Future Family Physician Clubs have been
established at all three schools, and five Michigan
hospitals now are offering family practice residen-
cies. The three medical schools have altered their
curricula to give more attention to family and
community medicine.

MSMS has urged the legislature and the medical
schools to create Departments of Family Practice,
and we are cooperating now in a special Michigan
Legislative Study Committee to study the complex
problem.

We are encouraged, too, with the reports in
Michigan that a much higher percentage of medi-
cal students is deciding today to enter general
practice as a meaningful way to treat the whole
person.

# * #

Need #3:

Distribution of physicians must be improved

There are areas in Michigan where there are
shortages of physicians and other health personnel.
We are deeply concerned about such shortages in
some rural areas, in some small communities, and
the inner city of Detroit.

Many rural areas lack educational facilities as
well as the chance for professional relationships
and cultural activities for the doctor and his fam-
ily. The center city has become a depressing place
to work or live and the threats to safety of the
person and property are real. For example, five
doctors of medicine have been murdered in the
inner city of Detroit in the past two years.

We are opposed to coercion or mandatory as-
signment to practice in any specified area, because
we believe the doctor should have freedom to
choose his own place to practice.

“Medicare and Medicaid
programs should cover home
health care service and
more preventive medicine ”

MSMS committees are active to solve these
problems and we see some improvements. Each
situation requires different solutions. We can
point to examples of group practice arrangements,
community health centers, satellite clinics, mobile
screening programs, and others as innovative
answers.

Here in Detroit, for example, a new medical
center was erected in 1971 by a group of Black
private physicians led by Doctor Lionel Swan to
provide them the opportunity to practice in one
building with savings in personnel, laboratory
facilities, business operations and other oppor-
tunities.

The Michigan Medical Society is the major
supporter of the Michigan Health Council which
operates an effective program to assist Michigan
communities to obtain more physicians. Since
1953 the Health Council has helped to place 1,100
physicians in our state.

* # #

Need # 4 :

There must be more preventive medicine

Because the level of education in Michigan and
the nation has never been higher than it is today
we find a new acceptance by the people of pre-
ventive medicine. Doctors are trained to practice
and preach preventive medicine and we are
pleased to see the climate improving.

The Michigan State Medical Society has adopted
resolutions endorsing multiphasic health screening,
and supporting the use of computers. MSMS regu-
larly sponsors public seminars on cancer, arthritis,
smoking and alcoholism, often with the support of
local newspapers. MSMS every day distributes edu-
cational materials about drug abuse, about venereal
disease, and other health problems to school chil-
dren.

Our Medical Society was active in urging the
Michigan legislature in 1969 to pass a law which
now assures comprehensive health education from
kindergarten through high school.

I will make further comments about preventive
medicine under Need #5.

* * *

Need #5:

There must be improvements in current governmental
health programs

In the original Medicare and Medicaid legisla-
tion, home health care services such as visiting
nurses were covered . . . but last year this part
of the program was severely curtailed. MSMS
adopted a resolution pointing out that such cur-

tailment denies health care to a large segment of
our chronically-ill aging population. Home health
services by visiting nurses under the direction of
physicians are traditional, are effective, and are
the most economical of all health services.

The present guidelines for Medicare and Medi-
caid must be changed to permit doctors to practice
preventive medicine with these patients. Today,
physical examinations, immunizations, Pap smears
for cancer, and other preventive medical pro-
cedures are not covered.

Speaking about Medicaid, the doctors of Michi-
gan have worked diligently to make the state
program operate effectively and efficiently. We
have conferred many times with state Medicaid
officials.

On March 2, 1971, MSMS presented 12 sugges-
tions to improve the state Medicaid program to
provide better health care for the medically indi-
gent. At that time, we advocated greater emphasis
on preventive programs, health maintenance, and
ambulatory care. A copy of the 12 recommenda-
tions is attached to the statement given members
of your policy council.

# * *

Need #6:

The pluralistic system must continue

The Michigan State Medical Society has an
official position recognizing that “there are cur-
rently many acceptable methods of practicing
medicine.” Michigan physicians “feel that multiple
options for the delivery of medical care should
remain open to physicians.”

Our nation is great because we do have plural-
istic systems of education, agriculture and others.
It is appropriate because no single approach will
work across our large nation where population
densities vary, where cultural values differ, and
so1 many conditions are unique.

In Michigan today we have solo medical prac-
tices, group practices, professional corporations,
clinics, hospitals with salaried staffs, hospitals with
fee-for-service staffs, and other forms of practice.
We believe that each in its own way is contrib-
uting to the effective practice of medicine in Mich-
igan. These variations permit the doctor to select
the best structure to provide care for his patients.

Any insistence that medicine be practiced the
same in the inner city of Detroit as in my rural
community in Western Michigah would be unwise.

* # #

Let me recap the six major Michigan medical
needs we have identified for you as requested in
your invitational letter:

“MSMS feels that multiple
options for the delivery
of medical care should
be open to physicians.”

TO MSMS MEMBERS:

As you read this testimony, I especially
call your attention to the discussion of the
six Michigan medical needs and to the copy
which describes our MSMS work to relieve
and solve these problems.

If you feel that too little has been done
to correct these problems, MSMS members
can take the following actions : ( 1 ) work
harder through appropriate component so-
ciety committees to develop positive pro-
grams, ( 2 ) urge component society delegates
to the MSMS House of Delegates to intro-
duce resolutions with workable plans to
attack the issues, and (3) encourage and
assist MSMS committees to deal effectively
with problems in their sphere of expertise.

This review of Michigan needs and our
efforts also will challenge the MSMS Com-
mittee on Planning and Priorities to step up
its work.

Any reactions to the testimony or sugges-
tions to improve MSMS efforts to solve
medical needs in our state will sincerely be
welcomed. Just mail them to me at MSMS,
120 West Saginaw, East Lansing 48823.

Brooker L. Masters, MD
Chairman, MSMS Council

1. Michigan medical schools should be enlarged.

2. Michigan needs more family physicians.

3. The distribution of physicians must be im-
proved.

4. There must be more preventive medicine.

5. There must be improvements in current
governmental health programs.

6. The pluralistic system must continue.

In discussing each of these Michigan needs, we
have described briefly only a few of the many posi-
tive programs of the Michigan State Medical So-
ciety. Our component county medical societies, too,
have action programs, as do the Michigan medical
specialty organizations.

“ The medical profession
accepts its vital role
in this evolution toward
further improvements ”

We continually work with and have offered our
services to the Michigan legislature, the medical
schools, the Michigan Consumer Council, and con-
cerned lay groups.

Our testimony has focused on Michigan medical
needs because we are certain the American Med-
ical Association will be invited to discuss national
issues later before the Democratic Party platform
committees.

# # #

Through our illustrations today we hopefully
have convinced you that the Michigan State Med-
ical Society is a responsible organization of dedi-
cated professional people. We think the individual
physicians of Michigan provide good quality care
for the people of Michigan.

We share the same concerns that consumers
have. New ideas must be considered jointly so
that practitioners in medicine can share in new
experimental programs.

The medical profession accepts its vital role in
this fast-moving evolution toward further improve-
ments. We are dedicated to making available med-
ical care for everybody. We are deeply concerned
about the costs of medical care. We are insistent
through our many review committees that high
professional standards of quality be maintained.

No country has developed, in the opinion of
physicians, a better combination of these three fac-
tors—general access, reasonable cost, and high qual-
ity.

There HAS been real progress in Michigan and
our nation.

The Michigan State Medical Society is dedicated
to working for further improvements. Toward this
end Michigan’s doctors are prepared to work with
any responsible political force such as this Council.

Thank you again for inviting us. If we can be
of further help, please call on us.

Jan. 12, 1972, Vol. 71, No. 1

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

MICHIGAN STATE MEDICAL SOCIETY

Published three times each month and four times in
December and January, 38 issues, by the Michigan State
Medical Society as its official journal. Second class
postage paid at East Lansing, Mich, and at additional
mailing offices. Yearly subscription rate, $9.00. Printed
in USA. All communications should be addressed to the
Publications Committee, Michigan State Medical Society,
120 West Saginaw Street, East Lansing, Michigan 48823.
© 1972 Michigan State Medical Society. Phone: Area
Code 517, 337-1351.

UNIVERSITY OF CAL
LIBRARY SCH OF MED
THIRD £ PARNASSUS AVE
SAN FRANCISCO CAL 94122

EDITOR: HERBERT A. AUER

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OFFICIAL JOURNAL OF THE MICHIGAN STATE MEDICAL SOCIETY • VOLUME 71, NUMBER 2 . JANUARY, 1972

MOTHER AND CHILD by Gari Melchers. Courtesy of the Art Institute of Chicago

See page 38 for complete program

of 1972 Michigan Conference on Maternal and Perinatal Health

IF MORE MEN CRIED

References: 1. Silen, W.: “Peptic Ulcer,” in Wintrobe, M. M.,
ct al. (eds.) : Harrison’s Principles of Internal Medicine, ed.
6, New York, McGraw-Hill Book Company, 1970, p. 1444.
2. Wolf, S., and Goodell, H. (eds.): Harold G. Wolff’s
Stress and Disease, ed. 2, Springfield, 111., Charles C
Thomas, 1968, pp. 68-69. 3. Ibid., p. 257. 4. Schottstaedt,
W. W.: Psychophysiologic Approach in Medical Practice,
Chicago, 111., The Year Book Publishers, Inc., 1960, p. 163.
5. Alvarez, W. C.: The Neuroses, Philadelphia, Pa., W. B.
Saunders Company, 1951, p. 384.

Hypersecretion— an atavistic response.

Stewart Wolf, who, with Harold G. Wolff,
studied the personalities of duodenal ulcer
patients, wonders if masculine competitive-
ness is related to “an atavistic urge to devour
an adversary.” It is striking, he reports, that
an accentuation of gastric acid secretion and
motility can be “induced in ulcer patients by
discussions that arouse feelings of inade-
quacy, frustration and resentment.”2

By chance? A lean, hungry lot. Was the
link between emotions and gastric hyper-
acidity acquired through mutation to serve
a purpose? During man’s jungle period of
evolution, the investigator points out, a male
dealt with a foe by killing and devouring it.
“It may be more than coincidence,” he con-
cludes, that peptic ulcer patients appear to
be “a lean, hungry, competitive lot.”3

At least seventy-five out of
one hundred adults with
duodenal ulcers are men.1
Why? It may be signifi-
cant that duodenal ulcer
patients tend to crave
recognition and are
“especially vulnerable to
threats to their manly
assertive independence.”2

Big boys don’t cry. If more men cried,
maybe fewer would wind up with duodenal
ulcers. But men will be men— the sum total of
their genes and what they
are taught. Schottstaedt
observes that when a
mother admonishes her
son who has hurt himself
that big boys don’t cry, she
is teaching him
stoicism.4 Crying is the
negation of everything
society thinks of as manly.
A boy starts defending his
manhood at an early age.

Take away stress,
you can take away symptoms.

There is no question that stress plays a
role in the etiology of duodenal ulcer.
Alvarez5 observes that many a man with an
ulcer loses his symptoms the day he shuts up
the office and starts out on a vacation. The
problem is, the type of man likely to have an
ulcer is the type least likely to take long
vacations or take it easy at work.

The rest cure vs. the two-way action of
Librax. For most patients, the rest cure is
as unrealistic as it is desirable. Still, the
stress factor must be dealt with. And here
is where the dual action of adjunctive Librax
can help. Librax is the only drug that com-

mes the antianxiety
ition of Librium
hlordiazepoxide HC1)
ith the dependable
ntisecretory/
ntispasmodic
Aion of
•uarzan® (clidinium Br).

Protects man from his own hungry per-
onality. The action of Librium reduces
nxiety — helps protect the vulnerable patient
[’om the psychological overreaction to stress
fiat clutches his stomach. At the same time,
le action of Quarzan helps quiet the hyper-
ctive gut, decreasing hypermotility and
ypersecretion.

An inner healing environment with 1
r 2 capsules, 3 or 4 times daily. Of course,
lere’s more to the treatment of duodenal
leer than a prescription for Librax. The pa-
ient — with your guidance — will have to ad-
ust to a different pattern of living if treat-
lent is to succeed. During this adjustment
eriod, 1 or 2 capsules of Librax 3 or 4 times
aily can help establish a desirable environ-
nent for healing.

Librax: It can’t change man’s nature.
But it can usually make it easier for men to
:ope with the discomfort of stress— both
)sychic and gastric — that can precipitate
ind exacerbate duodenal ulcer.

Abrax : Rx #60 1 cap. a.c. and 2 h.s.

Before prescribing, please consult complete product
information, a summary of which follows:

Indications: Indicated as adjunctive therapy to control
emotional and somatic factors in gastrointestinal
disorders.

Contraindications: Patients with glaucoma;
prostatic hypertrophy and benign bladder
neck obstruction; known hypersensitivity to
chlordiazepoxide hydrochloride and/or
clidinium bromide.

Warnings: Caution patients about possible
combined effects with alcohol and other CNS
depressants. As with all CNS-acting drugs,
caution patients against hazardous occupations
requiring complete mental alertness (e.g., operating
machinery, driving). Though physical and psychological
dependence have rarely been reported on recommended doses,
use caution in administering Librium (chlordiazepoxide
hydrochloride) to known addiction-prone individuals or those
who might increase dosage; withdrawal symptoms (including
convulsions), following discontinuation of the drug and similar
to those seen with barbiturates, have been reported. Use of any
drug in pregnancy, lactation, or in women of childbearing age
requires that its potential benefits be weighed against its
possible hazards. As with all anticholinergic drugs, an inhibiting
effect on lactation may occur.

Precautions: In elderly and debilitated, limit dosage to smallest
effective amount to preclude development of ataxia, over-
sedation or confusion (not more than two capsules per day
initially; increase gradually as needed and tolerated). Though
generally not recommended, if combination therapy with other
psychotropics seems indicated, carefully consider individual
pharmacologic effects, particularly in use of potentiating drugs
such as MAO inhibitors and phenothiazines. Observe usual
precautions in presence of impaired renal or hepatic function.
Paradoxical reactions (e.g., excitement, stimulation and acute
rage) have been reported in psychiatric patients. Employ usual
precautions in treatment of anxiety states with evidence of
impending depression; suicidal tendencies may be present and
protective measures necessary. Variable effects on blood
coagulation have been reported very rarely in patients receiving
the drug and oral anticoagulants; causal relationship has not
been established clinically.

Adverse Reactions: No side effects or manifestations not seen
with either compound alone have been reported with Librax.
When chlordiazepoxide hydrochloride is used alone, drowsi-
ness, ataxia and confusion may occur, especially in the elderly
and debilitated. These are reversible in most instances by
proper dosage adjustment, but are also occasionally observed
at the lower dosage ranges. In a few instances syncope has
been reported. Also encountered are isolated instances of skin
eruptions, edema, minor menstrual irregularities, nausea and
constipation, extrapyramidal symptoms, increased and
decreased libido— all infrequent and generally controlled with
dosage reduction; changes in EEG patterns (low-voltage fast
activity) may appear during and after treatment; blood dyscra-
sias (including agranulocytosis), jaundice and hepatic dys-
function have been reported occasionally with chlordiazepoxide
hydrochloride, making periodic blood counts and liver function
tests advisable during protracted therapy. Adverse effects
reported with Librax are typical of anticholinergic agents, i.e.,
dryness of mouth, blurring of vision, urinary hesitancy and
constipation. Constipation has occurred most often when
Librax therapy is combined with other spasmolytics and/or low
residue diets.

in the treatment of
duodenal ulcer
« i adjunctive

Librax

Each capsule contains 5 mg chlordiazepoxide HC1
and 2.5 mg clidinium Br.

Roche Laboratories

Division of Hoffmann-La Roche Inc.

Nutley, N.J. 07110

Our leaders

I

i

MSMS Officers

PRESIDENT

PRESIDENT-ELECT

SECRETARY

TREASURER

ASS T SECRETARY
ASST TREASURER

SPEAKER

VICE SPEAKER
PAST PRESIDENT

DIRECTOR

GENERAL COUNSEL
LEGAL COUNSEL
ECONOMIC CONSULTANT
SCIENTIFIC EDITOR

MSMS Council

CHAIRMAN

VICE CHAIRMAN

AMA DELEGATION CHAIRMAN

Sidney Adler, MD Detroit

John J. Coury, MD Port Huron

Kenneth H. Johnson, MD Lansing

John R. Ylvisaker, MD Pontiac

Ross V. Taylor, MD Jackson

Ernest P. Griffin, MD Flint

Vernon V. Bass, MD Saginaw

Janies D. Fryfogle, MD Detroit

Harold H. Hiscock, MD Flint

Warren F. Tryloff East Lansing

Lester P. Dodd Detroit

A. Stewart Kerr Detroit

Clyde T. Hardwick, PhD Houghton

John W. Moses, MD Detroit

Brooker L. Masters, MD Fremont

Robert M. Leitch, MD Battle Creek

Donald N. Sweeny, Jr., MD Detroit

COUNCILOR

First District Councilors: (Wayne County)

Edward J. Tallant, MD, Detroit
Ralph R. Cooper, MD, Detroit
Frank G. Bicknell, MD, Detroit
Brock E. Brush, MD, Detroit
Louis R. Zako, MD, Allen Park
Second District Councilor: Ross V. Taylor, MD, Jackson
Counties: Clinton, Eaton, Hillsdale, Ingham, Jackson
Third District Councilor: Robert M. Leitch, MD, Battle Creek
Counties: Branch, Calhoun, St. Joseph
Fourth District Councilor: W. Kaye Locklin, MD, Kalamazoo
Counties: Allegan, Berrien, Cass, Kalamazoo, Van Buren
Fifth District Councilor: Noyes L. Avery, MD, Grand Rapids
Counties: Barry, Ionia-Montcalm, Kent, Ottawa
Sixth District Councilor: Ernest P. Griffin, Jr., MD, Flint
Counties: Genesee, Shiawasse^

Seventh District Councilor: James H. Tisdel, MD, Port Huron
Counties: Huron, Sanilac, Lapeer, St. Clair
Eighth District Councilor: William A. DeYoung, MD, Saginaw
Counties: Gratiot-Isabella-Clare, Midland, Saginaw, Tuscola
Ninth District Councilor: Adam C. McClay, MD, Traverse City

Counties: Grand Traverse-Leelanau-Benzie, Manistee, Northern Michigan (Antrim, Charlevoix,
Cheboygan and Emmet combined), Wexford-Missaukee
Tenth District Councilor: Robert C. Prophater, MD, Bay City

Counties: Alpena-Alcona-Presque Isle, Bay-Arenac-Iosco, North Central Counties, (Otsego, Mont-
morency, Crawford, Oscoda, Roscommon, Ogemaw, Gladwin and Kalkaska, combined)

Eleventh District Councilor: Brooker L. Masters, MD, Fremont

Counties: Mason, Mecosta-Osceola-Lake, Muskegon, Newaygo, Oceana
Twelfth District Councilor: Raymond Hockstad, MD, Escanaba

Counties: Chippewa-Mackinac, Delta-Schoolcraft, Luce, Marquette-Alger
Thirteenth District Councilor: Donald T. Anderson, MD, Wakefield

Counties: Dickinson-Iron, Gogebic, Houghton-Baraga-Keweenaw, Menominee, Ontonagon
Fourteenth District Councilor: Donato F. Sarapo, MD, Adrian
Counties: Lenawee, Livingston, Monroe, Washtenaw
Fifteenth District Councilor: Sydney Scher, MD, Mount Clemens
Counties: Macomb, Oakland

2 MICHIGAN MEDICINE JANUARY 1972

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ANGRY?

Doctor, are you upset over the recent freeze
on medical fees or any in a series of political
moves to control the medical profession?
What are you going to do?

Ask yourself, how would George Meany or
Leonard Woodcock respond to similar
pressures? Almost every working man in
Michigan “voluntarily” contributes $1 a week,
$52 a year, for political action.

Can you afford to do less?

Within the past few days you have received
your billing statement for county, state and
AMA dues. Attached to the statement is a
separate billing for MDPAC, the Michigan
Doctors Political Action Committee, which is
voluntary and not deductible. In view of the
fee freeze, you have only three options on
the MDPAC contribution:

1. You can delete the MDPAC portion com-
pletely and continue to complain about
government control of health care.

2. You can make the minimal contribution
of $25 to MDPAC. If every physician in
Michigan contributed $25, the voice of
medicine would be able to speak out to the
tune of more than $200,000.

3. Or if you are really angry and want to
start playing the game by the same rules
as those who are consistent winners, cross
out the $25 and make your contribution for
$100. $100 makes you a sustaining member
of MDPAC.

Think about what a freeze on medical fees
means to you. Think about what kind of
precedent it sets for the future. Think about
it — and decide what you’re going to do
about it.

MDPAC

Michigan Doctors Political Action Committee

P.O. Box 769 East Lansing, Ml 48823

MICHIGAN MEDICINE JANUARY 1972 3

Coqteqts

SCIENTIFIC ARTICLES

15 Hypovolemic Shock, William R. Olsen, MD
27 Complications of Splenectomy, Robert D. Allaben, MD;
William S. Carpenter, MD; Paul J. Connolly, MD; Angelos
A. Kambouris, MD

33 Are Congenital Viral Infections Possible in Successive
Pregnancies? Thad H. Joos, MD

(£ Michigan (fMediciqe

SPECIAL ARTICLE

48 The status of Michigan’s Medicaid Program; Stuart
Paterson

NEW FEATURES

32 Clinical notes

54 County Society in the Spotlight

75 Sound Off

New Maternal Health Desk Reference Card on
"The High Risk Fetus,” page 69

OTHER FEATURES

2 Our leaders
7 Small doses
10 Your opinion please
26 Perinatal tips
36 MSMS in action
38 Zip Code 48823
58 Michigan Mediscene
60 In memoriam

71 New members

72 Classified

Publication of Michigan Medicine is under the direction
of the Publication Committee, Michigan State Medical So-
ciety. The scientific editor is responsible for the scientific
content. The managing editor is responsible for the pro-
duction, correspondence and contents of the journal. He
and the executive editor share final responsibility of the
entire publication.

Neither the editors nor the state medical society will
accept responsibility for statements made or opinions ex-
pressed by any contributor in any article or feature pub-
lished in the pages of the journal. In editorials, the views
expressed are those of the writer and not necessarily offi-
cial positions of the society.

SCIENTIFIC EDITOR

John W. Moses, MD

EXECUTIVE EDITOR

Herbert A. Auer

MANAGING EDITOR

Judith Marr

PUBLICATION COMMITTEE

Robert M. Leitch, MD
Battle Creek
Chairman

Donato F. Sarapo, MD
Adrian

Edward J. Tallant, MD
Detroit

Devoted to the interests of the medical profession and
public health in Michigan.

INFORMATION FOR CONTRIBUTORS

1. Address scientific manuscripts to the Publication Com-
mittee, Michigan State Medical Society, 120 West Saginaw
Street, East Lansing, Michigan 48823. Submit original, double-
spaced typewritten copy and two carbon copies or photo copies
on letter size (8V2 x H inch) paper. On page one, include
title, authors, degrees, academic titles, and any institutional or
other credits.

2. Authors are responsible for all statements, methods, and
conclusions. These may or may not be in harmony with the
views of the Editorial Staff. It is hoped that authors may have
as wide a latitude as space available and general policy will
permit. The Publication Committee expressly reserves the right
to alter or reject any manuscript, or any contribution, whether
solicited or not.

3. Illustrations should be submitted in the form of glossy
prints or original sketches from which reproductions will be
made by Michigan Medicine.

4. Articles should ordinarily be less than four printed pages
in length (3000 words).

5. References should conform to Cumulative Index Medicus,
including, in order: Author, title, journal, volume number,
page, and year. Book references should include editors, edition,
publisher, and place of publication, as well.

6. The editors welcome, and will consider for publication,
letters containing information of interest to Michigan physi-
cians, or presenting constructive comment on current contro-
versial issues. News items and notes are welcome.

7. It is understood that material is submitted for exclusive
publication in Michigan Medicine.

MICHIGAN MEDICINE is the official organ of the Michigan
State Medical Society, published under the direction of the
Publication Committee. Published Semi-Monthly, Trimonthly
in January and December; 26 issues, by the Michigan State
Medical Society as its official journal. Second class postage
paid at East Lansing, Mich, and at additional mailing offices.
Yearly subscription rate, $9.00; single copies, 80 cents. Addi-
tional postage: Canada, $1.00 per year; Pan-American Union,
$2.50 per year; Foreign, $2.50 per year. Printed in USA. All
communications relative to manuscripts, advertising, news,
exchanges, etc., should be addressed to Judith Marr, Mich-
igan State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. Phone Area Code 517, 337-1351.
© 1972 Michigan State Medical Society.

4 MICHIGAN MEDICINE JANUARY 1972

phenformin HCi

■Hi

DBI® phenformin HCI
tablets of 25 mg.

DBI-TD® phenformin HCI
capsules of 50 and 100 mg.

Indications: Stable adult diabetes mellitus;
sulfonylurea failures, primary and second-
ary; adjunct to insulin therapy of unstable
diabetes mellitus.

Contraindications: Diabetes mellitus that
can be regulated by diet alone; juvenile
diabetes mellitus that is uncomplicated and
well regulated on insulin; acute complica-
tions of diabetes mellitus (metabolic acido-
sis, coma, infection, gangrene); during or
immediately after surgery where insulin is
indispensable; severe hepatic disease; renal
disease with uremia; cardiovascular collapse
(shock); after disease states associated with
hypoglycemia.

Warnings: Use during pregnancy is to be
avoided.

Precautions: 1. Starvation Ketosis: This
must be differentiated from “insulin lack”
ketosis and is characterized by ketonuria

which, in spite of relatively normal blood
and urine sugar, may result from excessive
phenformin therapy, excessive insulin reduc-
tion, or insufficient carbohydrate intake.
Adjust insulin dosage, lower phenformin
dosage, or supply carbohydrates to alleviate
this state. Do not give insulin without first
checking blood and urine sugar.

2. Lactic Acidosis: This drug is not recom-
mended in the presence of azotemia or in
any clinical situation that predisposes to
sustained hypotension that could lead to
lactic acidosis. To differentiate lactic acido-
sis from ketoacidosis, periodic determina-
tions of ketones in the blood and urine
should be made in diabetics previously sta-
bilized on phenformin, or phenformin and
insulin, who have become unstable. If elec-
trolyte imbalance is suspected, periodic
determinations should also be made of elec-
trolytes, pH, and the lactate-pyruvate ratio.
The drug should be withdrawn and insu-
lin, when required, and other corrective
measures instituted immediately upon the
appearance of any metabolic acidosis.

3. Hypoglycemia: Although hypoglycemic
reactions are rare when phenformin is used
alone, every precaution should be observed
during the dosage adjustment period particu-
larly when insulin or a sulfonylurea has
been given in combination with phenformin.
Adverse Reactions: Principally gastrointes-
tinal; unpleasant metallic taste, continuing
to anorexia, nausea and, less frequently,
vomiting and diarrhea. Reduce dosage at
first sign of these symptoms. In case of vom-
iting, the drug should be immediately
withdrawn. Although rare, urticaria has been
reported, as have gastrointestinal symptoms
such as anorexia, nausea and vomiting fol-
lowing excessive alcohol intake.

(B) 98-146- 103-C

For complete details, including dosage,
please see full prescribing information.

GEIGY Pharmaceuticals
Division of CIBA-GEIGY Corporation
Ardsley, New York 10502
Distributors

DBI- 8345-9

/Burroughs Wellcome Co.

Research Triangle Park
North Carolina 27709

A gratifying
announcement about
Empirin Compound
with Codeine

You may now specify up to five refills
within six months when you prescribe
Empirin Compound with Codeine
(unless restricted by state law).

It is significant in this era of increased
regulation, that Empirin Compound with Co-
deine has been placed in a less restrictive category.
You may now wish to consider Empirin with
Codeine even more frequently for its predictable
analgesia in acute or protracted pain of moderate
to severe intensity.

Empirin Compound with Codeine No. 3 contains
codeine phosphate* (32.4 mg.) gr. V2. No. 4
contains codeine phosphate* (64.8 mg.) gr. 1.
*( Warning— may be habit-forming.) Each tablet
also contains: aspirin gr. 3V2, phenacetin gr. 2V2,
caffeine gr. V2.

,

SEDATE EFFECTIVELY

'

' -

With QUI-A-ZONE — you can sedate ef-
fectively. A balanced combination of short,
intermediate, and long-acting barbiturates
(totaling 100 mg.) in a rapidly disintegrat-
ing tablet — sedation is provided within a few
minutes . . . followed by sound restful sleep
. . . usually without morning hangover. The
four barbiturates in QUI-A-ZONE have dual
channels of elimination (renal and hepatic) to
lessen metabolic burden, decrease barbitu-
rate retention, and minimize depression.

QUI-A-ZONE

Each rapidly-disintegrating tablet contains 25 mg. secobar-
bital, 25 mg. pentobarbital, 25 mg. butabarbital, and 25 mg.
phenobarbital. Bottles of 100.

Usual Adult Dose: 1 to 2 tablets before retiring.
PRECAUTION: Should not be administered to patients sen-
sitive to barbiturates, or in cases of known previous addic-
tion. Warning: May be habit forming.

SEND FOR SAMPLES.

WALKER, CORP & CO., INC.
Syracuse, New York 13201

small doses

Charles L. Votaw, MD, Ann Arbor,

is new assistant dean for curriculum in the Uni-
versity of Michigan Medical School, effective
Dec. 1. He will be responsible for administrative
support to the development, implementation and
evaluation of the undergraduate medical school
curriculum.

Harold Roehm, MD, Bloomfield Hills,

is the recipient of a special plaque from St. Jo-
seph Mercy Hospital acknowledging his contri-
bution to the growth of its pediatric department,
which he founded in 1927. Doctor Roehm has
retired after 48 years in practice.

Memorial contributions

in the name of the late P. F. Stoller, MD, St.
Johns, will be used to refurnish and provide new
equipment for the pediatric department of the
Clinton Memorial Hospital. The department also
is being renamed for Doctor Stoller, who served
as school physician for the children of the com-
munity before his death Aug. 28.

Harry J. Burkholder, MD, Alpena,

has completed 50 years of service as a surgeon
in his northern Michigan community. He was
honored at an open house in the Alpena Civic
Auditorium recently, and at halftime during an
Alpena High School football game and by his
office staff and medical colleagues at the Alpena
Hospital. He was graduated in 1916 from Johns
Hopkins Medical School and received a 50-year
award in 1966 from MSMS.

James L. Conklin, MD, Ann Arbor,

is new associate dean for student affairs at the
Michigan State University College of Human
Medicine. He has been associate professor of
anatomy in the University of Michigan Medical
School. At MSU, Doctor Conklin will be responsi-
ble for student admissions, counseling and fi-
nancial assistance programs in the medical
school. He succeeds Daniel F. Cowan, MD, who
will return to full-time teaching and research.

David Charles Nolan, MD, Detroit,

is new director of the Detroit Health Depart-
ment’s epidemiology division and is therefore
responsible for reports and investigations of
communicable diseases. He has been associated
with the Wayne State University School of Med-
icine as an assistant professor of medicine.

Muskegon County is seeking

a new health department director since the resig-
nation Nov. 12 of Paul R. Engle, MD, who is
planning to relocate in California. Doctor Engle
has held the position since 1969.

MICHIGAN MEDICINE JANUARY 1972 7

In acute gonorrhea

(urethritis, cervicitis, proctitis when due
to susceptible strains of N. qonorrhoeae)

it

Sterile Trobicin®

(spectinomycin dihydrochloride pentahydrate)— For Intramuscu-
lar injections, 2 gm vials containing 5 ml when reconstituted
with diluent. 4 gm vials containing 10 ml when reconstituted with
diluent.

An aminocyclitol antibiotic active in vitro against most strains of
Neisseria gonorrhoeae (MIC 7.5 to 20 mcg/ml). Definitive in vitro
studies have shown no cross resistance of N. gonorrhoeae be-
tween Trobicin and penicillin.

Warnings: Antibiotics used to treat gonorrhea may mask cj
delay the symptoms of incubating syphilis. Patients should b 1,^
carefully examined and monthly serological follow-up for (j<::

Indications: Acute gonorrheal urethritis and proctitis in the male
and acute gonorrheal cervicitis and proctitis in the female when
due to susceptible strains of N. gonorrhoeae.

Contraindications: Contraindicated in patients previously
found hypersensitive to Trobicin. Not indicated for the treatment

of Syphilis. ®1972 The Upjohn Company

least 3 months should be instituted if the diagnosis of syphilis
suspected.

Safety for use in infants, children and pregnant women has nc
been established.

Precautions: The usual precautions should be observed wil
atopic individuals. Clinical effectiveness should be monitored t
detect evidence of development of resistance of N. gonorrhoea

Adverse reactions: The following reactions were observe
during the single-dose clinical trials: soreness at the injection sit
urticaria, dizziness, nausea, chills, fever and insomnia.

During multiple-dose subchronic tolerance studies in norm*
human volunteers, the following were noted: a decrease in heme

W

8 MICHIGAN MEDICINE JANUARY 1972

Irobkin

sterile spectinomycin dihydrochloride
penta hydrate, Upjohn

single-dose intramuscular treatn a r 1

igh cure rate:* 96% of 571 males, 95% of 294 females

)osages, sites of infection, and criteria for diagnosis and cure are defined below.)**

.ssurance of a single-dose, physician-controlled treatment schedule

o allergic reactions occurred in patients with an alleged history of penicillin sensitivity
fhen treated with Trobicin, although penicillin antibody studies were not performed

active against most strains of Neisseria gonorrhoeae in vitro (M I C 7.5-20 mcg/ml)

, single two-gram injection produces peak serum concentrations averaging about
50 mcg/ml in one hour (average serum concentrations of 15 mcg/ml present 8 hours after dosing)

ote: Antibiotics used in high doses for short periods of time to treat gonorrhea may mask or delay the
'mptoms of incubating syphilis. Since the treatment of syphilis demands prolonged therapy with any
■fective antibiotic, and since Trobicin is not indicated in the treatment of syphilis, patients being treated for
Dnorrhea should be closely observed clinically. Monthly serological follow-up for at least 3 months should
3 instituted if the diagnosis of syphilis is suspected. Trobicin is contraindicated in patients previously found
/persensitive to it.

*pta compiled from reports of 14 investigators. **Diagnosis was confirmed by cultural identification of N. gonorrhoeae on Thayer-
artin media in all patients. Criteria for cure: negative culture after at least 2 days post-treatment in males and at least 7 days post-

' satment in females. Any positive culture obtained post-treatment was considered evidence of treatment failure even though the
llow-up period might have been less than the periods cited above under “criteria for cure" except when the investigator determined
at reinfection through additional sexual contacts was likely. Such cases were judged to be reinfections rather than relapses or
ilures. These cases were regarded as non-evaluatable and were not included. JA72 1IM8-6

pbin, hematocrit and creatinine clearance; elevation of alka-
le phosphatase, BUN and SGPT. In single and multiple-dose
Eidies in normal volunteers, a reduction in urine output was
i ted. Extensive renal function studies demonstrated no con-
sent changes indicative of renal toxicity.

I>sage and administration: Keep at 25°C and use within
' hours after reconstitution with diluent.

i a/e — single 2 gram dose (5 ml) intramuscularly. Patients with
unorrheal proctitis and patients being re-treated after failure
' previous antibiotic therapy should receive 4 grams (10 ml). In
! ^ographic areas where antibiotic resistance is known to be pre-
sent, initial treatment with 4 grams (10 ml) intramuscularly is
eferred.

-male — single 4 gram dose (10 ml) intramuscularly.

satic Water for Injection with Benzyl Alcohol 0.9% w/v. Recon-
stitution yields 5 and 10 ml respectively with a concentration of
spectinomycin dihydrochloride pentahydrate equivalent to 400
mg spectinomycin per ml. For intramuscular use only.
Susceptibility Powder — lor testing in vitro susceptibility of N.
gonorrhoeae.

Human pharmacology: Rapidly absorbed after intramuscular
injection. A two-gram injection produces peak serum concentra-
tions averaging about 100 mcg/ml at one hour with 15 mcg/ml
at 8 hours. A four-gram injection produces peak serum concen-
trations averaging 160 mcg/ml at two hours with 31 mcg/ml at
8 hours.

For additional product information, see your Upjohn representa-
tive or consult the package insert. med-b-i-s (lwb)

Jw supplied: Vials, 2 and 4 grams — with ampoule of Bacterio-

Upjohn

The Upjohn Company, Kalamazoo, Michigan 49001

MICHIGAN MEDICINE JANUARY 1972 9

cYour> opiqiori please

MSMS asked the question:

What would you suggest be done to
slow down the emigration of medical
graduates from Michigan? (The recent
MSMS House of Delegates authorized
the speaker to appoint an Ad Hoc com-
mittee to investigate the reasons why
so many Michigan medical school grad-
uates go to other states for internships
and residencies , and to submit recom-
mendations back to the 1972 House to
help counteract this movement.)

These doctors replied :

Donald N. Fitch, MD
Escanaba

I think the answer obviously touches many fields
inasmuch as the reasons a physician picks to settle
in a certain area are practically as diverse as the
number of doctors themselves. Thus I think we
need to look at each level of the problem and see
what can be done at that particular level.

First of all, it depends somewhat on where the
medical students are taken from, as to where they
are most likely to return. Certainly this does not
hold true in every instance or maybe not even in
most instances, but it is a fact that many students
do return to a similar environment from which they
came. Consequently, we need to be sure we are
getting enough students from the rural areas and
from the minority and ghetto areas.

As far as attracting students to particular prac-
tice areas, I think the senior externship program is
probably the best means of accomplishing this. We
have had some experience with this, and I am sure
the results are going to prove this out within a few
years. Although we don’t necessarily expect any or
all of the students to come back to this area we
feel we have interested them in our type of prac-
tice and to some extent in our area. I think much
more could be done to encourage the senior stu-
dents to take externships outstate where they will
be exposed to the various practice situations to
which we hope to attract them later. Certainly this
is not always as convenient but those who do make
the effort, are very pleased with the results. Un-
questionably more encouragement could be given
by the faculties and counselors in this regard.

The internships and residencies certainly are a
major factor in a doctor’s decision on where
to practice. Many students prefer to take their
training in the area in which they hope to locate.

Doctor Fitch Doctor Stilwill

In this regard, there are several problems. First of
all, the internships themselves lately have become
of much less importance than the residency pro-
gram inasmuch as the full rotating internship is al-
most a thing of the past. Consequently many stu-
dents are looking very carefully at the particular
department in which they hope to specialize and
the internship as well is chosen with this in mind.
Thus we need to look carefully to see if our de-
partments are giving the leadership that the stu-
dents are looking for and are presenting as attrac-
tive programs to the students. In this regard also,
Michigan is far behind in developing family prac-
tice residencies as compared with several other
states which are very definitely attracting students
from our state. I think strong departments in family
practice should be organized with some if not most
representation in the departments being actual pre-
vious practitioners Of that type of medicine. In ad-
dition the medical schools themselves need to put
more emphasis in that specialty.

A further factor relates to the fact that many of
the out-state training programs in regard to intern-
ship and residency are probably not nearly as well
advertised as they might be. The students barely
know that they exist and certainly are not strongly
attracted to them unless they have some special
knowledge of the situations. In the same light,
however, I might state that there are also particular
internships, in which a strong effort is made to the
student but it is quickly found out once the intern-
ship is begun that what was stated and what ac-
tually exists are two entirely different things. I think
that this can only discourage a doctor from decid-
ing to settle in that area and certainly this situa-
tion is a very negative factor.

Finally, I think we have to propagandize to coun-
teract the mythological attraction of other areas of
the country. When it boils right down to it, I think
Michigan has more to offer than a lot of these
states and yet bepause we aren’t as well adver-
tised, the grass always seems much greener there.

(Continued on Page 12)

10 MICHIGAN MEDICINE JANUARY 1972

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MICHIGAN MEDICINE JANUARY 1972 11

YOUR OPINION PLEASE/Continued

But actually in talking to some of the emigrants to
these areas I don’t think they’re really that satis-
fied with their choice. If we could retain their in-
terest in Michigan before they go away, I think we
would have a much greater chance of keeping
these doctors.

A big factor, especially nowadays, is that a doc-
tor’s wife is probably one of the major deter-
minants in where they settle and how happy they
are going to be there. I think we have to pay a
particular attention to this aspect and see what
can be done to keep these girls content as well as
attracting them to certain areas in our state.

In summary then, I think there are many avenues
we might attack in improving the situation and
from the above comments I think there are definite
areas in which the Michigan State Medical Society
could actively participate to improve situations
which would help this problem area.

George E. Stilwill, MD
Lansing

I have thought about this a lot, both before and
after the meeting of the House of Delegates. I wish
I had the answers. I sincerely believe that I don’t
have the answers, and most likely nobody who has
been in practice more than five years has, either.

I think we’re going to have to go to those in-
volved.

I think the Speaker’s Committee should survey
the graduates of the last five years at Wayne State
University and at the University of Michigan and
ask them their opinions and specifically, their rea-
sons for staying in Michigan or leaving the state.

I know residents go where the desirable resi-
dencies are available, and most frequently when
they know the area, they generally stay fairly close
to where they took their residency. I cannot, how-
ever, back any of this with any facts. It would
seem to me that would be the major job of the
Speaker’s Committee — to gather facts, gather opin-
ions of those who have been graduates and resi-
dents and have started practices in the last five
years.

I personally am looking forward to the results of
the deliberations of the Speaker’s Committee on
immigration of medical students.

(Doctor Stilwill was the sponsor of the resolution
to appoint an investigative ad hoc committee, ap-
proved by the MSMS House.)

Doctor Swisher

Scott N. Swisher, MD
East Lansing

Physicians are virtually unanimous in believing
that successful therapy hinges on a correct diag-
nosis. We, and the people of Michigan whom we
serve, must be equally careful to insist first on an
accurate diagnosis of the causes of the loss of
young physicians from Michigan before we try to
deal with the problem. I, for one, would be more
impressed by factual data bearing upon the prob-
lem than by opinions about the situation, including
my own opinion!

Recognizing that efforts have been made and
may well be expanded to gather these necessary
facts, one might still consider an hypothesis. I
have been impressed with the number of young
people who, after 10 to 12 years of education in
one geographic area, are looking for a change of
location for the sake of change. With already ex-
tensive family commitments, many of these physi-
cians will make only one geographic move, com-
monly in search of a climate they at least think
will be more agreeable. They never return. Would
it not be wise to structure our undergraduate ed-
ucation, medical school experience and residency
training deliberately to encourage some movement
of students between geographic areas of the coun-
try with both rural and urban experiences? The
fact is that Michigan is an excellent place to live
and to practice medicine. If this can become
known by both our own students after they have
seen other areas and by other students who have
had an opportunity to see this State, we may find
ourselves in the position of receiving as many
graduates as we lose.

The modernization of our licensure laws is an im-
portant step in promoting this exchange. Since the
residency years seem to be crucial in determining
a physician’s location for practice, we should also
look to ways to strengthen these programs and to
extend their influence throughout the State.

12 MICHIGAN MEDICINE JANUARY 1972

r

v.

The Michigan Heart Association

1972 Heart Days and Scientific Sessions

April 13, 14 & 15, 1972 • Cobo Hall, Detroit

r

Friday, April 14

ATHEROSCLEROSIS AND ITS COMPLICATIONS

ATHEROSCLEROTIC CORONARY DISEASES AND SUDDEN DEATH

Wilson-Meyers Memorial Lecture

Charles K. Friedberg, M.D., Editor of “Circulation,” author
of the definitive text on CVD, Mt. Sinai School of Medi-
cine, New York.

ATHEROSCLEROSIS — LONGITUDINAL
OBSERVATIONS FROM FRAMINGHAM

William B. Kannel, M.D., Medical Director, Framingham
Heart Disease and Epidemiology Study, N.H.L.I., Fram-
ingham, Mass.

ATHEROSCLEROSIS: WHY AND HOW —

A PATHOLOGIST’S VIEW

Gardner C. McMillan, M.D., Ph.D., Chief, Atherosclerotic
Disease Branch, N.H.L.I., N.I.H., Bethesda, Md.

ATHEROSCLEROSIS AND HYPERTENSION
Ray W. Gifford, Jr., M.D., Head, Dept, of Hypertension and
Nephrology, Cleveland Clinic.

DIETARY TREATMENT OF HYPERLIPIDEMIA & ATHEROSCLEROSIS
William E. Connor, M.D., Director, Clinical Research Cen-
ter, University of Iowa College of Medicine.

PANEL - PRIMARY AND SECONDARY PREVENTION OF ATHEROSCLEROSIS

Saturday, April 15

CORONARY ARTERY DISEASE

THE SURGEON'S ROLE IN THE TREATMENT
OF CORONARY ARTERY DISEASE

Norman E. Shumway, M.D., Ph.D., Chief, Cardiovascular
Surgery Division, Stanford U. School of Medicine.

A RADIOLOGIST LOOKS AT CORONARY ARTERY DISEASE
Herbert L. Abrams, M.D., Chairman, Department of Radi-
ology, Harvard Medical School.

THE ENIGMA OF ANGINA IN PATIENTS
WITH NORMAL CORONARY ARTERIOGRAMS
Bernard L. Segal, M.D., Director, Post-Graduate Educa-
tion, Division of Cardiology, Hahnemann Medical Col-
lege, Philadelphia.

PANEL -CORONARY ARTERIOGRAPHY -
WHY, WHEN AND FOR WHOM?

Thursday, April 13

STROKE - MOBILIZING THE COMMUNITY FOR THE VICTIM

DIMENSIONS OF STROKE IN THE COMMUNITY
Charles Wylie, M.D., Ph.D., Professor of Public Health
Administration, School of Public Health, U. of M.

DEVELOPMENT OF STROKE ACUTE CARE UNITS
John Gilroy, M.D., Director, Department of Neurology,
Wayne State University School of Medicine.

V.

PANEL - PLANNING FOR THE DISCHARGE OF THE PATIENT

Four Concurrent Afternoon Workshops

vj Cardiovascular Nursing Sessions, all day Friday, April ^For technicians and nurses, a day long ECG Seminar,
14, will feature a faculty from Sinai Hospital of Detroit; Thursday, April 13.

keynote speaker will be Adrian Kantrowitz, M.D., Director K For those interested in emergency techniques, a CPR
of Surgery. session Thursday afternoon.

AAGP credit hours have been applied for
Headquarters hotel is the Pontchartrain; make reservations early.

Gerald M. Breneman, M.D., President, MHA
Donald C. Overy, M.D., Chairman, Heart Days; President-Elect, MHA
Irwin J. Schatz, M.D., Chairman, Scientific Sessions
Abraham Brickner, A.C.S.W., Executive Director, MHA

Affiliate: American Heart Association
Member: Michigan United Fund

For information, contact
HEART DAYS, 1972,

P.O. BOX LV-160
SOUTHFIELD, MICHIGAN 48076

MICHIGAN MEDICINE JANUARY 1972 13

Nowina i
200 -ml. I

breakable

Plastic

Bottle

Same price as
150-ml. size*

®

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phenoxymethyl

penicillin

Additional information
available to the
profession on request.

Eli Lilly arid Company
Indianapolis, Indiana 46206

*Based on Lilly selling price to wholesalers.

14 MICHIGAN MEDICINE JANUARY 1972

Scientific papers

, ^.,^^-.^.^3

Hypovolemic

shock

By William R. Olsen, MD
Ann Arbor

Although shock from low blood volume is a
common disease familiar to most physicians, recent
technological advances have allowed us to study
shock more thoroughly and to understand it bet-
ter. Hopefully, this increased understanding of the
pathophysiology and treatment will be reflected in
an increased survival of hypovolemic patients.

Although shock may be caused by a variety of
conditions, the resultant circulatory derangements
are similar. By definition, the common denom-
inator is inadequate blood flow in the peripheral
capillary bed.1-4 For one reason or another, capil-
lary perfusion is not sufficient to maintain normal
cellular function. If shock persists cells will die
and, with sufficient cellular death, the shock be-
comes irreversible, i.e., there are not enough viable
cells to sustain life of the individual. Hypotension,
per se, is not shock. Shock can exist with normal
or elevated blood pressure, especially if the pa-
tient is receiving vasopressors, and in some cir-
cumstances capillary perfusion may be quite ade-
quate despite a low arterial blood pressure.

Causes of Hypovolemia

The more common causes of hypovolemia need
no elaboration. External hemorrhage from wounds,
gastrointestinal hemorrhage, hemoperitoneum from
lacerations of the spleen, etc. are usually apparent
to the clinician. Bleeding into injured soft tissue
following blunt trauma or retroperitoneal hemor-
rhage from a ruptured aortic aneurysm may be
less obvious but severe. In some instances, the clin-
ical signs of hypovolemia may be the first indica-
tion of hemorrhage and are the tip-off to search
for the source.

External fluid losses from granulating wounds,
diarrhea, etc., although usually obvious may be
underestimated unless specifically measured.

Doctor Olsen is associate professor of surgery,
Section of General Surgery, The University of
Michigan, Ann Arbor.

Tissues injured by infection, bums, or blunt
trauma become edematous over a period of hours
after the injury. The resultant depletion of plasma
volume may be sufficient to cause shock and death.
Acute ileofemoral thrombophlebitis may cause
massive edema with extravasation of many liters
of fluid from the circulating blood volume and
the interstitial fluid space in other parts of the
body. The initial management of patients with
acute bowel obstruction usually requires liberal
fluid administration to replace the fluid trapped
in the distended bowel and not available for tissue
perfusion. This fluid reaccumulates very rapidly
after operative evacuation with a resultant in-
creased intravenous fluid need in the early post-
operative period. A similar rapid reaccumulation
of ascitic fluid after paracentesis may cause signif-
icant hypovolemia and shock, necessitating IV
fluid replacement.

It is important to emphasize that head injuries
do not produce shock except terminally. Although
many patients with severe head injuries are in
shock, the shock is almost always from loss of cir-
culating blood volume from hemorrhage else-
where.5 Frequently, the signs and symptoms of
the injury causing the hemorrhage may be ob-
scured by the unconsciousness caused by the head
injury. Beware of the patient with a head injury
and shock— he is bleeding somewhere.

Pathophysiology of Hypovolemic Shock

Since a deficiency of nutritive capillary blood
flow is accepted as the defect in hypovolemic
shock, the physician must understand the micro-
circulatory flow changes produced by hemorrhage
and the ability of therapeutic modalities to cor-
rect flow deficits if he is to evaluate methods of
treatment.

Hemorrhage is followed by a variety of com-
pensatory mechanisms, some more vestigial than
useful. As blood volume is reduced, venous return
to the heart is reduced with an associated de-
crease in ventricular diastolic filling and a de-
creased cardiac output. Baroreceptors in the aortic
arch, carotid sinus and perhaps elsewhere, respond
and trigger the release of epinephrine from the
adrenal gland and norepinephrine from the sym-
pathetic postganglionic nerve endings. These
catecholamines stimulate adrenergic receptors
throughout the body resulting in constriction of
arterioles and veins (alpha adrenergic response)
and tachycardia (beta adrenergic response) . The
alpha adrenergic receptors of the venous system
are probably more sensitive to minimal catechola-
mine stimulation than those of arterioles.6 There-
fore, early hypovolemia is followed by selective
venoconstriction. The venous (capacitance) sys-
tem normally contains about 70% of the circulat-
ing blood volume but can expand or contract

MICHIGAN MEDICINE JANUARY 1972 15

HYPOVOLEMIC SHOCK/ Continued

rapidly to accommodate larger or smaller volumes
without altering the internal pressure appreciably.
The arterial (resistance) system cannot change
capacity to accommodate volume changes. Arterial
volume changes are therefore reflected by changes
in arterial blood pressure. The selective veno-
constriction which accompanies early hypovolemia
causes a shift of blood to the arterial portion of
the circulation7 allowing the patient to maintain
a fairly normal cardiac output, arterial blood pres-
sure and nutritive capillary flow despite the loss
of 10 to 20% of the blood volume.

If the hemorrhage is limited or occurs slowly,
plasma volume may be expanded or maintained
by the inflow and protein from the interstitial
space with resultant anemia.8910 If the hemor-
rhage is rapid this compensatory mechanism oc-
curs too slowly to be of benefit.

As hemorrhage approaches 30 to 40% of the
blood volume, the venoconstrictor compensatory
mechanism is no longer adequate, the return of
blood to the heart is reduced, cardiac output falls,
catecholamine release is accentuated, arteriolar con-
striction predominates, and capillary flow is dimin-
ished. The resultant increase in peripheral resist-
ance further diminishes the outflow of the arterial
system but is insufficient to allow the maintenance
of arterial volume. The arterial blood pressure
falls, decreasing the nutritive capillary flow even
more. At this point, clinical shock has reached
dangerous proportions. If untreated, capillary
sludging, thrombosis and cellular death will follow
with eventual death of the patient.

Blood vessels in different vascular beds11 and in
different parts of the same organ12 react differently
to the same degree of hemorrhage. Thus, a blood
volume loss sufficient to produce ischemia in one
organ may not produce ischemia in another. This
may allow selective perfusion of some vital organs,
perhaps the central nervous system, in early shock
and allow temporary maintenance of life. Other
structures, for example the distal renal tubule,
become ischemic in early shock and, if sufficiently
damaged, may not function well enough to sustain
life in the late post-shock period. It is necessary
to understand the capillary flow changes produced
by hemorrhage on specific tissues to understand
the effects of hypovolemia and to be logical in its
treatment.

Attempts to study the flow changes in shock
have been hindered by the lack of methods of
measuring capillary flow. Many investigators have
attempted to estimate capillary flow by measuring
large vessel flow, usually by operative methods in
anesthetized dogs. Dogs are not good animals for
the study of clinical shock since they develop
splanchnic congestion following hemorrhage, a re-
sponse not seen in humans.13 Furthermore, meth-
ods which measure large vessel flow fail to differ-

Blood Volume (%)

Figure 1. Blood pressure response to graded
hypovolemia.19 Note the difference between the
anesthetized and nonanesthetized state.

entiate nutritive capillary flow from flow through
arteriovenous pathways. Frequently these methods
have failed to consider the significant hemo-
dynamic variables introduced by anesthesia,14-20
operative manipulation17*18-20'21 and the frequently
resultant mild hypothermia14-22 and hypovolemia,
making their validity questionable. Radioactive
methods can determine nutritive capillary flow
without the variables introduced by anesthesia or
operative manipulation.12-19-23-26 Although much
work remains to be done in this field, correlation
of the results of studies measuring capillary flow in
animals with clinical studies27-28 allows us to for-
mulate opinions regarding human responses to
hemorrhage.

Figure 1 illustrates the blood pressure responses
to graded arterial hemorrhage in the anesthetized
and nonanesthetized pig,19 an animal which does
not develop splanchnic congestion after hemor-
rhage. These pressure curves are similar to those
seen in humans after hemorrhage. When corre-
lated with data regarding capillary perfusion fol-
lowing hemorrhage,12-19 several generalizations can
be made.

A mild (10 to 20%) hemorrhage produces little
change in aortic blood pressure and no significant
change in capillary flow to tissues other than the
stomach. The venous, cardiac and arteriolar com-
pensatory mechanisms seem to be sufficient to
maintain a fairly normal microcirculation.

The protective compensatory mechanisms are
no longer adequate after a 40% hemorrhage. The
arterial blood pressure falls, peripheral vasocon-
striction is accentuated and significant decreases
occur in capillary blood flow to the renal cortex,
stomach, skin, and skeletal muscles. Interestingly,

16 MICHIGAN MEDICINE JANUARY 1972

adrenal blood flow is increased after hemorrhage.
The difference in the degree of ischemia of various
tissues is thought to represent local differences in
reactivity to the adrenergic stimulation of hemor-
rhage, with varying degrees of local arteriolar con-
striction.

It is of particular interest that, while studies
on anesthetized animals have shown the detri-
mental effect of hypotension on coronary artery
flow,16'19'29-32 this does not occur in the non-
anesthetized state.12

The effect of hemorrhage on the anesthetized
animal and human is considerably different than
that observed in the nonanesthetized state. Anes-
thesia has a profound effect on the local distribu-
tion of nutritive capillary blood flow after hemor-
rhage.19 A 20% hemorrhage under anesthesia will
cause hypotension and ischemia of the stomach,
skin and skeletal muscle in the presence of sodium
pentobarbital. A 40% hemorrhage in the presence
of anesthesia will cause a decrease in capillary
flow to the myocardium, stomach, small intestine
and skin. As in the nonanesthetized state, an in-
crease in adrenal blood flow is observed. In the
anesthetized state, the arterial blood pressure falls
as low after a 20% hemorrhage as it does after a
40% hemorrhage in the nonanesthetized state and
becomes a more sensitive indicator of the amount
of hypovolemia.

The differences in responses of the anesthetized
and nonanesthetized state are emphasized for two
reasons. First, to caution the clinician against un-
due reliance upon experimental data derived from
anesthetized animals, usually dogs, when evaluat-
ing and treating shock in nonanesthetized humans.
Second, to emphasize the dangers of anesthetizing
a patient in hypovolemic shock. Although a pa-
tient may be deceptively well compensated and
have a reasonable arterial blood pressure following
a 20% hemorrhage, anesthesia will convert him to
a poorly compensated state, interfering with local
capillary blood flow and causing the arterial blood
pressure to drop to an unacceptable level. Since
this mechanism may be responsible for some of
the cardiac arrests that are seen, with the institu-
tion of general anesthesia in hypovolemic patients,
it is important, when feasible, to assure that the
blood volume has been restored preoperatively.

The compensatory mechanisms and local capil-
lary flow changes of cardiogenic shock are similar
to those of shock from hypovolemia. A deficiency
of nutritive capillary flow is the basic pathophysi-
ologic defect in both types of shock. A low arterial
blood pressure results from a decrease in cardiac
output due to deficient ventricular contractile
force. A compensatory adrenergic response, clin-
ically indistinguishable from that of hypovolemia,
occurs with an increase in peripheral vascular tone
and a further decrease in capillary flow. Whereas

the patient with hypovolemic shock usually has a
decreased central venous pressure, the patient with
cardiogenic shock cannot propel his adequate
blood volume through the heart, resulting in an
overloading of the capacitance vessels and increase
in the central venous pressure. It is extremely im-
portant to differentiate cardiogenic shock from
hypovolemic shock or to detect a cardiogenic ele-
ment to hypovolemic shock. Whereas rapid fluid
administration is essential to the correction of
shock in the patient with hypovolemia, it may be
the coup-de-grace to the patient with cardiogenic
shock.

Recent evidence indicates that acidosis is usually
the result rather than the cause of the failing cir-
culation in human shock and indicates that clin-
ical acidosis is rarely a potentiating factor in
shock.33-15

Initial Management of the Patient in Shock

The patient in shock offers a unique clinical
challenge. There are few areas in medicine in
which prompt and resourceful treatment is more
liberally rewarded or where delays and mistakes
can lead to such tragedy. Proper care of these pa-
tients demands mature judgment, prompt action
and a conditioned awareness of priorities of treat-
ment.

Physician Attitude. One of the most important
factors in survival of the hypovolemic patient is
the degree of urgency with which the physician
evaluates and treats his shock. A sense of compul-
sive urgency or an urgent sense of compulsion is
mandatory if one is to treat shock successfully.
Patients don't live in shock. The natural course
of the disease is that of progressive deterioration
and death unless the cause is reversed by adequate
treatment. A direct relationship between the dura-
tion and severity of shock and survival exists. If
treated promptly and adequately, most patients
will recover from a 40 - 60% hemorrhage without
sequelae. If therapy is delayed, the same patient
will die from a lesser hemorrhage, especially if he
is aged or has associated problems. Treatment of
these patients cannot wait. The cause of the shock
and any contributing factors must be rapidly as-
sessed and treatment must be initiated and sus-
tained until the casual factors are controlled. A
physician who is not willing to exercise the degree
of dedication necessary to provide this type of care
should not assume responsibility for acutely ill
patients.

Monitoring. Since shock is a dynamic condition
which is either improving or worsening, it is im-
portant that the circulatory system be monitored
during evaluation and treatment. The cardiac out-
put, peripheral vascular tone, capillary flow (tissue
perfusion) and blood volume are of special in-

MICHIGAN MEDICINE JANUARY 1972 17

HYPOVOLEMIC SHOCK/Continued

terest. Although numerical values can be derived
using elaborate electronic equipment, adequate
approximations of these values can be obtained
and most patients can be successfully treated using
only the equipment available on any nursing sta-
tion provided the physician understands the dis-
ease.

The best way to follow the severity of shock and
to determine the adequacy of treatment is to ex-
amine the patient repeatedly. The clinical signs
and symptoms of shock appear sequentially and
disappear in the reverse order with adequate treat-
ment. The first sign of hypovolemia will usually
be oliguria. Signs and symptoms of more severe
oligemia proceed from poor peripheral venous fill
to pallor, tachycardia, diaphoresis, agitation, thirst,
hypotension, dyspnea, confusion, cyanosis, coma
and death.

A good approximation of the adequacy of the
myocardium can be made from the strength of the
pulse and the arterial pressure. Although a normal
myocardium will not be able to maintain a strong
pulse in the presence of severe hypovolemia, a
strong pulse and normal blood pressure indicates
that the myocardium is functioning adequately,
that the cardiac output is sufficient and excludes
the diagnosis of cardiogenic shock.

The status of the peripheral vascular tone is
best determined by examining the patient’s skin
and mucous membranes. Coldness and pallor of the
skin indicate vasoconstriction from an alpha adren-
ergic sympathetic response. Accompanying signs
are piloerection and iris dilatation, also alpha-
adrenergic responses and sweating, a cholinergic
sympathetic response. Cyanosis indicates more de-
ficient perfusion and capillary stasis. The change
of color of the ocular conjunctivae may be more
noticeable than skin color change, especially in
pigmented patients.

The urinary output is a very sensitive indicator
of the adequacy of the blood volume and should
be followed closely. An indwelling urinary cath-
eter should be inserted and the urinary output
recorded every 15 minutes. In adults with normal
renal function, a urinary output of about 50 ml.
per hour is an indication of adequate renal per-
fusion and can be assumed to indicate adequate
perfusion to other tissues as well. Small deficits in
blood volume are followed promptly by oliguria
before other clinical signs appear. A urinary out-
put of less than 30 ml. per hour is a cause for
concern since it may indicate renal ischemia and
is usually an indication to alter treatment to im-
prove renal perfusion. Vasopressors and diuretics
falsely elevate urine output and deprive the physi-
cian of this valuable guide to the treatment of
hypovolemia.

There are various means of measuring blood

Figure 2. Technique of percutaneous subclavian
venapuncture (see text).

volume numerically, usually by the use of radio-
isotopes. These methods are cumbersome, expen-
sive, time consuming and the determinations are
subject to the errors inherent in the use of com-
plex equipment and the problems of availability
of trained personnel. Since patients being actively
treated for shock usually have had significant fluid
losses and replacement between the time the blood
volume determination is made and the values are
available for interpretation, numerical blood vol-
ume results usually are obsolete before they can
be used and are rarely of clinical value.

Central venous pressure monitoring is a simple
and reliable means of determining the adequacy
of the blood volume and has been extremely
valuable in the management of volume replace-
ment in a variety of clinical situations. The re-
sults are immediately available and the determina-
tion can be repeated frequently. More important-
ly, this monitoring device determines that aspect
of blood volume which is most important to the
physician, i.e., the relationship of the effective cir-
culating blood volume to the adequacy of the
myocardium. Knowing this relationship allows the
clinician to distinguish cardiogenic shock from
hypovolemia, and to determine whether or not
the patient can tolerate more fluid. We really do
not need to know the numerical blood volume.
We only need to know if the patient can tolerate
more fluid or if more fluid will be apt to put him
into congestive failure and pulmonary edema.
Central venous pressure monitoring will allow this
determination. Radioisotopic blood volume deter-
minations will not.

Technique of Central Venous Pressure Monitor-
ing. Patients with manifest or imminent shock
regardless of the cause should have a catheter
placed in an intrathoracic vein and the central
venous pressure monitored. We usually accomplish
this by percutaneous subclavian venipuncture36-39

18 MICHIGAN MEDICINE JANUARY 1972

although percutaneous internal carotid venipunc-
ture seems completely satisfactory.40-41

With the patient recumbent, the skin of the
upper chest and base of the neck is carefully pre-
pared and draped. The patient is placed in the
Trendelenburg position (one of the few uses of
this position) to distend the subclavian veins. A
finger is placed in the suprasternal notch and a
large needle, usually attached to a syringe, is
passed horizontally just below the clavicle, aiming
for the tip of the finger over the sternum (Figure
2). The direction of the needle is usually perpen-
dicular to the long axis of the patient but occa-
sionally is aimed slightly more cephalad. When
the vein is entered, blood is withdrawn for neces-
sary laboratory determinations. A catheter is
threaded through the needle into an intrathoracic
vein. Peripheral venous pressure is misleading and
of no value in determining shock therapy.37 Care
must be taken to prevent air embolism during re-
moval of the syringe and passage of the catheter.
Radiopaque catheters are preferred so the position
of the catheter can be determined on subsequent
X-rays. If radiopaque catheters are not available
the position of the catheter can be checked by
filling the catheter with a small amount of radi-
opaque contrast material and obtaining a chest
X-ray. It is important to position the tip of the
catheter in the superior vena cava two to three
cms. above the heart. If the catheter rests in the
heart, arrhythmias may result or cardiac contrac-
tion may cause an erosion of the myocardium by
the catheter tip with pericardial tamponade and
death.42-44 The catheter is connected to tubing
containing an electrolyte solution and attached to
a manometer via a three-way stop cock.

Passage of the catheter through peripheral cut-
downs or venipunctures is more time consuming
and, if the catheter is to remain in place for
some time, is associated with a higher rate of sup-
purative thrombophlebitis. The cephalic and ex-
ternal jugular veins enter the subclavian vein at
angles which frequently will not allow passage of
the catheter. Therefore, these veins should not be
used for central venous catheterization if other
veins are available. Because of the excessively high
rate of deep thrombophlebitis and its sequelae
associated with intravenous infusions in the legs,
leg veins are not satisfactory routes for central
venous pressure monitoring.

Sepsis is one of the most common complications
of indwelling intravenous catheters.45-47 It is essen-
tial that these catheters be passed under aseptic
conditions and that the skin around the catheter
be kept sterile. Frequent skin cleansing, the appli-
cation of antibacterial ointment, and frequent
sterile dressing changes are important.

Serious complications of subclavian venipunc-
ture such as pneumothorax, hemothorax, hydro-

thorax, brachial plexus injury and subclavian ar-
tery puncture, although very infrequent, are the
result of performing the catheterization improp-
erly, usually from introducing the needle with
too great a posterior angulation.37-48

Special care should be taken to prevent shearing
ofF the intravenous catheter with resultant catheter
embolization.49 This usually occurs while attempt-
ing to position a catheter inserted through a
needle while the needle is still in the vein. The
catheter is withdrawn with the needle still in place
(a maneuver which should never be done!) and
the catheter is transected by the needle point. The
incidence of breakage and embolization of cath-
eters after their insertion can be reduced by sutur-
ing the catheter to the skin or using a catheter
with a flange for receiving the intravenous tubing
attached as an integral part of the catheter.

The possible complications of central venous
catheterization and subclavian venipuncture
should not discourage the appropriate use of these
valuable techniques. They are listed here to em-
phasize the need for caution and proper technique
in carrying out this extremely useful diagnostic
procedure. There are very few worthwhile means
of diagnosis and treatment which do not carry a
risk if used improperly. With such forewarning,
we believe that any physician can easily and re-
peatedly catheterize central veins with few prob-
lems.

Consistency in positioning the manometer is of
prime importance. A mark should be made with a
pen or marking pencil at the midaxillary line and
this mark used repeatedly as the zero reference
point for determining the venous pressure. The
head of the bed is lowered until flat and respira-
tors, which cause a flasely high reading, should be
momentarily disconnected. The manometer is
filled to the top with an electrolyte solution, all
bubbles are run out of the system, the stop cock
is turned and the fluid allowed to find its level.
If the catheter has been inserted recently, the fluid
will fluctuate with respirations, assuring that the
tip is in an intrathoracic vein. After a few days, a
thrombus and fibrin sleeve forms around the cath-
eter and may interfere with this fluctuation but
does not interfere with the continued use of the
catheter for fluid administration or venous pres-
sure measurements.

Naturally, the value of the central venous pres-
sure monitoring is dependent upon proper inter-
pretation of the reading. One must remain aware
that the central venous pressure is of value only
in indicating whether or not the patient’s heart
and pulmonary circulation aie capable of handling
the fluid volume already in the vascular system. It
will not indicate whether the patient’s blood vol-
ume is higher or lower than normal. If the mid-
axillary line is used as the zero reference point,

MICHIGAN MEDICINE JANUARY 1972 19

HYPOVOLEMIC SHOCK/Continued

the normovolemic patient will have a central ve-
nous pressure of three to eight cms. of water. If
the central venous pressure is normal or low, fluid
can be administered safely but should be adminis-
tered only if other signs indicate the need. One
should not use a seemingly low central venous
pressure per se as in indication for fluid adminis-
tion. If the central venous pressure is high, one of
three situations prevails; (1) too much fluid has
been administered, (2) the myocardium is failing
or (3) there is pulmonary interstitial edema. In
any case, the patient will not tolerate more fluid.

Treatment of Shock

Fluid Therapy. In shock from hypovolemia, nor-
mal capillary perfusion can be restored most ef-
fectively by rapid blood volume expansion. Re-
placement fluid should approximate the type and
amount of fluid lost. Whole blood loss is best
treated by whole blood replacement in equal
amounts. Unfortunately, it takes 45-60 minutes to
obtain crossmatched whole blood. Since patients
frequently will not tolerate such delays without
irreparable sequelae, emergency resuscitation must
be started with other methods of blood volume
expansion.

The shock position (Figure 3) with the trunk
and head elevated five degrees and the legs el-
evated 30 degrees will allow more rapid return of
venous blood from the extremities which, in effect,
constitutes an internal transfusion of several hun-
dred milliliters. The Trendelenburg position
(head down, legs up, hips straight) accomplishes
the same thing but impairs cerebral perfusion, in-
terferes with respiration and should not be used.

Since position alone, although helpful, is not
sufficient to restore normal capillary perfusion,
emergency resuscitation areas must be kept stocked
with satisfactory blood substitutes for use until
whole blood can be obtained. These substitutes
must be safe and effective and should be relatively
stable, easy to store and inexpensive.

The use of the dextrans as emergency blood
substitutes has been the subject of intensive labora-
tory and clinical investigation recently summarized
by Atik.50 Six percent Dextran 70 (clinical Dex-
tran; average molecular weight 70,000) , by virtue
of its colloid (oncotic) osmotic effect, is capable
of expanding the blood volume for over five hours.
Low molecular weight dextran (Dextran 40, Rheo-
macrodex) has an average molecular weight of
40,000. It contains more molecules than Dextran
70, thus is more osmotically active. However, the
small molecular fractions pass through semiper-
meable membranes rapidly and the fluid expand-
ing properties are more transient than those of
Dextran 70. Dextran 40 has the added advantage
of reducing the viscosity of whole blood when it

Figure 3. The shock position speeds venous re-
turn from the legs thereby improving cardiac
output during the resuscitative period of shock
therapy. The Trendelenburg Position accom-
plishes the same thing but, because it impairs
respiration and cerebral perfusion, should not be
used.

is abnormally high, as in clinical shock, which im-
proves tissue perfusion.

The dextrans must be used with caution. Severe
allergic reactions have occurred. Although they are
relatively safe if administered in the recommended
dose of 10-15 ml. /Kg body weight, higher concen-
trations will interfere with the clotting mechanism
and cause abnormal bleeding. This volume restric-
tion severely limits the usefulness of the dextrans
in hypovolemic shock.

Hydroxyethyl starch seems to possess properties
appropriate for an emergency plasma substitute. It
remains in the intravascular space longer than the
dextrans, interferes less with coagulation, is stable
in solution and is eliminated from the body with-
out significant tissue storage reactions.51 Although
allergic reactions have been reported they are in-
frequent.52 Widespread clinical use of this ma-
terial as a plasma expander must await more clin-
ical experience.

Ringer’s lactate solution is free of the disadvan-
tages of the above solutions and is our choice for
rapid volume replacement in hypovolemic patients
when blood is needed but not available. This solu-
tion is readily available, is stable indefinitely,
needs no refrigeration, is pyrogen free, causes no
allergic reactions, does not interfere with the clot-
ting mechanism, is inexpensive and, most impor-
tantly, is effective.8-53-55 Rapid infusion will restore
circulating blood volume and capillary perfusion

20 MICHIGAN MEDICINE JANUARY 1972

and will decrease the eventual blood require-
ment.56 Because Ringer’s lactate contains no pro-
tein, there is a potential risk that dilutional hypo-
albuminermia will occur after rapid infusion fol-
lowed by a rapid exit of the solution from the
vascular space with resultant interstitial edema.
However, serum albumin is not significantly low-
ered following mild hemorrhage and rapidly re-
turns to normal after massive hemorrhage treated
with protein-free electrolyte solutions.8-57 This indi-
cates that albumin enters the vascular space after
hemorrhage, thereby maintaining plasma oncotic
pressure. Clinical studies have shown that, if care
is taken to prevent iatrogenic fluid overload, peri-
pheral and pulmonary interstitial edema do not
occur when hemorrhage is treated by protein-free
electrolyte solutions.8

Since the serum electrolyte concentration is not
significantly altered by acute hemorrhage, the fluid
used for early resuscitation should have an electro-
lyte concentration similar to plasma. Lactated
Ringer’s solution meets this criterion.

Some surgeons have been concerned that the
hepatic threshold for metabolizing lactate may be
overcome by large volume infusions of lactate con-
taining solutions, causing lactic acidemia and ren-
dering the blood lactate levels useless. Clinical
studies now show that this does not occur.53

Because of the logistical delays in obtaining
whole blood when patients are admitted in shock
from hemorrhage, most of our patients receive
2,000 to 4,000 ml. of Ringer’s lactate before typed
specific or cross-matched whole blood is available.
This allows us to resuscitate the patient and re-
duces the amount of whole blood administered,
thereby reducing the risk of transfusion reactions
and hepatitis. The resultant post-therapy anemia
usually requires no treatment.

Although blood plasma would seem to be an
ideal solution for the emergency correction of
hypovolemia because of its protein content, the
risk of hepatitis and problems of storage preclude
its use. Furthermore, patients receiving protein
containing solution do not have significantly high-
er total protein or albumin levels after treatment
than patients receiving electrolyte solutions with-
out protein.58

The type of fluid used in the treatment of shock
from plasma loss depends upon the previous con-
dition of the patient and the relative concentra-
tions of serum electrolytes. However, several gen-
eralizations can be made. Hypovolemia from re-
peated vomiting often causes hypochloremic alka-
losis with resultant hypokalemia. Replacement
fluids should be high in chloride, e.g., normal sa-
line, with added potassium chloride. Most other
types of lost or extravasated fluids have an electro-
lyte concentration similar to plasma. If so, lactated

Ringer’s solution is usually the replacement fluid
of choice. If there are high protein losses such as
with granulating wounds, peritonitis, pancreatitis,
soft tissue trauma, etc., albumin may be added to
the replacement fluid.

If there is a combination of blood and fluid lost
as with significant soft tissue injuries after auto-
mobile accidents, both Ringer’s lactate and whole
blood will be needed. It must be remembered that
the fluid sequestered in injured or inflamed tis-
sues is released into the venous capillaries as the
tissue heals. Several days later this reabsorption of
fluid may equal or exceed the patient’s daily fluid
requirement and may cause hypervolemia. This
reabsorption should be anticipated and fluid ther-
apy altered accordingly.

The amount of fluid necessary to restore a nor-
mal hemodynamic state equals the loss and usually
is impossible to measure accurately. Adequate re-
placement can be determined only by the clinical
response of the patient.

The first indication that the patient will need
fluid therapy may be an appreciation of the se-
verity of the patient’s disease. A badly injured pa-
tient or a patient with severe peritonitis is going
to require fluid. The alert physician will anticipate
these requirements and begin fluid therapy
promptly, often before the clinical signs of shock
appear. The more proficient a physician is in the
treatment of shock, the less shock he will see. His
patients will endure less hypovolemia for shorter
periods of time and will reap the benefit in de-
creased morbidity and mortality.

With adequate therapy, the signs and symptoms
of shock abate in the reverse order in which they
appear. Since most patients will maintain a nor-
mal arterial blood pressure with a one liter blood
volume deficit, a normal arterial blood pressure
cannot be used as the end point of transfusion
therapy; such a patient may still be in shock. The
hematocrit is rarely of value in the initial treat-
ment of shock since the blood loss usually occurs
much more rapidly than the body’s ability to re-
place the blood volume with extracellular fluid.
Other means of judging the adequacy of fluid re-
placement are, therefore, necessary.

After estimating the relative proportions of
crystaloid and colloid solutions needed, fluid
should be administered rapidly while observing
the patient, monitoring the urinary output and
central venous pressure and auscultating the chest
repeatedly until one of three things happens.

1. The signs and symptoms of shock disappear
and the urinary output returns to normal.
This is the usual and hoped for goal and
indicates satisfactory re-establishment of a
normal blood volume.

MICHIGAN MEDICINE JANUARY 1972 21

HYPOVOLEMIC SHOCK/Continued

2. The central venous pressure rises to greater
than 10 cm. of water indicating imminent
fluid overload. If this occurs prior to the dis-
appearance of the signs and symptoms of
shock, it implies that the shock is at least
partially of cardiogenic origin and that fluid
replacement must be stopped while efforts
are made to improve cardiac output by in-
creasing the strength of ventricular contrac-
tion. This may require intravenous Isuprel
(a potent Beta stimulator which must be ad-
ministered cautiously to prevent excessive
tachycardia) or intravenous digitalis (espe-
cially useful in patients with pre-existing
cardiac disease or in patients with a pulse
greater than 120 per minute) .

3. Rarely, pulmonary edema occurs, signifying
an excessive accumulation of fluid in the
pulmonary interstitial space, perhaps, from
pulmonary contusions or congestive atelecta-
sis but frequently compounded by excessive
fluid administration. This usually, but not
always, will be accompanied by an increased
central venous pressure. A stethoscope is in-
dispensable in shock therapy.

Central venous pressure monitoring is most
useful in preventing over transfusion during the
rapid administration of fluid to patients who will
tolerate fluid excesses poorly. As long as the cen-
tral venous pressure is not elevated and the chest
is clear, fluid can be administered as rapidly as
desired without fear of fluid overload. When the
central venous pressure rises, the blood volume is
approaching the maximum that can be tolerated
by the heart and the rate of administration must
be decreased. This is the only role of central ve-
nous pressure monitoring. The currently popular
practices of using a low central venous pressure
reading as an indication for fluid therapy or in-
sisting upon raising the central venous pressure
above normal (indicating borderline congestive
failure) before slowing the rate of fluid adminis-
tration should be avoided. The central venous
pressure monitoring device is not like a fuel
gauge; it will not indicate when a patient is a
quarter full or three-quarters full! It will only
tell the physician when the patient is too full and
warn him against further fluid administration.

Vasopressors. Although vasopressors have been
used extensively in the treatment of hypovolemic
shock, convincing evidence of their clinical efficacy
is lacking. Studies of anesthetized animals have
shown the detrimental effect of hypotension on
coronary artery16-19-29-32 and renal artery30-59-61
flow, and the salutary effects of the artificial eleva-
tion of arterial blood pressure by vasopressors in
this setting.11-29-31-32-60-62 Our results from the use
of metaraminol in the anesthetized pig in hemor-
rhagic shock support these findings.24

Unfortunately, some authors have assumed that
vasopressors have a similar effect in nonanesthe-
tized humans and have advocated vasopressors in
the treatment of clinical shock. This assumption
fails to consider the variables introduced by anes-
thesia, the reports of the detrimental effects of
vasopressors,63-70 the role of catecholamines in pre-
venting re-expansion of the blood volume after
hemorrhage67 and the evidence indicating that
plasma catecholamine levels are already elevated
in shock. 9-71-72 Our studies indicate that a 40%
hemorrhage does not adversely affect myocardial
perfusion12 and that therapeutic amounts of me-
taraminol after hemorrhage decreases myocardial
perfusion and renal capillary blood flow in the
nonanesthetized animal.24 We are not aware of
any data which demonstrate that vasopressors im-
prove capillary perfusion in nonanesthetized hu-
mans.

The ischemic insult of acute hypovolemia with
profound hypotension frequently has its most se-
rious and lasting effects on the central nervous
system. Vasopressors may have an important role
in maintaining cerebral perfusion following acute,
massive hemorrhage in those few moments before
blood volume replacement can be begun. Similar-
ly, vasopressors may help overcome the loss of
peripheral vascular tone which accompanies acute
cardiac arrest, thereby shortening the period of
profound hypotension. Although logical, these
popular hypotheses are not substantiated. We must
know the effect of graded hypotension and vaso-
pressors on cerebral perfusion before the useful-
ness of vasopressors in profound hypotension is
accepted. In practice, we do not use vasopressors
except in the first few minutes after cardiac arrest
and in the anesthetized patient in profound hypo-
volemic shock before blood volume can be re-
placed.

Alkalinizing and Buffering Solutions. The cel-
lular anoxia of hypovolemic shock invariably in-
terferes with aerobic metabolism and causes some
degree of metabolic acidosis. The fear that this
acidosis will interfere with cardiovascular function
and, therefore, needs specific treatment seems to be
unjustified. Collins and co-workers have sum-
marized the published data on the role of acidosis
in shock and have confirmed it in their clinical
studies.34 Most patients whose hypovolemic shock
responds to fluid therapy will rapidly reverse the
metabolic acidosis without specific therapy and re-
gardless of the magnitude of the acidosis. Further-
more, most patients will have no difficulty from
the infused acid load of stored blood.

Patients who demonstrate persistent metabolic
acidosis and lactic acidemia after treatment usual-
ly have continued hemorrhage and shock or have
such extensive ischemic damage that survival is
unlikely. Administration of alkali to such patients

22 MICHIGAN MEDICINE JANUARY 1972

is usually without effect even when the acidosis is
reversed.

Metabolic defenses against acidosis are less effi-
cient during hypothermia, in the newborn and in
patients with impaired liver function or with pre-
existing myocardial disease. The normal defense
mechanisms may be overwhelmed by sustained
transfusion therapy exceeding one unit of banked
blood every four to six minutes. Under any cir-
cumstances, however, it is unlikely that clinical
acidosis significantly affects cardiovascular function
or that patients responding favorably to transfu-
sion therapy will require pharmacologic manipula-
tion of their acid-base balance.33-35 Routine admin-
istration of alkalinizing solutions during rapid or
sustained blood transfusions may cause hypocal-
cemia, ventilatory depression, increased urinary
potassium losses and decreased oxygen transport.34
If alkalinizing or buffering solutions are consid-
ered in patients who are not responding well to
transfusion therapy, their use should be based on
objective measurements of the acid-base status and
should be accompanied by the cautious adminis-
tration of calcium.

Operative Therapy. Occasionally, it becomes evi-
dent that the patient is losing blood as rapidly as
it is being administered and that re-establishment
of normal circulatory dynamics by rapid fluid ad-
ministration is not going to be successful. If so,
immediate operation is necessary to obtain hemo-
stasis. Once the bleeding organ is exposed, hemo-
stasis should be accomplished as expeditiously as
possible, usually by simple suture or tamponade
until the blood volume can be restored and de-
finitive surgical correction carried out with the
patient normovolemic.

Summary

Most patients with hypovolemic shock are best
treated by adequate fluid replacement. The patho-
physiology of shock is discussed. Methods of bed-
side patient monitoring to determine the adequacy
of fluid replacement are emphasized.

References

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2. Clauss, R.H., and Ray, J. F.: Pharmacologic Assist-
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Surg. Gynec. Obstet. 126:611-631 (March) 1968.

3. Hamit, H. F.: Current Trends of Therapy and Re-
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4. Mills, L.C., and Moyer, J.H.: “Shock and Hypo-
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Twelfth Hahnemann Symposium, New York:
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5. Wilson, C.B., Vidrine, A., and Rives, J.D.: Un-
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6. Mellander, S.: Comparative Studies on the Adren-
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7. Dow, R.W., and Fry, W.J.: Venous Compensatory
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8. Cloutier, C.T., Lowery, B.D., and Carey, L.C.:
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9. Moore, F.D.: Annual Discourse: The Effects of
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10. Skillman, J.J., Awwad, H.K., and Moore, F.D.:
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11. Catchpole, B.N., Hackel, D.B., and Simeone, F.A.:
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L-Nor-Epinephrine, Ann. Surg. 142:372-381 (Sept)
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12. Simon, M.A., and Olsen, W.R.: Capillary Flow in
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13. Cohn, H.E., and Ballinger, W.F.: “Research Meth-
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14. Beconsfield, P., and Messent, D.: Blood Flow After
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15. Greisheimer, E.M.: “The Circulatory Effects of
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D.C.: American Physiologic Society, 1965, vol 3, sec
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16. Hackle, D.B., and Goodale, W.T.; Effects of Hem-
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Intact Dogs, Circulation 11:628-634 (April) 1955.

17. Heilbrunn, A., and Allbritten, F.F.: Cardiac Out-
put During and Following Surgical Operations,
Ann. Surg. 152:197-210 (Aug) 1960.

18. Nash, C.B., Davis, F., Woodbury, R.A.: Cardio-
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19. Olsen, W.R., and Simon, M.A.: Capillary Flow in
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20. Price, H.L.: General Anesthesia and Circulatory
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21. Barclay, A.E., and Bentley, F.H.: The Vasculariza-
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ogy 12:177-183 (Feb) 1949.

22. Suzuki, M., and Penn, I.: A Reappraisal of the
Microcirculation During General Hypothermia,
Surgery 58:1049-1060 (Dec) 1965.

23. Olsen, W.R.: A New Research Technique to De-

MICHIGAN MEDICINE JANUARY 1972 23

HYPOVOLEMIC SHOCK/Continued

termine Changes in Blood Capillary Flow, Arch.
Surg. 99:637-640 (Nov) 1969.

24. Olsen, W.R.: Capillary Flow in Hemorrhagic

Shock. Ill: Metaraminol and Capillary Flow in the
Nonanesthetized and Anesthetized Pig, Arch. Surg.
99:637-640 (Nov) 1969.

25. Sapirstein, L.A.: Fractionation of the Cardiac Out-
put of Rats With Isotopic Potassium, Circ. Res.
4:689-692 (Nov) 1956.

26. Sapirstein, L.A.: Regional Blood Flow by Fraction
Distribution of Indicators, Amer. J. Physiol. 193:
161-168 (April) 1958.

27. Beecher, H.K., et al: The Internal State of the
Severely Wounded Man on Entry to the Most For-
ward Hospital, Surgery 22:672-711 (Oct) 1947.

28. Shenkin, H.A., et al: On the Diagnosis of Hem-
orrhage in Man: A Study of Volunteers Bled Large
Amounts, Amer. J. Med. Sci. 208: 421-436 (Oct)
1944.

29. Corday, E., et al: Effect of Systemic Blood Pressure
and Vasopressor Drugs on Coronary Blood Flow
and the Electrocardiogram, Amer. J. Cardiol. 3:626-
637 (May) 1959.

30. Sapirstein, L.A., Sapirstein, E.H., and Bredemeyer,
A.: Effect of Hemorrhage on the Cardiac Output
and its Distribution in the Rat, Circ. Res. 8: 135-
MS (Jan) 1960.

31. Sarnoff, S. J., et al: Insufficient Coronary Flow and
Myocardial Failure as a Complicating Factor in
Late Hemorrhagic Shock, Amer. J. Physiol. 176:
439-444 (March) 1954.

32. Vowles, K.D.J., Couves, C.M., and Howard, J.M.:
Coronary and Peripheral Blood Flow Following
Hemorrhagic Shock, Transfusion, and Norepine-
phrine, Circulation 16:946 (Oct) 1957.

33. Clowes, G.H.A., et al: Effects of Acidosis on Car-
diovascular Function in Surgical Patients, Ann.
Surg., 154:524-555 (Oct) 1961.

34. Collins, J.A., et al: Acid-Base Status of Seriously

Wounded Combat Casualties: II: Resuscitation

with Stored Blood, Ann. Surg. 173:6-18 (Jan)
1971.

35. Feins, N.R., and DelGuercio, L.R.M.: Increased
Cardiovascular Function in Clinical Metabolic Aci-
dosis, Surg. Forum 17:39-40, 1966.

36. Dudrick, S.J., Wilmore, D.W., Vars, H.M., and
Rhodes, J.E.: Can Intravenous Feeding as the Sole
Means of Nutrition Support Growth in A Child
and Return Weight Loss in an Adult? An Affirma-
tive Answer, Ann. Surg. 169:974-984 (June) 1969.

37. Longerbeam, J.K., Vannix, R., Wagner, W., and
Joergenson, E.: Central Venous Pressure Monitor-
ing: A Useful Guide to Fluid Therapy During
Shock and other Forms of Cardiovascular Stress,
Amer. J. Surg. 110:220-230 (Aug) 1965.

38. Mogil, R.A., Delaurentis, D.A., and Rosemond,
G.P.: The Infraclavicular Venipuncture: Value in
Various Clinical Situations Including Central Ve-
nous Pressure Monitoring, Arch. Surg. 95:320-324
(Aug) 1967.

39. Wilson, J.N., Grow, J.B., Demong, C.V., Prevedel,
A.E., and Owens, J.C.: Central Venous Pressure in
Optimal Blood Volume Maintenance, Arch. Sugr.
85:563-578 (Oct) 1962.

40. Daily, P.O., Griepp, R.B., and Shumwhy, N.E.:
Percutaneous Internal Jugular Vein Cannulation,
Arch. Surg. 101:534-536 (Oct) 1970.

41. Mostert, J.W., Kenny, G.M., and Murphy, G.P.:
Safe Placement of Central Venous Catheter Into
Internal Tugular Veins, Arch. Surg. 101:431-432
(Sept) 1970.

42. Geis, P.W., et al: Extrapericardial (Mediastinal)
Cardiac Tamponade, Arch. Surg. 100:305-306
(March) 1970.

43. Lawton, R.L., Rossi, N.P., and Funk, D.C.: Intra-
cardiac Perforation, Arch. Surg. 98:213-216 (Feb)

1969.

44. Thomas, C.S., Carter, J.W., and Lowder, S.C.:
Pericardial Tamponade from Central Venous Cath-
eters, Arch. Surg. 98:217-218 (Feb) 1969.

45. Collins, R.N., et al: Risk of Local and Systemic
Infection with Polyethylene Intravenous Catheters.
A Prospective Study of 213 Catheterizations, New
Eng. J. Med. 279:340-343 (Aug 15) 1968.

46. Glover, J.L., O’Byrne, S.A., and Jolly, L.: Infusion
Catheter Sepsis: An Increasing Threat, Ann. Surg.
173:148-151 (Jan) 1971.

47. Smit, H., and Freedman, L.R.: Prolonged Venous
Catheterization as a Cause of Sepsis, New Eng. J.
Med. 276:1229-1233 (June 1) 1967.

48. Smith, B.E., et al: Complications of Subclavian
Vein Catheterization, Arch. Surg. 90:228-229 (Feb)

1965.

49. Doering, R. B., Stemmer, E.A., and Connolly, J.E.:
Complications of Indwelling Venous Catheters with
Particular Reference to Catheter Embolus, Amer.
J. Surg. 114:259-266 (Aug) 1967.

50. Atik, M.: Dextran 40 and Dextran 70: A Review,
Arch. Surg. 94:664-672 (May) 1967.

51. Thompson, W.L., et al: Intravascular Persistence,
Tissue Storage, and Excretion of Hydroxyethyl
Starch, Surg. Gynec. Obstet. 131:985-972 (Nov)

1970.

52. Metcalf, W., et al: A Clinical Physiologic Study of
Hydroxyethyl Starch, Surg. Gynec. Obstet. 131:255-
267 (Aug) 1970.

53. Carey, L.C., Lowery, B.D., and Cloutier, C.T.:
Hemorrhagic Shock, Curr. Probl. Surg., pp. 31-33
(Jan) 1971.

54. Dillon, J., et al: The Bioassay of Treatment of
Hemorrhagic Shock, Arch. Surg. 93:537-555 (Oct)

1966.

55. Dillon, J., et al: The Treatment of Hemorrhagic
Shock, Surg. Gynec. Obstet. 122:967-978 (May)
1966.

56. Rush, B.F., et al: Limitation of Blood Replacement
with Electrolyte Solutions. A Controlled Clinical
Study, Arch. Surg. 98:49-52 (Jan) 1969.

57. Moore, F.D., et al: Hemorrhage in Normal Man:
I. Distribution and Dispersal of Saline Infusion
Following Acute Blood Loss: Clinical Kinetics of
Blood Volume Support, Ann. Surg. 163:485-504
(April) 1966.

58. Carey, L.C., Lowery, D.B., and Cloutier, C.T.:
Hemorrhagic Shock, Curr. Probl. Surg., pp. 36-37
(Jan) 1971.

59. Dow, R., and Fry, W.J.: Hemorrhagic Shock;

24 MICHIGAN MEDICINE JANUARY 1972

a

MICHIGAN
DEPARTMENT
OF PUBLIC
HEALTH

Monthly Surveillance Report

Cases of Certain Diseases Reported
To the Michigan Department of Public Health

For the Four-Week Period Ending November 26, 1971

1971

1970

1971

1970

Total

This

Same

Total

Total

Cases

4-Week

4-Week

To Above

Same

for

Period

Period

Date

Date

1970

Rubella

85

104

2,854

2,883

3,012

Congenital Rubella Syndrome

0

0

1

0

2

Measles

96

34

2,523

1,798

1,834

Whooping Cough

9

7

132

187

195

Diphtheria

—

—

—

—

—

Mumps

Scarlet Fever &

375

937

10,124

6,394

7,825

Strep Sore Throat

826

958

9,941

10,265

11,863

Tetanus

1

2

3

8

8

Poliomyelitis (paralytic)

0

0

0

1

2

Hepatitis

Salmonellosis

381

331

4,388

4,153

4,594

(other than S. typhi)

64

51

634

596

665

Typhoid Fever (S. typhi)

0

0

7

12

14

Shigellosis

32

20

229

194

225

Aseptic Meningitis

17

21

208

284

296

Encephalitis

7

8

100

142

155

Meningococcic Meningitis

2

4

59

65

69

H. Influenza Meningitis

8

12

75

51

61

Tuberculosis

136

143

1,706

1,786

2,006

Syphilis

459

309

4,134

3,458

3,900

Gonorrhea

2,035

1,397

19,949

18,506

20,676

Information can be supplied by the local health department on the local incidence of disease.

Maurice Reizen, M.D., Director
Michigan Department of Public Health

Changes in Renal Blood Flow and Vascular Re-
sistance, Arch. Surg. 94:190-194 (Feb) 1967.

60. Mills, L.C., and Moyer, J.H.: The Effects of Var-
ious Catecholamines on Specific Vascular Hemo-
dynamics in Hypotensive and Normotensive Sub-
jects, Amer. J. Cardiol. 5:652-659 (May) 1960.

61. Mills, L.C., Moyer, J.H., and Handley, C.A.: Ef-
fects of Various Sympathicomimetic Drugs on Ren-
al Hemodynamics in Normotensive and Hypoten-
sive Dogs, Amer. J. Physiol. 198:1279-1283 (June)
1960.

62. West, J.W., Guzman, S.V., and Bellet, S.: Com-
parative Cardiac Effects of Various Sympathomim-
etic Amines, Circulation 16:950 (Nov) 1957.

63. Close, A S., et al: The Effect of Norepinephrine on
Survival in Experimental Acute Hemorrhagic
Hypotension, Surg. Forum 8:22-26 (Oct) 1957.

64. Drucker, W.R., Kingsbury, B., and Graham, L.:
Metabolic Effect of Vasopressors in Hemorrhagic
Shock, Surg. Forum 13:16-18 (Oct) 1962.

65. Finnerty, F.A., Jr., Buchholz, J.H., and Guillaudeu,
R.L.: The Blood Volumes and Plasma Protein
During Levarterenol-Induced Hypertension, /. Clin.
Invest. 37:425-429 (March) 1958.

66. Jackson, A.J., and Webb, W.R.: Effects of Nor-
epinephrine of Differential Blood Flow in Graded
Hemorrhage, Surg. Forum 13:14-15 (Oct) 1962.

67. Lister, J., et al: Transcapillary Refilling after
Hemorrhage in Normal Man: Basal Rates and
Volumes; Effect of Norepinephrine, Ann. Surg.
158:698-712 (Oct) 1963.

68. Longerbeam, J.K., Lillehei, R.C., and Scott, W.R.:
The Nature of Irreversible Shock: A Hemodynamic
Study, Surg. Forum 13:1-3 (Oct) 1962.

69. Morris, R.E., Jr., Graff, T.D., and Robinson, P.:
Metabolic Effects of Vasopressor Agents, Bull. N.Y.
Acad. Med. 42:1007-1022 (Nov) 1966.

70. Schmutzer, K. J., Raschke, E., and Maloney, J.V.,
Jr.: Intravenous L-Norepinephrine as a Cause of
Reduced Plasma Volume, Surgery 50:452-457
(Sept) 1961.

71. Rosenberg, J.C., et al: Studies on Hemorrhagic
and Endotoxin Shock in Relation to Vasomotor
Changes and Endogenous Circulating Epinephrine,
Norepinephrine and Serotonin, Ann. Surg. 154:
611-628 (Oct) 1961.

72. Walker, W.F., et al: Adrenal Medullary Secretion
in Hemorrhagic Shock, Amer. J. Physiol. 197:773-
780 (Oct) 1959.

MICHIGAN MEDICINE JANUARY 1972 25

cPeriqatal ^Tips

By Paul M. Zavell, MD
Detroit

The following case from the files of the Wayne
County Medical Society Perinatal Mortality Com-
mittee is presented as an aid in continuing educa-
tion.

Maternal

This was the first pregnancy for a 23 year old,
white O T mother. Her pregnancy had been un-
eventful and she had received regular prenatal
care. At term she went into labor and delivered a
5 lb. 8 oz. female infant in eleven hours. The
mother had a negative VDRL.

Fetal

At birth this infant was in a depressed state
with a cord around the neck. Initial resuscitation

Doctor Zavell is chairman, Neo-Natal and Hos-
pital Care Committee, Michigan Chapter, A.A.P.;
and chairman, Perinatal Mortality Study Com-
mittee, Wayne County Medical Society.

efforts were not successful (though vigorous) so
that it was necessary to intubate her and later use
a Bennett respirator. The heart rate varied from
100-120 per minute.

When first seen by the pediatric staff (30 min-
utes later) the infant was cyanotic and still not
breathing spontaneously. Breath sounds were
heard poorly on the left side and none were
noted on the right. Thinking this might be res-
piratory distress, sodium bicarbonate 8cc as a di-
rect push followed by 50% glucose water were in-
stilled via the umbilical vein. No improvement
was noted. A chest film revealed a massive right-
sided tension pneumothorax which was immedi-
ately relieved by direct needle aspiration so that
respirations immediately improved. Shortly there-
after a catheter was inserted into the right chest.
The infant’s color became excellent and she now
breathed normally. The endotracheal tube was re-
moved shortly thereafter without difficulty.

On the second day of life she weighed 5 lbs. 4
ozs. and was generally doing well. Only minimal
amounts of air were recovered following thorac-
otomy drainage so that it was possible to remove
the tube successfully 48 hours later. The infant’s
course was completely uneventful thereafter and
she was discharged home on the fifth day.

Perinatal Committee Comments

1. This case nicely stresses the truth of the
statement that not all babies having respiratory
distress have the true respiratory distress syndrome.
That is, respiratory distress may be due to CNS,
cardiac, respiratory, hematologic, or other prob-
lems and not due primarily or only to “hyaline
membrane disease.”

2. Whenever an infant is having respiratory dis-
tress symptoms, a chest X-ray should be done to
rule out possibilities other than respiratory distress
symptoms (such as a pneumothorax here) .

3. Not all pneumothoracies need treatment but
tension pneumothorax does (indeed, treatment is
life-saving here) .

26 MICHIGAN MEDICINE JANUARY 1972

SPLENECTOMY

COMPLICA TIONS OF

By Robert D. Allaben, MD
William S. Carpenter, MD
Paul J. Connolly, MD
Angelos A. Kambouris, MD
Detroit

The incidence of complications following sple-
nectomy has been variably reported from 30% to
90%. The frequency has been related to the indi-
cations for the procedure, to coexisting diseases or
to specific technical factors. 1-2-3'4^ Although sple-
nectomy is a relatively common operation, there
are only sporadic reports relative to the associated
morbidity and mortality and little information
about the reasons for its performance.

In order to evaluate the incidence and type of
such complications, the authors reviewed their
personal experience with 50 consecutive splenec-
tomies performed from 1964 to 1969.

Materials

The records of 50 consecutive patients who un-
derwent splenectomy by the authors in three pri-
vate hospitals in Detroit were thoroughly analyzed.
Emphasis was placed on the type of underlying
disease, the intraoperative and postoperative
course and the type and seriousness of the com-
plications.

There were 30 female and 20 male patients.
Their ages varied from eight to 84 years with a
median of 53.5 years. Forty-seven patients were
Caucasian and three were Negroes. Indications were
divided into four categories (Table I).

As a primary procedure, splenectomy was per-
formed through a left subcostal incision. Fre-
quently a drain was left in the splenic bed and
removed between the second and seventh post-
operative day. Gastric decompression by nasogas-
tric suction was employed selectively; early ambu-
lation and bronchopulmonary care were instituted
immediately after operation. Frequent platelet
counts were obtained and anticoagulation was
instituted when platelets exceeded one million/
cu.mm.

The authors are associated with Harper Hos-
pital, Mt. Carmel Mercy Hospital and Sinai Hos-
pital, all in Detroit.

Table I Indications for Splenectomy

Group

Indication

No.

Pts.

%

1.

Hematologic

22

44%

2.

Incidental to Major Operations

13

26%

3.

Iatrogenic Trauma

11

22%

4.

External Trauma

4

8%

Total

50

100%

Complications were classified as follows:

a. Pulmonary such as atelectasis, pneumonitis,
pleural effusion or empyema.

b. Subphrenic abscess and collection at the area
of the splenic bed.

c. Miscellaneous including peritonitis, bleeding
and thrombotic episodes.

Results

1. Hematologic Disorders:

Twenty-two patients underwent splenectomy for
hematologic diseases (Table II). The largest spleens
removed weighed 1907 gms. (for lymphoma) and
1930 gms. (for hypersplenism) .

Complete hematologic evaluation and oftentimes
prolonged specific treatment, including steroids
and immunosuppressive drugs, had preceded op-
eration in all instances. Four patients had plate-
lets of less than 30,000/cu.mm, and in two the
platelet level was below 10,000/cu.mm. Although
no platelets were administered preoperatively,
none of these patients exhibited abnormal bleed-
ing during or following the procedure. Likewise
post-splenectomy thrombocytosis of 500,000 to
750,000/cu.mm, developed in eight patients (36%),
but no clinical thrombotic episodes were observed.
Fifteen patients had been on long-term steroid
therapy; appropriate dose adjustment prevented
episodes of adrenal insufficiency and all wounds
healed primarily. Accessory spleens were found in
six patients (27%) . In one instance three acces-
sory spleens were removed 30 years following sple-
nectomy for acquired hemolytic anemia. The
splenic bed was chained in eight patients (36%).
No complications related to the drain were en-
countered.

As indicated in Table II, atelectasis in two pa-
tients and pneumonitis in one were the only com-
plications in this group. All but three patients

MICHIGAN MEDICINE JANUARY 1972 27

SPLENECTOMY /Continued

Table II Complications of Splenectomy for Hematologic Disease

No. Complications

Primary Disease

Pts.

A

B

c

Deaths

Idiopathic Thrombocytopenic Purpura

6

0

0

0

0

Hypersplenism

5

2

0

0

0

Felty's Syndrome

4

0

0

0

1

Acquired Hemolytic Anemia

4

0

0

0

1

Leukemia-Lymphoma

2

1

0

0

0

Gaucher's Disease

1

0

0

0

0

Total

22

3(14%)

0

0

2(9%)

A. Bronchopulmonary

B. Subphrenic

C. Miscellaneous

Table III Complications of Splenectomy Incidental to Major Operations

Primary Operations

No.

Pts.

A

Complications

B

C

Esophagogastrectomy

8

6

1

0

Pancreatectomy

3

2

0

1

Colectomy

1

0

0

0

Splenorenal Shunt

1

0

0

0

Deaths

3

1

0

1

Total 13 8(62%)

5(38%)

A.

B.

C.

Bronchopulmonary

Subphrenic

Miscellaneous

(,

I.

were discharged by the fifteenth postoperative day.
One patient remained longer because of an eye
infection associated with Felty’s syndrome. Two
patients died in the hospital from septic processes
not related to the splenectomy; one on the forty-
ninth postoperative day from sepsis incident to
immunosuppression for treatment of hemolytic
anemia, the other on the sixty-eighth postoperative
day from sepsis secondary to extensive decubitus
ulcers associated with Felty’s syndrome.

2. Splenectomy Incidental to Major Operations:

In 13 patients the spleen was removed as a
normal part of another definite procedure (Table
III). In eight instances the spleen was removed in
the course of resective procedures for gastric or
esophageal carcinoma. In three it accompanied
distal pancreactomy. Subtotal colectomy for carci-
noma attached to the splenic capsule and spleno-
renal shunt were indications for splenectomy in
the remaining two patients. Penrose drains were
placed in the left upper quadrant in 1 1 instances.
Severe bronchopulmonary complications devel-
oped in eight patients (62%) and subphrenic ab-
scess due to an anastomotic leak occurred in one
instance. Asymptomatic thrombocytosis of 650,000/
cu.mm, was encountered only once. There were
five hospital deaths in this group, all related to
the extent of the operation and/or the underlying
disease; none could be directly attributed to sple-
nectomy (Table IV).

3. Iatrogenic Trauma:

Splenectomy was performed in 11 patients for
accidental injury in the course of operations in the

upper abdomen (Table V). Five injuries occurred
in the course of subtotal or total gastrectomy, three
in the course of vagotomy, two while repairing
esophageal hiatus hernias and the last during
left colectomy for carcinoma. Four patients (36%)
in this group developed serious bronchopulmonary
complications; three of them expired, while the
fourth recovered after closed thoracotomy drainage
for tension hydropneumothorax. Subphrenic ab-
scess as part of upper abdominal sepsis was en-
countered in two patients. A duodenal fistula was
considered the source in one, but no obvious
source could be found in the other patient. This
second patient, a cirrhotic with upper gastrointesti-
nal hemorrhage -developed subphrenic abscess
which progressed to diffuse peritonitis associated
with ascites and died 30 days following vagotomy
and hemigastrectomy.

Ileus of short duration was recorded in six of
the seven patients who had an uncomplicated re-
covery and in three of the four who expired.

Focal pancreatitis of no clinical significance was
found at autopsy in two patients (cases 9 and 11).
One (case 9) died of acute pulmonary edema four
days after attempted vagotomy for bleeding peptic
ulcer. The other patient (case 11) died 42 days
after total gastrectomy for recurrent hemorrhagic
gastritis and after multiple septic and cardiopul-
monary complications.

The splenic bed was drained in eight patients
in this group. No complications were directly re-
lated to the drain. Underlying diseases of serious
nature (cases 8,11) and serious technical problems
(cases 6,10) accounted for the complications and

I

l*

IB

1

4

(i

til

[«

tii

28 MICHIGAN MEDICINE JANUARY 1972

Table IV Fatal Complications in Group 2

Age/Sex Primary Procedure Fatal/Complication Day of Death Post op.

52, M Proximal Gastrectomy Leak, Empyema 9

84, F Proximal Gastrectomy Myocardial Infarction

Pulmonary edema 6

57, F Esophagogastrectomy

and Colon Interposition Leak, Empyema 12

53, M Splenorenal Shunt Liver failure 15

60, M 95% Pancreatectomy Myocardial Infarction 3

Table V Complications and Deaths in Patients with Accidental Splenic Injury

Age Complications

No.

Sex

1° Disease

Procedure

Incision

Injury

Drain

A

B

C

Outcome

Comments

1.

83, M

Ca. Stomach

Gastrectomy

Midline

Splenic

Tear

+

0

0

Ileus

Recovered

2.

62, F

Gastric Polyps

11

”

It

-

0

0

’’

>f

3.

65, F

Leiomyoma,

Excision,

71

”

+

0

0

11

11

Stomach

Pyloroplasty

4.

69, M

Bleeding

Gastritis

Gastrotomy

Transverse

11

+

0

0

11

5.

66, F

Cholelithiasis

Cholecystectomy

Right

11

+

0

0

0

"

Hiatus hernia

Hernia repair

subcostal

6.

69, F

Recurrent

Hernia repair

Midline

Tear of

+

Hydro-

11

Closed Chest

hiatus hernia

Suture of

esophagus

pneumo-

0

Ileus

Drainage

Esophagus

thorax

7.

72, F

Ca, Left Colon

Left Colectomy

Lt. Para-

Splenic

+

0

0

”

11

Median

Pedicle

Tear

8.

59, F

U.G.I. Bleeding

Vagotomy

Midline

Splenic

—

0 Abscess

Peritonitis

Expired

30th p.o. day

Cirrhosis

Hemigastrectomy

Tear

Ascites

9.

63, M

Bleeding

Attempted

”

11

+

Pneumo-

0

Ileus

”

4th p.o. day

Peptic Ulcer

Vagotomy

nitis

Tail Pancre-

Effusion

atitis at

Pulm. edema

Autopsy

10.

76, M

U.G.I. Bleeding

V+P Suture

1}

Splenic

—

Effusion

0

Ileus

11

16th p.o. day

on ACTH

Esophagus

Esophageal

Tear

A-C block

11.

75, M

Bleeding

Total

11

Splenic

+

Broncho-

0

Duod.

11

42nd p.o. day

Gastritis

Gastrectomy

Tear

pneumonia

Fistula

had V+P

Congestive

Abscess

2 wks. preop.

Failure

Wound

Autopsy:

Dehiscence

Focal

Pancreatitis

probably the fatal outcome. Although no death
could be directly attributed to the splenectomy,
there is little doubt that the additional procedure
prolonged the operating time, increased the opera-
tive and postoperative stress, and added to the
postoperative morbidity.

4. External Trauma:

Of the four patients in this category (Table VI)
two sustained fractures of the left rib cage in auto-
mobile accidents; another was injured falling off a
a stepladder and the last received a direct blow
with a baseball bat. Splenectomy was performed
through a left subcostal incision in three, through
a midline incision in the other. The splenic bed
was drained in three instances and no related com-
plications developed. Mild transient ileus was re-
corded in all patients. One patient with multiple
rib fractures developed a transient left pleural ef-
fusion and thrombocytosis of over 1 million/
cu.mm. She was treated with anticoagulants and

discharged the twenty-sixth postoperative day.
Asymptomatic thrombocytosis of 610,000/cu.mm,
was observed in the other patient with rib fracture
but no anticoagulants were used; he was dis-
charged on the eighth postoperative day.

Discussion

A. Complications:

Very few complications developed following
splenectomy for hematologic diseases. All three
pulmonary complications were minor, in spite of
pre-existing illness of long standing, of significant
hematologic deviations and of prolonged use of
steroids. Splenectomy for isolated splenic trauma
was also associated with minimal morbidity. The
only complication occurred in one patient with
fractured ribs and was probably related to the
associated injury.

All subphrenic abscesses occurred in instances
where the gastrointestinal tract had been entered.

MICHIGAN MEDICINE JANUARY 1972 29

SPLENECTOMY/Continued

Table VI Complications of Splenectomy for External Trauma

Complications Day of

Age/Sex Injury Drai

62, F Auto Accident, +

Rib Fractures

36, M Auto accident +

Rib Fracture

23, M Fall -

12, M Direct Injury +

None of eight patients in group I (hematologic)
and of three patients in group IV (trauma) where
clean splenectomies were drained, developed
wound infection or subphrenic abscess. This tends
to refute the contention that drains lead to wound
or subphrenic spaced infection.5 We are currently
using drains only selectively and remove them by
, the fourth postoperative day unless a pancreatic

injury is suspected or recognized, when drainage
may be necessary for longer periods. We agree
with Daoud, et al.,7 that patients have equal chance
for infection whether drains are used or not and
that special circumstances dictate the use of drtins.

The high incidence of complications and deaths
in group II (incidental) reflects the seriousness
and the extent of the primary operations and is
not related to the splenectomy. Six of the eight
bronchopulmonary complications and three of the
four deaths occurred after extensive thoroabdom-
inal resective procedures where the spleen was part
of the intended surgical specimen. Only one of 11
patients writh left upper quadrant drains developed
subphrenic abscess and this was due to an anasto-
motic leak. This again supports our impression
that special circumstances dictate the use of drains.

The incidence of splenectomy for accidental
splenic injury in the course of abdominal opera-
tions is variously quoted from 3% to 40%. J, 2,3,6, -
Accidental injury occurs most frequently in the
course of upper abdominal operations and is more
likely to occur when such operations are of an ur-
gent or emergency nature. Inadequate exposure,
lack of adequate skilled assistance and the sense of
need for rapid completion of an emergency pro-
cedure contribute to the higher incidence of
splenic injury when compared to that accompany-
ing elective upper abdominal operations. Five of

Table VII

Causes of Death

Group

No. Deaths

Cause of Death

1.

2/22

Systemic Sepsis

2

2.

5/13

Mycardial Infarction

2

Bronchopulmonary Sepsis

2

Liver Failure

1

3.

4/11

Pulmonary Edema

1

Bronchopulmonary Sepsis

2

Peritonitis

1

4.

0/4

Total

n

A

B

C

Discharge

Comments

Effusion

0

+

26th

Platelets

over l,000,000mm3
Anticoag. Rx.

0

0

+

8th

Platelets3
610,000mm no Rx

0

0

0

7th

0

0

0

8th

our 1 1 patients who had splenectomy for iatro-
genic injury, were operated for upper gastro-
intestinal bleeding under urgent or emergency
conditions. Olsen and Beaudoin3 attributed most
accidental splenic injuries to misdirected traction
of the stomach or colon during upper abdominal
procedures, causing avulsions at the splenic hilum.
This would explain the splenic rupture in two of
their patients following exploration through the
inguinal hernial sac at the time of herniorrhaphy.
Placing a pack cephalad to the spleen as advocated
by Baker,1 directing gastric or colonic traction to-
ward the patient’s left foot and avoidance of deep
retractors in the left upper quadrant have been
effective in reducing splenic injuries in our hands.

The contribution of the iatrogenic splenic in-
jury to morbidity or mortality is difficult to assess.
Olsen and Beaudoin3 reported 20 complications
and four deaths in a group of 121 splenectomies
for iatrogenic injury. Bostrom and Page0 observed
50% complications and 19% deaths in 16 patients
who required splenectomy for accidental injury.
Although we could not directly link the complica-
tions and death of any of our patients in group
III (accidental) to the splenectomy there is little
doubt that the additional procedure prolonged the
operative time and the surgical stress, contributed
to a change in blood coagnlation status and in-
directly influenced the clinical course in an ad-
verse manner.

Post-splenectomy thrombocytosis is frequently
recorded and occasionally accounts for deaths from
thromboembolic phenomena.8 In our patients
thrombocytosis reached its maximum between the
5th and 7th postoperative day. One of our patients
developed thrombocytosis with platelets in excess
of one million and was treated with anticoagulants
for three weeks. In nine more patients the platelet
levels reached 500,000 to 750,000/cu.mm, and then
reverted to normal with no treatment. In contrast
to others8 we believe that anticoagulant treatment
should be instituted if platelets exceed one mil-
lion/cu.mm.

Accessory spleens were found in six patients
undergoing splenectomy for hematologic disease
and only once in the incidental group. This find-
ing has been commented upon by Olsen and Beau-
doin.9 Recurrence of the original hematologic dis-

30 MICHIGAN MEDICINE JANUARY 1972

order after splenectomy should alert one to such
a possibility.

B. Deaths:

There were 11 deaths in the entire series (22%).
When broken down by group, however, it is ob-
vious that the majority of deaths were due to fac-
tors not related to splenectomy (Table VII).

Both deaths in group I were due to septic proc-
esses. In one the septic process was obviously ag-
gravated by immunosuppression. Whether splenec-
tomy as such had a detrimental systemic effect on
the patient's defense mechanisms as alluded to by
Hodam2 would be difficult to ascertain. The deaths
in group II (incidental) have no relation to the
removal of the spleen as indicated in Table IV. Of
the four deaths in group III (iatrogenic) one was
attributed to acute pulmonary edema, confirmed
by autopsy on the 4th postoperative day. Two
more were directly related to severe bronchopul-
monary complications; left pleural effusion with
alveolocapillary block following vagotomy and
pyloroplasty and sepsis after total gastrectomy
for recurrent bleeding gastritis, two weeks follow-
ing vagotomy and pyloroplasty. This latter patient
also had extensive upper abdominal sepsis from
duodenal fistula, wound infection with dehiscence
and prolonged ileus. He had been successfully
resuscitated by open cardiac massage eight years
previously, with residual serious cardiopulmonary
damage. At autopsy it was noted that the abdom-
inal sepsis had cleared, but bronchopulmonary
sepsis and chronic congestive failure persisted and
were considered responsible for his demise. The
fourth patient developed peritonitis, liver failure
with ascites and died BO days after vagotomy and
hemisgastrectomy. No drain had been left in the
abdomen. The gastrointestinal anastomosis most
likely accounted for the peritoneal sepsis, while
the pre-existing cirrhosis and ascites curtailed her
chances for recovery.

Summary and Conclusions

Experience with 50 patients who underwent sple-
nectomies for various indications is summarized.
Eleven patients (22%) died as a result of the un-
derlying disease or of complications developing
from the primary operations. Severe bronchopul-
monary cardiac complications accounted for seven
deaths, sepsis for three, and liver failure for one.
No death could be directly attributed to the sple-
nectomy.

The overall complication rate was 40% with a
preponderance of bronchopulmonary complica-
tions in 32%. This high incidence of bronchopul-
monary complications is attributed to extensive
upper abdominal or thoraco-abdominal operations
in patients of the older age group and does not
seem to be directly related to the splenectomy.

There were no complications associated with the
use of drains when adjacent organs were left in-
tact.

Preoperative thrombocytopenia of significant de-
gree was not associated with hemorrhagic prob-
lems. Postoperative thrombocytosis occurred in
20% of the patients, but remained asymptomatic
and was treated with anticoagulants in only one
patient.

Most of the splenic injuries in the iatrogenic
group occurred in patients undergoing emergency
procedures or in those with improper technical
exposure. Improvement of these technical factors
should be associated with a lower incidence of in-
jury and decrease in the associated morbidity.

References

]. Rich, N.M., Lindner, H.H., and Mathewson, C.,
Jr.: Splenectomy incidental to Iatrogenic Trauma.
Am. J. Surg. 110: 209-215, 1965

2. Hodam, R.P.: The risk of Splenectomy. A review of
310 cases. Am. J. Surg. 119: 709-713, 1970

3. Olsen, W.R., and Beaudoin, D.E.: Surgical Injury
to the Spleen. Surg. Gynec. Obstet. 131: 57-62, 1970

4. Olsen, W.R.: Emergency Splenectomy. Surg. Gynec.
Obstet. 123: 351-353, 1966

5. Olsen, W.R., and Beaudoin, D.E.: Wound drainage
after Splenectomy. Indications and Complications.
Am. J. Surg. 117: 615-620, 1969

6. Bostrom, P.D., and Page, H.G.: Splenectomy. An
eleven year Review. Arch. Surg. 98: 167-170, 1969

7. Daoud, F.S., Fischer, D.C., and Hafner, C.D.: Com-
plications following Splenectomy with special em-
phasis on drainage. Arch. Surg. 92: 32-34, 1966

8. Devlin, H. Brendan, Evans, D.S., and Birkhead,
J.S.: Elective Splenectomy for primary Hematologic
and Splenic Disease. Surg. Gynec. Obstet. 131: 273-
276, 1970

9. Olsen, W.R., and Beaudoin, D.E.: Increased inci-
dence of Accessory Spleens in Hematologic Disease.
Arch. Surg. 98: 762-763, 1969

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MICHIGAN MEDICINE JANUARY 1972 31

CftutoaJP note*

Hematoma

of the nasal septum

By Oliver B. McGillicuddy, MD
Lansing

It is more important to examine the septum of
the nose of an injured child or teenager than to
X-Ray the nasal bones. X-Rays may not reveal a
nasal bone and septal dislocation but should be
taken for possible legal action. Palpation of the
nasal arch and careful inspection is more apt to
reveal deformity.

On careful inspection of the interior of the
nose, it is not uncommon to find the septum dis-
lodged from its midline base and it becomes a
matter of judgment as to whether or not it can
or needs to be corrected.

It becomes an emergency if a hematoma of the
septum is discovered. Fortunately, this complica-
tion is rare and probably most general practition-
ers and many pediatricians have never encoun-
tered it. Unfortunately, rhinologists often see these
cases too late to save the septal cartilage.

The hematoma develops after severe trauma to
the nose. The septal cartilage is fractured. A blood
vessel in the perichondrium is lacerated and bleed-
ing occurs under the perichondrium.

As the bleeding continues, the perichondrium
is lifted off the septal cartilage on both sides.

Cartilage without its perichondrial blood sup-
ply softens like “butter on a hot stove.”

If diagnosed early, and this means within forty-
eight hours, the treatment is simple. The septum is
incised, blood is aspirated from the interior of the
septum and both nostrils are firmly packed, press-
ing the perichondrium and mucous membrane
against the septal cartilage. The packs are left in
place for three or four days.

If diagnosed late, the treatment is the same but
the end result is a disaster. The septal cartilage
will have become jelly and the septal support to
the lower two thirds of the dorsum of the nose
will be lost.

Doctor McGillicuddy is a Lansing otolaryngolo-
gist and is past chairman of the MSMS Council
and past MSMS president.

32 MICHIGAN MEDICINE JANUARY 1972

The inevitable result will be an ugly saddle
deformity of the nose. This saddle deformity can
be corrected later, after scar tissue contraction has
ceased, by a bone implant under the dorsum skin
and a strut of bone in the columella. If the child
is young, the implants may have to be replaced
when or if the nose has reached its full growth.
The nose may remain infantile.

The long period of waiting, often six months or
more, before corrective surgery can be started, is
a very emotionally traumatic experience for the
child.

The patient with a hematoma of the septum
complains of increasing nasal obstruction and
headache. The parents, sometimes unaware of the
injury, think the child has a severe cold or has
developed a nasal allergy. There is no epistaxis.
Home and drug store remedies are frequently ad-
ministered. When the child finally sees a doctor
it is apt to be too late to save the septal cartilage.

On examination of the interior of the nose, the
doctor, if he as aware of the possibility of a hema-
toma, may see both nostrils blocked by a red
swelling. If late, the swollen tissue will actually
protrude from the anterior nares. If early, he will
note a thickening of part or all of the septum.

The most common mistake is to diagnose this
swollen tissue as nasal polyps or a severe allergic
swelling or to temporize and think it a swelling
due to the injury and to wait for it to subside.

This complication may occur in adults but is
much more common in children.

On discovery, a dislocated septum can often be
corrected without too much deformity even a week
after injury. The neglected hematoma of the
septum is a childhood tragedy.

U-M research
of early abortions
supported by new grant

Two research projects aimed at developing drugs
to produce early abortions either by pill or injec-
tion are included in a new $1,089,428 federal grant
to The University of Michigan Center for Popula-
tion Planning. The Center is a unit of the School
of Public Health.

One study will involve implanting a transducer
into the uterus of 15 female volunteers. The other
will seek an antibody which will cause rejection of
the early fetus allowing repeated abortions with
minimal effect on the patient.

The two projects are among seven scientific in-
vestigations to be funded for three years for $572,-
036 by the U.S. Agency for International Develop-
ment (AID). They are directed by Samuel J. Behr-
man, MD, professof of obstetrics and gynecology.

Are congenital virus infections possible
in successive pregnancies?

By Thad H. Joos, MD
Detroit

That maternal infection with a viral agent dur-
ing early pregnancy, can lead to multiple congen-
ital defects in the offspring has been well docu-
mented.1’2-3'4 This report is presented not to en-
large an already adequate fund of information,
but to pose the following question. Can the prod-
ucts of two successive pregnancies be victims of
congenital virus infections?

Case Reports: Mr. and Mrs. M. were both nor-
mal Caucasians of the ordinary child-producing
age. There was a paternal great grandfather who
at age of 80, developed cataracts and Mrs. M. had
infectious hepatitis in 1960 with complete recov-
ery.

Mrs. M's first pregnancy ended in a miscarriage
at six weeks in 1961. The cause was unknown.
The second pregnancy produced a full-term, nor-
mal female on February 3, 1965.

Pregnancy number three began in December,
1964. A respiratory infection occurred during the
first six weeks and was treated with aspirin and
an antihistamine preparation. At two months some
minor vaginal bleeding occurred, which promptly
stopped. Vitamins and iron were taken during the
pregnancy.

A. M. was born at term on August 29, 1965.
The weight was 3750 grams. At three weeks of age,
bilateral cataracts along with icterus were noted.
A urinary test for galactose was negative. The
icterus gradually faded.

On examination by the author on November
15, 1965, the cataracts were observed, but in addi-
tion, a cardiac murmur was heard and the frontal
bossae were prominent. Head circumference was
42.3 cm. Neither the spleen nor liver were palpa-
ble.

The cataract OD was removed on December 10,
1965 and on December 19, 1965 the child was ad-
mitted to the Children’s Hospital of Michigan for
further evaluation. Pertinent findings were: (1)

small IV septal defect; (2) very large bilateral
porencephalic cysts; (3) rubella antibody titers
using the indirect fluorescent antibody technique5
were positive in the mother between 1:64 and
1:128, and in the baby positive 1:4. The baby’s

Doctor Joos is an adjunct instructor in pedi-
atrics at Wayne State University College of Med-
icine.

titer most likely would have been higher had not
the serum become contaminated with mold; (4)
cultures from the nasopharynx of both baby and
mother grown on rabbit cornea cells were negative
for rubella virus.6 The child’s head size continued
to rapidly increase and her motor development
lagged. She was placed in custodial care at 10
months of age.

The fourth pregnancy began in November of

1966, or about 15 months after the birth of A. M.
Vaginal bleeding occurred at 2 and S1/2 months.
The latter being controlled by one month of bed
rest. No respiratory infections were present, and
as in previous pregnancies, vitamins and iron were
taken, J.M. was born near term on August 16,

1967, weighing 2500 grams. The placenta was nor-
mal. The neonatal course was normal except for
slight icterus. No hepto or splenomegally was pres-
ent. At two months of age a cataract was found
OD and at three months OS. Their descriptions
were: “advanced lens opacities in the right, the
left eyes, a central white opacity surrounded by
small granular opacities.”7 To date, no other
anatomic abnomalies have been found. Urine for
galactose was negative as were two nasopharangeal
cultures from the mother and baby for rubella
virus. These were obtained in December, 1967,
and February, 1968. Rubella antibody titers done
in December of 1967 on the mother’s serum
showed a positive titer as in 1965. Those done on
the baby’s serum were equivocal for the presence
of rubella antibody.

Cataract removal was performed in November,
1967, and the report is as follows. “Suction extrac-
tion was done on the right. The iris pigment tend-
ed to adhere to the anterior capsule indicating
separation of posterior synechia. Again the lens
material, as with the sibling two years ago, was
quite tenacious. A central plaque was present,
which was dislodged nasally. The presence of the
adhesions between the iris and lens suggest an in-
flammatory etiology such as the rubella virus.’’8 A
contact lens was employed in the operated eye and
some vision has been maintained. Her growth and
development have been normal considering the
visual handicap.

In November of 1967 the fifth pregnancy began,
and ended fortunately with the delivering of a
normal female infant weighing 3600 grams. As of
December 1, 1968, no abnormalities have been
found in this child.

The placenta was normal, nasopharangeal cul-
tures for rubella virus were negative from mother

MICHIGAN MEDICINE JANUARY 1972 33

CONGENITAL VIRUS INFECTIONS/Continued

and baby. Quantitative immunoglobulins on cord
blood showed IGG 1000 mgm%, IGM trace, IGA
absent. Rubella antibodies were absent in the same
blood specimen. Lack of facilities precluded some
of these studies on the earlier babies.

Discussion: Coffey and Jessop9 in a hospital
survey reported that an influenza-like upper res-
piratory infection was obtained five times as often
from mothers of abnormal babies (18.4 per cent)
as from controls (3.6 per cent) . In an excellent
review article by Wright,1 however, it is stated
that while a number of maternal viral diseases
have been etiologically incriminated in congenital
defects only two, rubella and cytomegalovirus,
have definitely been proven to be associated with
defects. All babies in the series of Weller and
Hanshaw10 with cytomegalic inclusion disease had
heptosplenomegally. Jaundice and neurological
sequelae were frequent, but not ocular lesions.

Even with the absence of clinical rubella in Mrs.
M. during her third pregnancy, the offspring fits
the rubella syndrome, with eye, heart, and nervous
system abnormalities. Conception occurred in 1964,
a rubella epidemic year. Karmody,11 Butler, et al,12
Schiff, et al,13 and Weller, et al,14 report that fre-
quently a clinical case of rubella is diagnosed only
in retrospect after finding the stigmata in the child
and rubella antibodies in the sera of the mother
and child.

The antihistamine chlorcyclizine has been re-
ported to cause major anomalies in the fetus,15
but there was no use of this particular antihista-
mine by Mrs. M. in either pregnancy.

The case for rubella-caused cataracts is indeed
less impressive for the fourth child, J. M., with
only a questionable antibody titer in the serum
and negative cultures from the nasopharynx. Clin-
ically and pathologically the cataract fits into the
type, seen with congenital rubella. Gregg16 de-
scribes the rubella cataract as follows . . . “In the
undilated condition of the pupil the opacities
filled the entire area. After dilation, the opacities
appeared densely white— sometimes quite pearly in
the central area with a small, apparently clear
zone between this and the pupillary border of the
iris.” Zimmerman17 further supports the above by
stating that histologically, “The most marked al-
terations are always observed centrally, accounting
for the dense nuclear cataract observed clinically.”

Hereditary cataracts are pathologically different
and, typically occur as a dominant trait or reces-
sive factor, but sex linked inheritance has been
reported.18 It seems, therefore, that more than one
remote member of the family would have had
cataracts had heredity been involved.

One would like to believe that two such de-
formed babies were chance happenings and not
etiologically related. Circumstantial evidence, how-

ever, makes the physician observer wonder if such
were the case.

Summary: The problem of viral infections ante
natal in the mother is briefly discussed. A family
is presented that may well represent such infec-
tions in two successive pregnancies.

References

1. Wright, H. T.: Congenital Anomalies and Viral
Infections in Infants. Calif. Med., 105, 345, 1966

2. Nora, J. J., Nora, A. H„ Sommerville, R. J., Hill,
R. M., and McNamara, D. G.: Maternal Exposure
to Potential Teratogens. JAMA, 202, 1065, 1967

3. Katz, R. G., White, L. R., and Sever, J. L.: Ma-
ternal and Congenital Rubella. Clin. Ped., 7, 323,
1968

4. Whitty, R. J.: Foetal Infections, With Special Ref-
erence to Rubella. J. of Irish Med. Assoc., 60, 86

1967

5. Brown, G. C., Maassab, H. F., Veronelli, J. A.,
and Francis, T., Jr.: Rubella Antibodies in Human
Serum: Detection by the Indirect Fluorescent Anti-
body Technique. Science, 145, 943, 1964

6. Phillips, C. A., Melnick, J. L., and Burkhardt, M.:
Isolation, Propagation and Neutralization of Rubel-
la Virus in Cultures of Rabbit Cornea (SIRC)
Cells. Proc. Soc. Exp. Biology ir Med. 122, 783,
1966

7. Personal communication with Paul L. Cusick, MD

8. Ibid. #7

9. Coffey, V. P., and Jessop, W. J. E.: Congenital Ab-
normalities, Irish J. Med. Sci. p 30, 1955

10. Weller, T. H., and Hanshaw, J. B.: Virologic and
Clinical Observations on Cytomegalic Inclusion
Disease. New Eng. J. Med. 266, 1233, 1962

11. Karmody, C. S.: Sub-clinical Maternal Rubella and
Congenital Disease. New Eng. J. Med. 278, 809,

1968

12. Butler, N. R., Dudgeon, J. A., Hayes, K., Peckham,
C. S., and Wybar, K.: Persistence of Rubella Anti-
body With and Without Embryopathy. A Follow-
up Study of Children Exposed to Maternal Rubel-
la. Brit. Med. J. 2, 1027, 1965

13. Schiff, G. M., Sutherland, J. M„ Light, I. J., and
Bloom, J. E.: Studies on Congenital Rubella. Pre-
liminary Results on the Frequency and Significance
of Presence of Rubella and the Effect of Gamma-
globulin in Preventing Congenital Rubella. Am. J.
Dis. Child. 110, 441, 1965

14. Weller, T. H., Alford, C. A., and Neva, F. A.:
Retrospective Diagnosis by Serologic Means of Con-
genitally Acquired Rubella Infections. New Eng. J.
Med. 270, 1039, 1964

15. Sheldon, J. M., Lovell, R. G., and Mathews, K. P.:
A Manual of Clinical Allergy, ed. 2. Philadelphia,
Pa.: W. B. Saunders, p 142, 1967

16. Gregg, N. M.: Congenital Cataracts Secondary to
German Measles. Trans. Ophth. Soc. of Australia.
3, 35, 1941

17. Zimmerman, L. E.: Histopathologic Basis for Oc-
ular Manifestations of Congenital Rubella Syn-
drome: Am. J. of Ophth. 65, 839, 1968

18. Dept, of Ophth., Hosp. for Sick Children, Toronto.
The Eye in Childhood. Chicago, Illinois: Year
Book Med. Publishers, pp 414-415, 1967

34 MICHIGAN MEDICINE JANUARY 1972

It's got the same headroom
and legroom as the
Rolls-Royce Silver Shadow.

And the same kind of
steering system
as the Ferrari racing car.

a division of Volkswagen

The Audi IOOLS.

A test drive in the Audi never fails to sur-
prise people.

You see, the Audi gives you the comfort of
a luxury car without sacrificing the handling of
a sports car.

Aside from the Rolls and Ferrari, the Audi
has something in common with a lot of other
great cars.

It's got front-wheel drive like the Cadillac
Eldorado, an interior incredibly similar to the
Mercedes-Benz 280SE and as much trunk space
as the Lincoln Continental.

But the similarities to these expensive cars
go only so far.

They stop, in fact,
at the price sticker.

^ood Imports, Inc. Prestige Porsche Audi, Inc.

1415 Gratiot Ave., Detroit 2955 S. Division Ave., Grand Rapids

Tom Sullivan Porsche Audi Co.

499 S. Hunter Blvd., Birmingham

Camp’s Cars, Inc.

00 S. Saginaw Rd., Midland

Williams Porsche Audi

2924 E. Grand River Ave., Lansing

Traverse Motors, Inc.

1301 Garfield Ave., Traverse City

£MSmS ill actiori

Better obstetrical services
to Michigan 's residents
goal of MSMS committee

An MSMS subcommittee is now beginning work
on its plan to involve county medical societies, lo-
cal hospitals and planning groups in effective plan-
ning for obstetric and newborn services at the
community level.

Through its efforts in 1972, the MSMS Subcom-
mittee on Better Utilization of Obstetrical Beds
hopes to eliminate and/or consolidate poorly-uti-
lized obstetrical services, obtain needed obstetrical
beds and services, plan regional centers for the
care of high risk mothers and infants where such
care is not now available.

The subcommittee, a wing of the MSMS Maternal
and Perinatal Health Committee, won approval of
its plans and some financial support from The
MSMS Council at The Council’s November meeting.

“We are convinced that it is exceedingly impor-
tant for a professional nongovernmental organiza-
tion to provide the initiative and leadership in this

SEVENTEENTH ANNUAL

^ MEDICLINICS

^ POSTGRADUATE MEDICAL
£n,- > REFRESHER COURSE

r/T March 6-16, 1972

FORT LAUDERDALE, FLORIDA

Headquarters:

Galt Ocean Mile Hotel

Sponsored by Florida Academy of
General Practice and the Broward
a ° General Hospital. Accepted for 32
hours of credit by the American
Academy of General Practice.

&5T

Registration information:

MEDICLINICS

itSlT 832 Central Medical Building
Saint Paul, Minnesota 55104
Registration Fee: $100.00

Pre-Registration Hotel Room Guaranteed

effort,” says Richard T. Mellis, MD, Kalamazoo,
chairman of the maternal and perinatal health com-
mittee.

Seven subcommittee meetings are planned, three
at MSMS headquarters and four in communities
around the state to be devoted to actual involve-
ment in local planning efforts.

The committee includes representatives of the
Department of Public Health, the Michigan Hos-
pital Association and the Michigan Association of
Osteopathic Physicians and Surgeons.

Doctor, are you stumped when young peo-
ple ask you what colleges and universities
offer courses in dietetics, medical technology,
medical librarianships? Would you like a
handy reference to describe various medical
careers, as well as your own?

Then write MSMS headquarters, Box 950,
East Lansing, Mich. 48823, for the AMA
Horizons Unlimited career handbook.

Scientific Sessions

presents a Seminar with a distinguished faculty

Ala Moana Hotel — Honolulu, Hawaii

FEBRUARY 21, 22, 23, 1972

• Electrocardiography: Model for Normal and In-
traventricular Conduction Defects. Heart Block
and the Hemiblocks ; Indications for Pacing

Peter C. Block, M.D., Cardiac Unit,

Mass. General Hospital

• Diagnosis, Treatment, Prevention of Specific Viral
Diseases in Man

Thomas C. Merigan, M.D., Chief
Div. Infectious Diseases,

Stanford Univ. Medical Center

• Cancer Immunology Applied to Early Diagnosis
of Tumor Growth. Detection CEA in Patient's
Blood

Phil Gold, M.D., Ph.D., F.R.C.P. (C).
Montreal General Hospital Div.

Clinical Immunology & Allergy
Registration Limited

Program Director, Dr. Robert L. Pekarsky

Enclosed is my registration fee of $175.00
(Check payable to Scientific Sessions,

217 Alexander St., Rochester, N.Y. 14607)

,| | Want assistance with airline reservations
,[ | Information on group tours
Q Will make reservations with Ala Moana
Hotel for Special Scientific Sessions Rate

DR —

ADDRESS

36 MICHIGAN MEDICINE JANUARY 1972

CAMPBELL’S SOUPS IN DIABETIC DIETS*

RECOMMENDATIONS FOR PLACING CAMPBELL'S
SOUPS* INTO EXCHANGE LISTS

* These recommendations are based on a one cup portion when prepared
according to directions on the label. If milk is used in the preparation,
use part of your daily requirement.

Exchange Substitution for
1 Bread and V2 Fat

Tomato

Tomato, Bisque of
Tomato Rice, Old Fashioned

Exchange Substitution (or
T Meat and f/2 Bread

Hot Dog Bean
Split Pea with Ham

Exchange Substitution for
Vi Bread and V2 Fat

Asparagus, Cream of

Exchange Substitution for
VS Meat and '/2 Bread

Chicken Gumbo
Chicken Noodle

Campbell's Soups are appetizing and enjoyable and,
because of the many varieties available, offer your dia-
betic patients the opportunity to plan and enjoy more
interesting and appealing meals.

*To obtain copies of “Recommendations for Placing Campbell’s
Soups Into Exchange Lists,” suitable for distribution to patients,
write to Campbell Soup Company, Dept. 500, Campbell Place,
Camden, NJ. 08101.

here s a soup
for almost every patient and diet
.for every meal
and, it’s made by

I

I

i

I

When diarrhea
wrings the
wedding belle..

It’s all very well to counsel patience in diarrhea
patients. There are times when relief of symptoms
can’t come too soon.

X-ray studies1 in 16 normal subjects showed just how
promptly the active ingredient in Lomotil does
its work.

Lomotil retarded gastrointestinal motility particularly
during the first three hours after administration.

It continued its moderating action on the bowel for
at least three hours more.

Physicians prescribe Lomotil more often than any
other drug when the urgency for the control of
diarrhea is most distressing.

7. Demeulenaere, L.: Action du R 1132 sur le transit gastro-intestinai, Acta gastroent.

Belg. 21:674-680 (Sept. -Oct.) 1958.

Lomotil

Warnings: Lomotil should be used with
caution in patients taking barbiturates
and, it not contraindicated, in patients
with cirrhosis, advanced liver disease or
impaired liver function.

TABLETS/LIQUID

Each tablet and each 5 cc. of liquid contain
Diphenoxylate hydrochloride . . .2.5 mg
(Warning: may be habit-forming)
Atropine sulfate 0.025 mg

Precautions: Lomotil is classified as a
Schedule V substance by Federal Law with
theoretically possible addictive potential
at high dosage; this is not ordinarily a
clinical problem. Use Lomotil with con-
siderable caution in patients receiving ad-
dicting drugs. Recommended dosages

Saves the Day

should hot 88 exceeded, and medication
should be kept out of reach of children.
Sips of accidental overdosage may In*
elude severe respiratory depression, flush-
ing, lethargy or coma, hypotonic reflexes,
nystagmus, pinpoint pupils, tachycardia;
continuous observation is necessary, lie
subtherapeutie amount of atropine sulfate
is added to discourage deliberate over-
dosage.

Adverse Reactions: Side effects re-
ported with Lomotil therapy include nau-
sea. sedation, dizziness, vomiting,

pruritus, restlessness, abdominal discom-
fort. headache, angioneurotic edema,
giant urticaria, lethargy, anorexia, numb-
ness of the extremities, atropine effects,
swelling of tire gums, euphoria, depression
and malaise.

Overdosage: Tie medication should
hi kept out of reach of children since ae*
cidental overdosage may cause severe,
even fatal, respiratory depression.
Dosage: lie recommended average ini-
tial daily dosages, given in divided doses
until diarrhea is controlled, are as follows:

Children:

3-6 mo. ... % tsp.* t.i.d. {3 mg.)

6-12 mo.. . % tsp. q.i.d. (4 mg.)

t-2 yr % tsp. S times daily (5 mg.)

2-5 yr I tsp. t.i.d. (6 mg.)

5-8 yr.... .1 tsp. q.i.d. (8 mg.)

8-12 yr.. . . 1 tsp. 5 times daily (10 mg.)

Adults: 2 tsp, 5 times daily (20 mg.)

or 2 tablets q.i.d.

* Based on 4 cc. per teaspoonful.

Use of Lomotil is not recommended in infants
less than 3 months of age,

Maintenance dosage may be as low as one-
fourth the initial dally dosage.

Manufactured by SEARLE & CO.
San Juan, Puerto Rico 00936

For more detailed medical information write,
G. 0. Searlo & Co., Medical Department,

P.O. Box 5110. Chicago, Illinois 60680
Research in the Service of Medicine

WILLIAM P. POYTHRESS& COMPANY, INC.

P. O. BOX 26946, RICHMOND, VA. 23261

epanilTen-ta

(continuous release form)

liethylpropion hydrochloride, N. F.)

contro

Vhen girth gets out of control, TEPANIL can provide sound
upport for the weight control program you recommend.
EPANIL reduces the appetite — patients enjoy food but eat
3ss. Weight loss is significant— gradual — yet there is a rela-
ively low incidence of CNS stimulation.

ontraindications: Concurrently with MAO inhibitors, in patients hypersensitive to
>is drug; in emotionally unstable patients susceptible to drug abuse.

/arning: Although generally safer than the amphetamines, use with great caution in
otients with severe hypertension or severe cardiovascular disease. Do not use dur-
ig first trimester of pregnancy unless potential benefits outweigh potential risks,
dverse Reactions: Rarely severe enough to require discontinuation of therapy, un-
leasant symptoms with diethylpropion hydrochloride have been reported to occur
i relatively low incidence. As is characteristic of sympathomimetic agents, it may
ccasionally cause CNS effects such as insomnia, nervousness, dizziness, anxiety,
nd jitteriness. In contrast, CNS depression has been reported. In a few epileptics
n increase in convulsive episodes has been reported. Sympathomimetic cardio-
bscu/ar effects reported include ones such as tachycardia, precordial pain,

arrhythmia, palpitation, and increased blood pressure. One published report
described T-wave changes in the ECG of a healthy young male after ingestion of
diethylpropion hydrochloride; this was an isolated experience, which has not been
reported by others. Allergic phenomena reported include such conditions as rash,
urticaria, ecchymosis, and erythema. Gastrointestinal effects such as diarrhea,
constipation, nausea, vomiting, and abdominal discomfort have been reported.
Specific reports on the hematopoietic system include two each of bone marrow
depression, agranulocytosis, and leukopenia. A variety of miscellaneous adverse
reactions have been reported by physicians. These include complaints such as dry
mouth, headache, dyspnea, menstrual upset, hair loss, muscle pain, decreased
libido, dysuria, and polyuria.

Convenience of two dosage forms: TEPANIL Ten-tab tablets: One 75 mg. tablet
doily, swallowed whole, in midmorning (10 a.m.); TEPANIL: One 25 mg. tablet three
times daily, one hour before meals. If desired, on additional tablet may be given in
midevening to overcome night hunger. Use in children under 12 years of age is not
recommended. 1-3325 ( 2876 )

S N MERRELL- NATIONAL LABORATORIES

( Merrell ) Division of Richardson -Merrell Inc.

' Cincinnati, Ohio 45215

s

f

!

I

unwelcome bedfellow
forany patient-

including those with arthritis,
diabetes or PVD

Painful
night leg
cramps...

□ Prevents painful night
leg cramps

□ Permits restful sleep

□ Provides simple
convenient dosage —
usually just one tablet
at bedtime

CN MERR

Merrell ) Divisi

V Cinci

Quinamm

Prescribing Information — Composition: Each white, beveled, compressed tablet
contains: Quinine sulfate, 260 mg., Aminophylline, 195 mg. Indications: For the
prevention and treatment of nocturnal and recumbency leg muscle cramps, includ-
ing those associated with arthritis, diabetes, varicose veins, thrombophlebitis,
arteriosclerosis and static foot deformities. Contraindications: Quinamm is con-
traindicated in pregnancy because of its quinine content. Precautions/ Adverse
Reactions: Aminophylline may produce intestinal cramps in some instances, and
quinine may produce symptoms of cinchonism, such as tinnitus, dizziness, and gas-
trointestinal disturbance. Discontinue use if ringing in the ears, deafness, skin rash,
or visual disturbances occur. Dosage: One tablet upon retiring. Where necessary,
dosage may be increased to one tablet following the evening meal and one tablet
upon retiring. Supplied: Bottles of 100 and 500 tablets.
MERRELL-NATIONAL LABORATORIES i-siosisoio)

Merrell ) Division of Richardson-Merrell Inc.

nnati, Ohio 45215 Trademark: Quinamm

Specific therapy for night leg cramps.

HIS SPACE CONTRIBUTED BY TH E PUBLISHES AS A PUBLIC SERVICE

With the steady
improvement in the
therapy of cancer, and
consequent increase in
the number of 5-year
survivals, our programs
reflect increasing
concern with the future
of the cancer patient—
with the quality of his
survival.

High priority is
being given to the
rehabilitation of cancer
patients— those having
had mastectomies,
colostomies, laryngec-
tomies, amputations,
and other drastic
treatments for cancer.

Our “Reach to
Recovery” program is
a dramatic example.
This program helps the
physician meet many
special needs of the
postmastectomy
patient on the road to
total recovery. Patients
receive psychological
reassurance and
practical help from
women who have had
the same surgery.

The laryngectomee
also receives the benefit
of our rehabilitation
program. Supported

by the Society, the
International Associa-
tion of Laryngectomees,
through its local IAL
clubs, provides such
services as individual
and group speech
therapy, psychological
counseling, visits to new
patients, safety training,
public education and
social activities.

Our rehabilitation
programs not only give
heart and help to
patients but provide the
physician with vital aids
necessary to improve
the quality of survival.

American Cancer Society^

When irritable colon feels like this

. . .in the presence of spasm or hypermotility,
gas distension and discomfort, KINESED
provides more complete relief :

O belladonna alkaloids— for the hyperactive bowel
□ simethicone— for accompanying distension and pain due to gas
D phenobarbital— for associated anxiety and tension

Composition: Each chewable, fruit-flavored, scored tab-
let contains: 16 mg. phenobarbital (warning: may be
habit-forming); 0.1 mg. hyoscyamine sulfate; 0.02 mg.
atropine sulfate; 0.007 mg. scopolamine hydrobromide;
40 mg. simethicone.

Contraindications: Hypersensitivity to barbiturates or
belladonna alkaloids, glaucoma, advanced renal or he-
patic disease.

Precautions: Administer with caution to patients with
incipient glaucoma, bladder neck obstruction or uri-

nary bladder atony. Prolonged use of barbiturates may
be habit-forming.

Side effects: Blurred vision, dry mouth, dysuria, and
other atropine-like side effects may occur at high doses,
but are only rarely noted at recommended dosages.
Dosage: Adults: One or two tablets three or four times
daily. Dosage can be adjusted depending on diagnosis
and severity of symptoms. Children 2 to 12 years: One
half or one tablet three or four times daily. Tablets may
be chewed or swallowed with liquids.

STUART PHARMACEUTICALS I Pasadena, California 91109 | Division of ATLAS CHEMICAL INDUSTRIES, INC.

(from the Greek kinetikos,
to move,

and the Latin sedatus,
to calm)

KINESED*

antispasmodic/sedative/antiflatulent

Spring peeper (tree frog, Hyla crucifer):
this small amphibian can expand
its throat membrane with air until it is
twice the size of its head.

MICHIGAN MEDICINE JANUARY 1972 47

Here is definitive summary

of current status of Michigan Medicaid program

The Medicare and Medicaid programs were
passed by Congress as joint additions to the So-
cial Security Act in 1965. By adding two new titles
to this basic legislation, Title 18 (Medicare) and
Title 19 (Medicaid), the Congress authorized a
mechanism to finance certain health services for
the elderly through the Social Security Administra-
tion on the one hand, and provided Federal match-
ing money to states which wished to provide health
care to its “categorically needy” or “medically in-
digent” on the other. Michigan’s decision to par-
ticipate in the Medicaid program was expressed in
Public Act 321 of 1966.

Implementation of the Michigan program began
on Oct. 1, 1966. Since funds were not available to
cover the estimated cost of full services for the
full year, the Legislature provided that services
should be initiated on a phased-in basis as follows:

Oct. 1, 1966

1. Inpatient and outpatient hospital services.

2. Nursing home services and care in approved
county medical care facilities.

3. Physician’s services in the hospital.

4. Home nursing services.

This article is for Michigan physicians who
would like to know more about the Michigan
Medical Assistance Program (Medicaid) and:

(1) The basis for the state’s decision to as-
sume fiscal agent duties for Medicaid and the
implications of this decision for physicians;

(2) problems associated with the “eligibility
process”;

(3) the lack of formalized publicized Medicaid
policies and procedures;

(4) peer review and the Michigan State Med-
ical Society, and

(5) the present methodology used to deter-
mine physician reimbursement.

The information comes from the text of a talk
made at the recent joint meeting of the MSMS
committees on governmental medical care pro-
grams and legal affairs. The speaker was Stuart
Paterson, deputy director, Medical and Manage-
ment Information Systems, Michigan Department of
Social Services whose insight and observations so
impressed the committee members that they
wished to have all MSMS members share in the in-
formation.

Jan. 1, 1967

1. Physician’s services in his office, client’s
home, or elsewhere.

2. Prescribed drugs.

April 1, 1967

1. Dental services.

2. Eyeglasses and other prosthetic devices.

3. Ambulance and other services.

By Jan. 1, however, it was already clear that fis-
cal requirements had been seriously underesti-
mated and Governor Romney therefore ordered that
the provision of physician office services and pre-
scribed drugs be suspended for the “medically
needy” and that dental and eyeglasses services be
suspended for all recipients. As we all know, the
basic structure of benefits provided under Medicaid
has remained constant since that time.

It is worth noting that Michigan was not alone in
its plight. Many other states were caught in a cost
bind as well, and the Federal Government relying
on an estimate of $800 million in Federal funds
was probably the most surprised of all when the
first eight states to initiate Medicaid submitted
combined cost estimates equal to that amount. To
be sure, some suspected something to this effect
when the legislation was passed, but it appears
that no one fully appreciated the monetary implica-
tion of Title 19.

I trust the obvious attention to Medicaid’s fiscal
impact does not suggest that I do not appreciate
its other effects as well — on the provider, the recip-
ient and the health facility. But I do think the most
graphic illustration of what we have been faced
with lies in a brief look at dollars expended. In its
initial year, the Medicaid budget for Michigan was
$81.3 million. By Fiscal 1969 it had grown to $188.7
million; last year $270.0 million was spent; and our
71-72 budget bill now stands at $326.0 million. This
represents an increase of 400% in five years.

Seldom, if ever, has so large an undertaking been
implemented in so short a time.

By the fall of 1968, the implications of this fact
were clear to the Department of Social Services,
the Executive Office and the Legislature. Some
overt action was required to recapture control of
Medicaid. Two critical problems, largely attributable
to the fact that early implementation has precluded
a thorough pre-planning, were crippling our ability
to deal effectively with the program.

The first was a lack of information. For example,
the average number and cost of prescriptions ob-
tained by recipients per month would have per-
mitted a better estimate of funds necessary to sup-
port the provision of drugs. As it is, the Department

48 MICHIGAN MEDICINE JANUARY 1972

has found it necessary to request supplemental ap-
propriations for this purpose.

The second general problem was a lack of man-
agement control. An example of this is that no
mechanism exists to ensure that the recipient in-
formation supplied Blue Cross and Blue Shield by
the State is completely accurate or that they prop-
erly update their eligibility files.

Consequently, the Department requested, the
Governor recommended and the Legislature appro-
priated funds for a Title XIX Systems Development
Project in the Social Services 1969-70 budget. The
project was to “develop a system for the adminis-
tration of the Medicaid program, to create effective
utilization and fiscal controls and supporting sys-
tems including claims processing, financial audit,
medical surveillance, information reports, program
planning and evaluation and the selection of a fis-
cal agent or agents.”

Shortly after passage of the bill, a request for
proposals to aid the Department in defining the re-
quirements of Medicaid was sent to major consult-
ing firms. A contract was signed with Touche Ross
& Co. in November, 1969. The result of this effort
was the “Michigan Medicaid Systems Design Re-
quirements” published in April, 1970. It represents
the basis for what we now call the “new system.”

In June another request for proposal was issued
for aid in the implementation of the requirements.
Touche Ross & Co. was again the successful bid-

The speaker, Stuart Paterson, center, is intro-
duced by Kenneth H. Johnson, MD, left, chair-
man of the MSMS Legal Affairs Committee. At
right is Robert E. Rice, MD, Greenville, chairman
of the MSMS Committee on Governmental Med-
ical Care Programs. The two committees met
jointly to hear Mr. Paterson.

der and in August a contract was signed with them
for assistance in implementing four of the eight
Medicaid subsystems: recipient eligibility; provider
enrollment; invoice processing; and performance,
surveillance and utilization review. The remaining
four: government reporting; cost settlement and
auditing; Medicare premium processing; and in-

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“At no time was the ability or integrity of either
individuals of Blue Cross and Blue Shield or the
organizations as a whole, questioned in any way ”
(in the decision for state take-over of Medicaid).

STATUS OF MEDICAID/ Continued

quiry and advisory services would be carried out
by the State.

Two other items of major importance were like-
wise to be our sole responsibility — organization

planning and fiscal agent selection.

★ * *

This then brings us to the first item of attention,
the selection of a fiscal intermediary for the new
system. The design requirements spelled out, in
detail, those functions to be carried out by a fiscal
agent. In order to ensure that these duties would
be performed for the least cost consistent with a
high standard of performance, it was decided to
permit all interested parties to bid on the work. A
letter requesting an indication of interest and qual-
ifications was sent to eighteen outside organiza-
tions on October 1, 1970. Positive indication was
received from seven. On December 15, 1970, a re-
quest for proposal was issued and on February 1,
1971, responses were received from four: Blue
Cross, Blue Shield, Nationwide and Prudential. The
state had also determined the cost and feasibility
of becoming its own fiscal agent during this time.

A fiscal agent review committee composed of
two Senators, two Representatives and two mem-
bers of the Executive Office was established to re-
view all proposals. In May, after extensive analysis,
it was decided that further discussion and negotia-
tion should be carried out with Blue Cross and
Blue Shield. This occurred during June and July.
By early August revised proposals had been sub-
mitted and examined.

A meeting of the review committee was then
convened at which time it was determined that the
fiscal agent functions of the new Medicaid system
should be administered by the state itself.

It is my observation that the bases for this deci-
sion were two. First, the proposals of the Blues
represented an annual cost of some $1.0 million
over that of the state. Second, the decision was
consistent with sound management principles: The
integration of similar responsibilities into one or-
ganization thus reducing communications problems;
The elimination of duplication of effort.

I think it important to emphasize that at no time
was the ability or integrity of either individuals of
Blue Cross and Blue Shield, or the organizations
as a whole, questioned in any way.

Let me take just a minute to outline the major
components of the cost differential. Quite under-
standably there has been some questioning of gov-
ernment’s ability to do anything for less money
than those outside.

I’m sure you know that the Department must
create and maintain a computer file of eligible re-
cipients. In order for anyone else to process
claims, they must have a copy of this file and an-
nual cost of this duplication approaches $150,000.
Other areas of major cost differentials were in pro-
vider enrollment and invoice processing. The rea-
sons for differences here are not so clear, but they
amount to some $550,000 annually.

Turning to the specifics of the transfer, we ex-
pect to begin on April 1, 1972, and complete the
process by the following April. The exact schedule
is now a matter of discussion, but will be an-
nounced as soon as possible. Generally, we will
make the transition on a provider type by provider
type basis.

Let me now turn to four features which we are
confident will be welcomed by providers:

1. Any claims which are not subject to special
review, such as individual consideration, will
be processed and paid within 30 days;

2. A remittance advice will accompany each
payment. It will detail all claims received and
note their status. Where payment is other
than billed, an explanation will be provided;

3. Providers will be able to place their own
identification or file numbers on the invoice
and receive them back on payments to ease
bookkeeping; and,

4. A mechanism for positive determination of
eligibility will be available.

* * *

We have just identified the second major item
of concern — recipient eligibility.

As most of you are painfully aware, this repre-
sents the greatest single obstacle to the efficient
operation of Medicaid. Why? Most simply put, be-
cause eligibility informatidn is not always accurate
nor is it always timely. Without boring you with de-
tails, suffice it to say that it takes from 9-13 weeks

50 MICHIGAN MEDICINE JANUARY 1972

to move information from the county to the state
to the Blues. Hence the inordinate non-eligible re-
jection rate.

The solution of this problem is underway and
represents one of the most massive management
efforts ever undertaken by the Department of So-
cial Services. When fully implemented the Client
Information System will:

1. Ensure that eligibility files are accurate and
timely.

2. Issue M.A. identification cards only after the
file to be used in invoice processing is prop-
erly updated.

3. Provide state-wide information to all author-
ized inquirers.

4. Maintain positive control over all data con-
tained within the system.

5. Control the processing of applications for
assistance and services.

6. Provide reports which will assist the Depart-
ment in case load management at the county
office.

This will all be accomplished through the use of
an “on-line” telecommunications network. In lay-
man’s language this means that changes will be
made directly into the computer rather than by
mailing paper to the state office where it is man-
ually put into batches, keypunched, verified and
then entered into the computer. This latter process
now accounts for a good portion of the 9-13
weeks mentioned earlier.

Because of the scope and complexity of the
Client Information System, it is being implemented
in phases. Complete state-wide operation is sched-
uled for the first quarter of 1973. At this time, we
do have the capability to inquire against the files —
which are still updated by paper. In early 1972 the
first county will begin “on-line” update. Others will
follow as rapidly as possible and following “on-
line” update, “on-line” registration will occur.

The important thing to you, however, is that as
more and more counties go “on-line” the state’s
files will become more timely and more accurate.
When fully operational, virtually instantaneous file
changes will occur whenever counties determine
an action is indicated.

M.A. identification cards will be issued the eve-
ning of the day in which the file is changed and
since this file will also serve as recipient eligibility
verification for invoice processing, accuracy is as-
sured in that function as well.

At some time in the future, we fully intend to
make this telecommunications network available to
providers. I assure you that we will keep the So-
ciety advised of our progress in this area.

Next, I would like to touch on what we are doing
to close what we recognize to be our communica-
tions gap. It certainly is no secret that a clearly
written, easily used provider manual for the Mich-
igan Medicaid Program does not exist today. One
of the primary responsibilities of a newly created
Provider and Recipient Services unit will be the

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development and maintenance of such a document.
It will contain information on recipient eligibility,
provider enrollment, how to prepare invoices, etc.,
and will be geared to the specific needs and con-
cerns of the various provider types. Obviously,
these must be available prior to the transfer of
fiscal agent duties to the state. Since this transfer
will occur on a provider by provider basis, how-
ever, a proper sequencing will permit us to meet
this obligation.

We also are planning “billing seminars” which
will be held around the state to ensure that the
people who prepare claims for you fully understand
what is expected of them.

gates. We have also recently obtained a copy of
the Society’s research bulletin which reports
“Trends in Overhead Costs of Medical Practice.”
It suggests that costs as a percent of revenues do
not vary significantly across the state.

We anticipate arriving at a decision on physician
reimbursement methodology prior to the implemen-
tation of the new invoice processing system for
physicians. Since this will occur no earlier than
next fall, sufficient lead time still exists to permit a
thorough review of alternatives. Dr. Leland Hall,
Deputy Director for Research and Program Anal-
ysis, whom I think is familiar to some of you, will
provide needed expertise in this analysis.

In short, we recognize that we must give this
area explicit attention and are taking steps to do
so.

* ★ *

The next subject is no less complex than at least
two already discussed.

When Representative Raymond Kehres mailed a
questionnaire to Michigan’s physicians last May
some 39% of those responding indicated that they
didn’t understand the current method of reimburse-
ment for services rendered under Medicaid. I can’t
say I blame them. Most briefly put, Medicaid, like
Blue Shield itself, pays the lesser of: 1. the charge;
2. the physician’s usual and customary fee for that
procedure; or 3. the prevailing rate for that pro-
cedure in his area. That is the mechanism. I am
quick to recognize one other factor of major im-
portance.

Pursuant to H.E.W. Policy Regulation 40-4, effec-
tive July 1, 1969, reimbursement for physicians is
frozen at amounts paid as of January 1, 1969.
While Medicare has since relaxed this somewhat,
the Medicaid program has not. We are cognizant
of the inequities inherent in this policy — the rela-
tive freedom of the brand new physician to set his
usual and customary rate as he enters practice,
while those in practice in 1969 are held to their
then usual and customary amounts. Our concerns
have been made known to Washington, but to date
we have no indication that this regulation is to be
modified or removed.

In this regard it is important to note another por-
tion of 40-4 which can be summarized as follows:

Any change in reimbursement methodology can-
not be made in a way which circumvents the es-
sence of the 1969 freeze.

All this is by way of saying that if it is deter-
mined to use a relative value schedule in Medicaid,
the conversion amount would have have to be in
conformity with current regulation. I might add
here, that at the request of the Michigan State
Medical Society we will use the Current Procedural
Terminology designations and have provided capa-
bility to carry the appended relative value into the
payment system. Whether or not a relative value
schedule is to be adopted is a matter under cur-
rent examination and notes the passage of Resolu-
tion 6 at your last meeting of the House of Dele-

52 MICHIGAN MEDICINE JANUARY 1972

The fifth and final topic is that of peer review.

Ever increasing public attention is being focused
on the “high cost of health care” and one of the
mechanisms held forth as a means to lessen the
increase is peer review. You are all familiar with
utilization review committees, for example. In re-
cent years, some state medical societies have cre-
ated medical foundations to provide a means for
peer review in its broadest sense. I understand that
a similar move is contemplated here. We welcome
such a development.

Until such time as this occurs, however, we are
working directly with the Society in the develop-
ment of a peer review process for Medicaid. A
committee of four physicians has been appointed
by The Council to work with the Department of
Public Health with which we have a contract to
carry out this function. We are most pleased and
encouraged by its progress.

Let me emphasize our firm belief that only
through the help and cooperation of physicians
can any measure of real improvement be achieved
in the delivery of health services to Michigan’s
citizens.

As I have indicated, we are making a major ef-
fort to improve the administration and operation of
Medicaid. Until this is accomplished, primary atten-
tion is necessarily given to the many day-to-day
crises brought on by the inability of a quickly de-
veloped system to deal with a massive program.

We have high hopes that this stage of develop-
ment will soon be behind us and that we can to-
gether move on to address ourselves to the more
significant problems in health care.

“We are making a
major effort to im-
prove the administra-
tion and operation of
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thyroid compound. West Med 5:67, 1964 3. Titeff, A. S. Methyltestosterone-thyroid in treating impotence
Gen Prac 25:6, 1962 4. Heilman, L., Bradlow, H. L., Zumoff. B., Fukushima, D. K.,and Gallagher, T F
Thyroid-androgen interrelations and the hypocholesteremic effect of androsterone J Clin Endocr 19:936
1959. 5. Farris, E. J., and Colton, S. W. Effects of L-thyroxine and liothyronine on spermatogenesis
J Urol 79:863, 1958. 6. Osol, A., and Farrar. G. E. United States Dispensatory (ed, 25). Lippincott, Phi
delphia. 1955, p. 1432. 7. Wershub, L. P. Sexual Impotence in the Male. Thomas, Springfield
III., 1959, pp. 79-99.

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MICHIGAN MEDICINE JANUARY 1972 53

New Feature: County Spotlight

Kent County
leads the nation
in emergency care

By Jeanne Smith
Assistant

MSMS Communications

Early this year, one of the potentially most effec-
tive emergency medical care programs in the coun-
try will be operative in the Grand Rapids area as
the latest achievement of the Kent County Medical
Society’s emergency services committee.

The dedicated physicians who have worked in
this program since it began seven years ago with
first aid classes for policemen and firemen talk
about the program in terms of the accident victims
it has aided, the acutely ill individuals it has
helped.

But the public relations value of the program,
which recently caused the Grand Rapids Press to
comment editorially, “There are few communities
that can boast anything similar to it,” cannot be
overlooked.

The latest achievement in the Kent County pro-
gram involves installation of a separate radio sys-
tem linking police emergency vehicles and private

(See related editorial, page 76)

ambulances to emergency rooms of Grand Rapids
hospitals and special training of police and ambu-
lance attendants in electrocardiography, the same
training given nurses working in intensive care
units in hospitals.

With equipment already installed in emergency
vehicles and ambulances, emergency personnel will
be able to relay electrocardiograms to be printed
out in emergency rooms.

The specially trained police and ambulance at-
tendants will be permitted to proceed with defibril-
lation and other emergency treatment for patients
under direct instructions from physicians given by
radio from emergency rooms.

Financing of the $40,000 program has been ar-
ranged by the Kent County Medical Society under
a grant from the federal government, with the aid
of matching local funds obtained by the society.

It is the first such program in Michigan and is
believed to be one of only two now being under-
taken in the United States.

The new aid for heart patients becomes the
latest step in the program that began under im-
petus from C. Mark Vasu, MD, chairman of the

(Photo courtesy of Grand Rapids Press)

C. Mark Vasu, MD, chairman of the Kent County
Medical Society emergency services committee,
explains use of defibrillator to Grand Rapids
policement.

Kent County emergency services committee. Start-
ing with first aid courses, the next step was the
establishment of the “Crash Squad” of volunteer
physicians who devote weekends to duty with po-
lice emergency vehicles, not only providing med-
ical care but also giving in-service training to po-
lice personnel.

Doctor Vasu, along with other key members of
his committee, Lee R. Pool, MD, John R. Wilson,
MD, and Fred A. Doornbos, MD, have police radios
in their cars and frequently respond to off-time
emergency calls as well as taking their regular
turns of duty on the list of 20 MD “Crash Squad”
volunteers.

Specialized training for police assigned to the
emergency vehicles has produced skilled person-
nel devoted to their work. Special arm patches
have been provided for them by the county med-
ical society.

“We have seen this develop as an important
community relations program for police,” said Doc-
tor Pool. “The E Units have become well known
and, particularly in the inner city, help alleviate
fear of police.”

As of January 1, only police who have com-
pleted specialized training are assigned to emer-
gency units, eliminating the one-time system of ro-
tating emergency vehicle service for police as for
other types of duty.

Grand Rapids firemen regularly complete courses
in cardiopulmonary resuscitation in a KCMS-Mich-
igan Heart Association program.

According to Doctor Vasu, Grand Rapids’ ambu-
lance ordinance, adopted in 1968 with the urging

54 MICHIGAN MEDICINE JANUARY 1972

f the county medical society, has been vital in im-
lementing the work of the emergency services
ommittee.

He called the Grand Rapids code “the strongest
mbulance ordinance of its type in the United
tates,” adding, “It is strong because it requires
/vo men in an ambulance instead of one man as is
pecified in the state ordinance and it provides ad-
itional training which can be matched no where
Ise.”

Each of the physicians involved in the Kent
ounty program has his own special reasons for
is interest, but Doctor Vasu summarized the gen-
ral motivation for participation:

“The Grand Rapids and Kent County area has
ttracted attention nationwide to some of the more
nique aspects of our program. When we carefully
nalyze these aspects, we find that it boils down
) one simple fact, that the physician has willingly
nd graciously allowed himself to be involved in
ommunity affairs.”

■lints for county societies
onsidering this idea:

contributed to the success of the seven-year-
old emergency care program in Grand Rapids.

In addition to providing an important com-
munity service, the program has had strong
public relations value for physicians as well
as for police in Grand Rapids.

According to the committee, the medical
community must take the lead in establishing
such a program. Here are some of the in-
gredients:

1. A group of physicians who are moti-
vated to see improvements in the emergency
care given accident victims.

2. Rapport and cooperation with police and
fire departments.

3. A strong ambulance ordinance, as writ-
ten into law in Grand Rapids, insuring that
the patient is getting attention from qualified
personnel. Kent County physicians note that
pressure from the medical profession is im-
portant in achieving effective ordinances cov-
ering operation of ambulances.

4. A group such as the KCMS emergency
services committee to explore and propose
programs.

Intense interest and activity by members of
the Kent County Medical Society’s emergency
services committee, along with the backing
and cooperation of the entire society, have

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VASODlLAN

the compatible vasodilator

• may be used in your patients with
coronary insufficiency.

• conflicts have not been reported with
diuretics, corticosteroids, antihypertensives
or miotics.

• complications in the treatment of diabetes
hypertension, peptic ulcer, glaucoma or
liver disease have not been reported.

In fact, there are no known contraindica-
tions in recommended oral doses other
than it should not be given in the presence
of frank arterial bleeding or immediately
postpartum.

Although not all clinicians agree on the value of vasodilators in vascular disease, several
investigators'''1 have reported favorably on the effects of isoxsuprine. Effects have been dem-
onstrated both by objective measurement and observation of clinical improvement. 1,3
Indications: Cerebrovascular insufficiency, arteriosclerosis obliterans, diabetic vascular
diseases, thromboangiitis obliterans (Buerger’s disease), Raynaud’s disease, postphlebitic
conditions, acroparesthesia, frostbite syndrome and ulcers of the extremities (arterio-
sclerotic, diabetic, thrombotic). Composition: VasodTlan tablets, isoxsuprine HC1 10 mg.
and 20 mg. Dosage: Oral — 10 to 20 mg. t.i.d. or q.i.d. Contraindications and Cautions:
There are no known contraindications to recommended oral dosage. Do not give imme-
diately postpartum or in the presence of arterial bleeding. Side Effects: Occasional pal-
pitation and dizziness can usually be controlled by dosage reduction. Complete details
available in product brochure from Mead Johnson Laboratories. References : (1) Clarkson,
I. S., and LePere, D. M. : Angiology 77:190-192 (June) 1960. (2) Horton, G. E., and
Johnson, P. C., Jr. : Angiology 75:70-74 (Feb.) 1964. (3) Dhry-
miotis, A. D., and Whittier, J. R. : Curr. Ther. Res: 7:124-128
(April) 1962. (4) Whittier, J. R. : Angiology 75 :82-87 (Feb.) 1964.

© 1971 MEAD JOHNSON a COMPANY • EVANSVILLE, INDIANA 47721 U.S.A.

182971

LABOR ATO RIBS

£Micliigaii medisceqe

Jan. 5 — Council of Medical Specialty Societies, 2
p.m., MSMS Headquarters, contact: Glenn E.
Moore, MD, 323 W. Second St., Flint, 48503
Jan. 7-9 — Michigan Allergy Society Family Winter
Weekend, Shanty Creek Lodge, contact: Rudolph
E. Wilhelm, MD, Michigan Allergy Society, 751 S.
Military Rd., Dearborn, 48124
Jan. 19 — Conference on Changing Patterns of Care
for Children and Youth, Michigan Nurses Asso-
ciation, 9:30 a.m., MNA Headquarters, contact:
Mrs. Susan Gerds, conference secretary, MNA,
120 Spartan Ave., East Lansing, 48823
Jan. 21 — Michigan Association for Regional Med-
ical Programs, board meeting, 2 p.m., MSMS
Headquarters, contact: Miss Gaetane LaRocque,
acting coordinator, MARMP, 1111 Michigan, East
Lansing, 48823

Jan. 24-28 — Family Practice Review with the Mich-
igan Academy of Family Physicians, Towsley
Center, University Medical Center, Ann Arbor,
contact: Neal A. Vanselow, MD, acting chairman,
Department of Postgraduate Medicine, Towsley
Center, Ann Arbor, 48104

Jan. 25 — Woman’s Auxiliary to MSMS, executive
committee meeting, MSMS Headquarters, con-
tact: Mrs. Charles Schoff, 5209 Sunset Drive, Mid-
land, 48640

Jan. 29-30 — Educational seminar and board meet-
ing, Michigan State Medical Assistants Society,
Holiday Inn, Battle Creek, contact: Patricia Voke,
196 S. Woodrow Ave., Battle Creek 49015
Feb. 9— Michigan Committee on Trauma, American
College of Surgeons, 6:30 p.m., MSMS Head-
quarters, contact: Thomas C. Blair, MD, 1322 E.
Michigan Ave., Lansing, 48912
March 20-21 — Spring Session, MSMS House of
Delegates, Detroit Hilton Hotel, contact: Richard
Campau, MSMS Headquarters
March 26 — Board meeting, Michigan State Medical
Assistants Society, 11 a.m., MSMS Headquarters,
contact: Mrs. Betty L. Boers, president, MSMAS,
1116 Sheridan, Kalamazoo, 49001
March 29 — Muskegon Trauma Day, Holiday Inn,
Muskegon, contact: Guida Anessa, MD, 205 Med-
ical Center, Muskegon

March 29-30 — Annual Michigan Conference on Ma-
ternal and Perinatal Health, Olds Plaza Hotel,
Lansing, contact: Joseph L. Sheets, MD, 2909 E.
Grand River, Lansing, or Helen Schulte, MSMS
Headquarters

April 3 — Annual Beaumont Lecture — Wayne County
Medical Society, Detroit, contact: William Blod-
gett, MD, Wayne County Medical Society, 1010
Antietam, Detroit, 48207

April 13-15 — Michigan Heart Association Heart
Days, Cobo Hall, Detroit, contact: Harold Arnow,
publicity director, MHA, 13100 Puritan, Detroit,
48227

April 19 — Woman’s Auxiliary to MSMS, Legislative
Day, Olds Plaza, Lansing, contact: Mrs. R. J.
Westerhoff, WAMSMS legislative chairman, 2458
Maplewood, SE, Grand Rapids, 49506
April 19-20 — Woman's Auxiliary to MSMS, spring
conference, Hospitality Inn, Lansing, contact:
Mrs. Charles Schoff, 5209 Sunset Drive, Midland,
48640

April 27-30 — Annual Convention, Michigan State
Medical Assistants Society, Holiday Inn, Cross-
town Parkway, Kalamazoo, contact: Mrs. Betty
Boers, 1116 Sheridan, Kalamazoo, 49001
April 30-May 5 — American Nurses Association Bi-
ennial Convention, Cobo Hall, Detroit, contact:
Miss Virginia Stone, executive director, Detroit
District, Michigan Nurses Association, 316 Fisher
Building, Detroit, 48202

May 18-19 — Annual Gull Lake meeting, MSMS Com-
mittee on Maternal and Perinatal Health, Kellogg
Biological Station, Gull Lake, contact: Helen
Schulte, MSMS Headquarters
May 22-23 — Michigan chapter meeting and scien-
tific session of the American College of Emer-
gency Physicians, Shanty Creek, Bellaire, con-
tact: Gaius Clark, MD, 865 Pebblebrook Lane,
East Lansing, 48823

June 2-3 — Gaylord Trauma Day, Hidden Valley Ot-
sego Ski Club, Gaylord, contact: Benjamin Henig,
MD, Keyport Clinic, 308 Michigan Ave., Grayling,
49738

June 5-7 — Initial Management of the Acutely III and
Injured Patient, Ann Arbor, contact: Charles F.
Frey, MD, Department of Surgery, University of
Michigan Medical Center, Ann Arbor, 48104

MSMS bureau
has new member file

The MSMS Bureau of Economic Information has
developed, with the help of the AMA, a new com-
puter system that will have vital information on
each member physician. The system will be up-
dated on a yearly basis, through the use of the
AMA’s master files, and will facilitate specific mail-
ings.

Some of the information maintained on each
member will be his year and place of graduation,
his specialty and his board achievements. Qualified
associations may obtain such information from the
Bureau.

For further information, contact John H. Anthony,
chief of the bureau, at MSMS headquarters.

What better forum for your ideas is there
than Michigan Medicine, which monthly
reaches over 8,000 physicians? Instead of let-
ting your flashes of insight, gripes and full-
blown theories end with the hospital staff
meeting or colleagues gathered over coffee,
develop them, put them on paper and mail
them to Michigan Medicine.

Maybe you can move mountains.

58 MICHIGAN MEDICINE JANUARY 1972

For my patients who need a laxative, I recommend
EVAC-U-GEN . . . because it relieves constipation
gently . . . particularly important in cardiac and
post surgical patients

FVA(M I-CFM very^pa£a table

JLj V £ ^ economical

A highly-flavored and palatable tablet of yellow phenolphthalein, bismuth subcarbonate, bismuth subgallate
in special base. Chewable. Bottles of 35 and 100. Adult Dose: Chew 1 or 2 tablets night or morning. Children
(up to age 10): 1/2 tablet. A citrus drink taken with tablet will stimulate action.

PRECAUTION: Do not use when symptoms of appendicitis are present and discontinue use if skin rash
appears. Dependence on laxatives can result from continued use.

WALKER, CORP & CO., INC. Syracuse, New York 13201

MICHIGAN MEDICINE JANUARY 1972 59

^Itl memoriam

J. Kenner Bell, MD
Highland Park

Detroit-area gastroenterologist for 40 years, J.
Kenner Bell, MD, died Nov. 25 at the age of 73.

Doctor Bell was former doctor for the Highland
Park Police Department, and medical director of
the Shrine Circus and the Moslem Shrine in De-
troit.

Doctor Bell was graduated from the University
of Toronto School of Medicine and was affiliated
with Hutzel and Receiving hospitals of Detroit and
Highland Park General Hospital, where he was a
past chief of staff. He had been a member of the
council of the Detroit Gastroenterological Society.

A. W. Byrnes, MD
Battle Creek

A. W. Byrnes, MD, former director of the Battle
Creek VA Hospital from 1963 to 1967, died Nov. 3
at the age of 61.

Doctor Byrnes, a native of Traer, Iowa, had also
served as chief of the neuropsychiatric service at

VA facilities in Dayton, Ohio; as chief of physical
medicine and rehabilitation service at the Downey,
III., and Danville, III., VA hospitals; as chief of staff
at the St. Cloud, Minn., VA hospital and as director
of the Knoxville, Iowa, VA hospital.

Doctor Byrnes also had held medical positions
with the Army and was a retired lieutenant colonel.
He was a graduate of the Iowa University School
of Medicine.

Willard Chipman, MD
Detroit

Willard Chipman, MD, former chief of staff at Mt.
Carmel Mercy Hospital, died Nov. 30 at the age of
74.

Doctor Chipman was a graduate of Harvard Med-
ical School and had practiced medicine for 50
years. He was a member of the American College
of Surgeons, the International College of Surgeons
and the Society of Abdominal Surgeons.

William T. Krebs, MD
Grosse Pointe Farms

William Thomas Krebs, MD, a Detroit-area gen-
eralist, died Dec. 2 at the age of 63. He had served
as medical director for the Hudson Motor Par Co.
from 1937-1946.

Doctor Krebs was graduated from University of
Michigan Medical School and was affiliated with

ypecia

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GRAND RAPIDS OFFICE: G. J. Haworth, Representative
422 Federal Square Building, Grand Rapids 49502 Telephone: 616-454-4477

60 MICHIGAN MEDICINE JANUARY 1972

Cottage and Evangelical Deaconess hospitals in
Detroit. He was a charter member of the Michigan
Industrial Hygienic Society and also was a mem-
ber of the American Association of Industrial Hy-
gienists.

Herbert K. Kent, MD
Lansing

Retired Lansing physician Herbert K. Kent, MD,
died Nov. 4 at the age of 77.

Doctor Kent was a life member of the Ingham
County Medical Society and had been on the
senior staffs at Sparrow and Ingham Medical hos-
pitals in Lansing.

An enterologist, Doctor Kent was a graduate of
Loyola University.

John J. Long, Sr., MD
Southfield

John Joseph Long, MD, Southfield generalist,
died Nov. 8 at the age of 66.

Doctor Long was a staff member of Mt. Carmel
Mercy Hospital, and had been a member of the
Wayne County Medical Society Council. He was
graduated from Detroit College of Medicine and
was a member of the American Academy of Fam-
ily Physicians.

Daniel Landron, MD
Jackson

Daniel Landron, MD, Jackson generalist, died
Nov. 26 at the age of 63. He was affiliated with
W. A. Foote and Mercy hospitals in Jackson. Doc-
tor Landron was a native of Puerto Rico. He was
graduated from Temple University School of Med-
icine.

Doctor Landron was vice president of the Jack-
son County Doctor’s Emergency Service which he
helped found. He was a member of the American
Academy of Family Physicians.

Harold C. Mitchell, MD
Grand Rapids

Harold C. Mitchell, MD, retired Grand Rapids
physician, died Nov. 6 at the age of 70.

Doctor Mitchell had served as chief medical of-
ficer at the Michigan Veterans Facility in Grand
Rapids, as chief medical officer at,Coldwater Train-
ing School for Children and chief officer at Ionia
Reformatory. He also had been in private practice
in Grand Rapids and Bay City.

Doctor Mitchell was a graduate of the University
of Toronto Medical School and was a past presi-
dent of the Mecosta-Osceola-Lake and Branch
county medical societies.

Group

Professional Management Offices
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ANN ARBOR, BATTLE CREEK, BERKLEY, DETROIT,
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Black and Skaggs Associates
PM Systems, Incorporated

181 North Avenue PM BUILDING Battle Creek, Michigan 49017

MICHIGAN MEDICINE JANUARY 1972 61

IN MEMOR I AM /Continued

Bradley M. Patten, PhD
Ann Arbor

Bradley M. Patten, PhD, professor and chairman
emeritus of the University of Michigan Medical
School’s anatomy department, died Nov. 8 at the
age of 82. Doctor Patten was a member of the
Washtenaw County Medical Society.

An internationally recognized researcher in his
field, Doctor Patten authored textbooks used world-
wide. He is credited with laying the cornerstone of
modern embryological teaching and with being one
of the top scientists in his field for his pioneering
work in time-lapse cinematography for the study of
early developmental changes in heart and blood
vessels.

Doctor Patten was U-M anatomy department
chairman from 1936 to 1958 when he retired.

E. C. Raabe, MD
Morenci

Elmer Charles Raabe, MD, Morenci generalist,
was struck and killed by a truck Nov. 11. He was
75.

Doctor Raabe had practiced medicine in Morenci
since 1925 and was affiliated with Morenci Area
Hospital, where he was chief of staff this year, and
Bixby Hospital in Adrian. He was a graduate of
Ohio State University School of Medicine.

Doctor Raabe was a past president of the Len-
awee County Medical Society.

David Standiford, MD
Bay City

David Standiford, Bay City obstetrician-gynecolo-
gist, died Oct. 27 after a long illness. He was 47.

Doctor Standiford was a graduate of the Univer-
sity of Michigan Medical School and was affiliated
with Mercy and General hospitals in Bay .City. He
was certified with the American Board of Obstetrics
and Gynecology and was a member of the Interna-
tional Society for the Advancement of Humanistic
Studies in Gynecology.

Max 0. Wolfe, MD
Detroit

Retired Detroit Psychoanalyst Max O. Wolfe, MD,
died Nov. 25 at the age of 74.

Doctor Wolfe was a graduate of Marquette Uni-
versity School of Medicine and had practiced in
Detroit until retiring seven months ago. He was a
former director of the Haven Sanitarium in Roch-
ester, past Michigan president of the Cornelian
Corner and past treasurer of the Detroit Psycho-
analytic Society.

PFIZERPEN VK

(POTASSIUM PHENOXYMETHYL PENICILLIN)

ACTIONS: Microbiology: Phenoxymethyl penicillin

exerts high in vitro activity against staphylococci (ex-
cept penicillinase-producing strains), streptococci
(groups A, C, G, H, L, and M) and pneumococci. Other
organisms sensitive to phenoxymethyl penicillin are
Corynebocterium diphtheriae. Bacillus anthracis, Clos-
tridia, Actinomyces bovis, Streptobocillus moniliformis.
Listeria monocytogenes, Leptospira, and Neisseria go n-
orrhoeae Treponema pallidum is extremely sensitive.
Pharmacology: Phenoxymethyl penicillin is more re-
sistant to inactivation by gastric acid than penicillin G.
It may be given with meals and average blood levels
are two to five times higher than the levels following
the same dose of oral penicillin G Once absorbed,
phenoxymethyl penicillin is about 80% bound to serum
protein. Tissue levels are highest in the kidneys, with
lesser amounts in the liver, skin, and intestines and
small amounts in all other body tissues and cerebro-
spinal fluid. Only about 25% of the dose given is
absorbed. In neonates, young infants, and individuals
with impaired kidney function, excretion is considerably
delayed.

INDICATIONS: Phenoxymethyl penicillin is indicated in
the treatment of mild to moderately severe infections
caused by penicillin G-sensitive microorganisms that
are sensitive to the low serum levels common to this

articular dosage form Therapy should be guided by

acteriological studies (including sensitivity tests) and
by clinical response. Culture and sensitivity testing are
especially important in suspected staphylococcal infec-
tions because increased resistance has been reported.
Phenoxymethyl penicillin is not active against penicil-
linase-producing bacteria

Note: Severe pneumonia, empyema, bacteremia, peri-
carditis, meningitis, and arthritis should not be treated
with phenoxymethyl penicillin during the acute stage.

Indicated surgical procedures should be performed.

Medical conditions in which oral penicillin therapy is
indicated as prophylaxis: For the prevention of recur-
rence following rheumatic fever and/or chorea. To pre-
vent bacterial endocarditis in patients with congenital
and/or rheumatic heart lesions who are to undergo
dental procedures or minor upper respiratory tract sur-
gery or instrumentation.

Note Oral penicillin should not be used as adjunctive
prophylaxis for genitourinary instrumentation or sur-
gery, lower intestinal tract surgery, sigmoidoscopy and
childbirth.

CONTRAINDICATION: A previous hypersensitivity reac-
tion to any penicillin.

WARNINGS: Serious and occasionally fatal hypersen-
sitivity (anaphylactoid) reactions have been reported in
patients on penicillin therapy. While more frequent fol-
lowing parenteral therapy, anaphylaxis has occurred in
patients on oral penicillins. These reactions are more apt
to occur in individuals with a history of sensitivity to
multiple allergens.

Some individuals with a history of penicillin hyper-
sensitivity reactions have experienced severe hypersen-
sitivity reactions from a cephalosporin. Before therapy
with a penicillin, careful inquiry should be made con-
cerning previous hypersensitivity reactions to penicillins,
cephalosporins, and other allergens. If an allergic reac-
tion occurs, the drug should be discontinued and the
patient treated with the usual agents, e.g., pressor
amines, antihistamines and corticosteroids.
PRECAUTIONS: Penicillin should be used with caution
in individuals with histories of significant allergies
and/or asthma.

The oral route of administration should not be relied
on in patients with severe illness, or with nausea, vomiting,
gastric dilatation, cardiospasm, or intestinal hypermotility.

Occasional patients will not absorb therapeutic
amounts of orally administered penicillin.

In streptococcal infections, therapy must be sufficient
to eliminate the organism (10 days minimum); other-
wise the sequelae of streptococcal disease may occur.
Cultures should be taken following completion of treat-
ment to determine whether streptococci have been
eradicated.

Prolonged use of antibiotics may promote the over-
growth of nonsusceptible organisms, including fungi.
Should superinfection occur, appropriate measures
should be taken

ADVERSE REACTIONS: While the incidence of reactions
to oral penicillins is much less than with parenteral
therapy, it should be remembered that all degrees of
hypersensitivity, including fatal anaphylaxis, have been
reported with oral penicillin.

The most common reactions to oral penicillin are
nausea, vomiting, epigastric distress, diarrhea, and
black hairy tongue The hypersensitivity reactions re-
ported are skin eruptions (maculopapular to exfoliative
dermatitis), urticaria and other serum sickness reactions,
laryngeal edema, and anaphylaxis. Fever and eosino-
philic may frequently be tne only reaction observed.
Hemolytic anemia, leucopenia, thrombocytopenia, neu-
ropathy, and nephropathy are infrequent reactions and
ore usually associated with high doses of parenteral
penicillin.

HOW SUPPLIED: Pfizerpen VK (potassium phenoxy-
methyl penicillin) for Oral Solution Each 5 ml. of recon-
stituted solution contains potassium phenoxymethyl
penicillin equivalent to 125 mg (200,000 units) or 250
mg. (400,000 units) of phenoxymethyl penicillin.

1 25 mg. bottles of 1 00 ml. and 1 50 ml.

250 mg. bottles of 1 00 ml. and 150 ml.

Pfizerpen VK (potassium phenoxymethyl penicillin)
Tablets. Each tablet contains potassium phenoxymethyl
penicillin equivalent to 250 mg (400,000 units) or 500
mg. (800,000 units) of phenoxymethyl penicillin.

250 mg. bottles of 100.

500 mg. bottles of 100.

More detailed professional information available on
request.

LABORATORIES DIVISION

PFIZER INC . NEW YORK. N Y 10017

62 MICHIGAN MEDICINE JANUARY 1972

8S3wkS8S&^ SHE?:

Now there are two ways to cut the cost of
brand-name penicillin therapy.

Pfizerpen VK now joins Pfizerpen G (potas-
sium penicillin G) for true economy in
brand-name penicillin therapy.

When you write penicillin VK, it's for acid
stability, solubility and rapid absorption.
But when you write Pfizerpen VK, you add
economy. Pfizerpen VK, more economical
than the two leading brand-name peni-
cillin VK products. G or VK. Just make sure
it's Pfizerpen.

Tablets and Powder for Syrup

, PFIZERPEN VK 4

(POTASSIUM PHENOXYMETHYL PENICILLIN)

G OR VK. JUST
MAKE SURE IT’S PFIZERPEN.

Name

Address

City/State/Zip

Who are they? Why are they rejected by the medical
profession? What exactly is the cult of chiropractic?

Learn the answers to these questions and many more
from a startling new book by renowned medical jour-
nalist and public affairs specialist, Ralph Lee Smith.

AT YOUR OWN RISK: The Case Against Chiropractic is
a probing study of chiropractors and their methods of
A treatment. It follows the history of chiropractic from
its conception by an Iowa grocer in 1895 to present
day practices.

Travel with Mr. Smith as both patient and visitor to
many of the nation’s chiropractic schools and clinics.
And learn why he recommends that chiropractic be
the subject of immediate legislative review.

Available from the AMA through special arrangements
with the publisher. Send your order to the AMA, 535
North Dearborn Street, Chicago, Illinois 60610.

I enclose $-
The Case Against Chiropractic.

copy(s) of At Your Own Risk:

All Other
Countries

U.S., U.S. Poss.

Mexico, Canada

□ Paperbound

OP-22, 184 pages $1.00 $1.50

Quantity order prices available on request.

Medical Students,
Hospital Interns,
and Residents*

Payment must accompany order.

’Special subsidized rate available in U.S., U.S. Poss.. Canada
and Mexico only.

INTRODUCING

Alelhol-50

the new USV brand of
phenformin HCI

Meltrol-50 (phenformin HCI)

50 mg. timed-disintegration capsules

also Meltrol-100™

(100 mg. timed-disintegration capsules)
Meltrol-25™(25 mg. tablets)

FROM
THE NEW

USV PHARMACEUTICAL CORP.,Tuckahoe,N.Y. 10707

When you select this familiar antibiotic for
IV infusion you have available a broad dosage range
that hospitalized patients may need.

Intravenous Lincocin (lincomycin
hydrochloride, Upjohn), with its 1.2 to
8 grams/day dosage range, covers many
serious and even life-threatening
infections. Lincocin is effective in
infections due to susceptible strains of
streptococci, pneumococci, and
staphylococci. Lincocin IV therefore
can be as useful in your hospitalized
patients as its IM use has proved to be in
your office patients. As with all
antibiotics, in vitro susceptibility studies
should be performed.

In life-threatening situations as much
as 8 grams/ day has been administered
intravenously to adults.

1.2 to 8 grams/ day IV dosage

Most hospitalized patients with
uncomplicated pneumonias respond
satisfactorily to 1 .2 to 1 .8 grams/ day of
Lincocin IV. These doses may have to
be increased for more serious infections.

In usual IV doses, Lincocin (lincomycin
hydrochloride, Upjohn) should be
diluted in 250 ml or more of normal
saline solution or 5% glucose in water.
But when 4 grams or more per day is
given, Lincocin should be diluted in not
less than 500 ml of either solution,
and the rate of administration should
not exceed 1 00 ml/hour. Too rapid
intravenous administration of doses
ceeding 4 grams may result in
tension or, in rare instances,
cardiopulmonary arrest.

Effective gram-positive antibiotic:

Lincocin IV is effective in respiratory
tract, skin and soft-tissue, and bone

nfections caused by susceptible strains
>f pneumococci, streptococci, and
taphylococci, including penicillin-
esistant strains. Staphylococcal strains
esistant to Lincocin (lincomycin
lydrochloride, Upjohn) have been
ecovered. Before initiating therapy,
ulture and susceptibility studies should
>e performed. Lincocin has proved
aluable in treating patients hyper-
ensitive to penicillin or cephalosporins,
ince Lincocin does not share
ntigenicity with these compounds,
lowever, hypersensitivity reactions
[ave been reported, some of these in
•atients known to be sensitive to
ienicillin.

administered concomitantly with other
antimicrobial agents when indicated.
However, Lincocin should not be used
with erythromycin, as in vitro antagonism
has been reported.

Sterile Solution (300 mg per ml)

(lincomycin hydrochloride, Upjohn)

For further prescribing information, please see following page.

Veil tolerated at infusion site: Lincocin
itra venous infusions have not
iroduced local irritation or phlebitis,
(hen given as recommended. Lincocin
» usually well tolerated in patients who
re hypersensitive to other drugs.
Nevertheless, Lincocin should be used
autiously in patients with asthma or
ignificant allergies.

n patients with impaired renal function
tie recommended dose of Lincocin
hould be reduced to 25—30% of
tie dose for patients with normal
idney function. Its safety in
regnant patients and in infants
iss than one month of age has
ot been established.

jncocin may be used with other
ntimicrobial agents: Since Lincocin
> stable over a wide pH range, it is
uitable for incorporation in
itra venous infusions; it also may be

5 1972 The Upjohn Company

(lincomycin hydrochloride, Upjohn)

Up to 8 grams per day by IV infusion for
hospitalized patients with life-threatening infections.
Lincocin is effective in infections due to
susceptible strains of streptococci, pneumococci,
and staphylococci. As with all antibiotics,
in vitro susceptibility studies should be performed.

Each Lincomycin

preparation hydrochloride

contains: monohydrate

equivalent to
lincomycin base

250 mg Pediatric Capsule 250 mg

500 mg Capsule 500 mg

‘"Sterile Solution per 1 ml 300 mg

Syrup per 5 ml 250 mg

'■'Contains also: Benzyl Alcohol 9 mg; and,
Water for Injection — q.s.

Lincocin (lincomycin hydrochloride) is in-
dicated in infections due to susceptible strains
of staphylococci, pneumococci, and strepto-
cocci. In vitro susceptibility studies should
be performed. Cross resistance has not been
demonstrated with penicillin, ampicillin,
cephalosporins, chloramphenicol or the tet-
racyclines. Some cross resistance with eryth-
romycin has been reported. Studies indicate
that Lincocin does not share antigenicity
with penicillin compounds.

CONTRAINDICATIONS: History of prior
hypersensitivity to lincomycin or clindamy-
cin. Not indicated in the treatment of viral
or minor bacterial infections.

WARNINGS: CASES OF SEVERE AND
PERSISTENT DIARRHEA HAVE BEEN
REPORTED AND HAVE AT TIMES
NECESSIT ! 77 D DISCONTINUANCE
OF THE DR l (E 1 HIS DIARRHEA HAS
BEEN OCCASIONALLY ASSOCIATED
WITH BLOOD AND MUCUS IN THE
STOOLS AND HAS AT TIMES RE-
SULTED IN CUTE COLITIS. THIS
SIDE EFFECT l LY HAS BEEN

ASSOCIATED WITH INF ORAL DOS-
AGE FORM BUT LY HAS

BEEN REPORTED FOLLOWING PA-
RENTERAL THERAPY . A careful inquiry
should be made concerning previous sensi-
tivities to drugs or other allergens. Safety
for use in pregnancy has not been estab-
lished and Lincocin (lincomycin hydrochlo-
ride) is not indicated in the newborn. Reduce
dose 25 to 30% in patients with severe im-
pairment of renal function.

PRECAUTIONS: Like any drug, Lincocin
should be used with caution in patients
having a history of asthma or significant
allergies. Overgrowth of nonsusceptible or-
ganisms, particularly yeasts, may occur and
require appropriate measures. Patients with
pre-existing monilial infections requiring
Lincocin therapy should be given concomi-
tant antimoniHal treatment. During pro-
longed Lincocin therapy, periodic liver
function studies and blood counts should be
performed. Not recommended (inadequate
data) in patients with pre-existing liver dis-
ease unless special clinical circumstances in-
dicate. Continue treatment of /3-hemolytic
streptococci infections for 10 days to
diminish likelihood of rheumatic fever or
glomerulonephritis.

ADVERSE REACTIONS: Gastrointestinal
—Glossitis, stomatitis, nausea, vomiting. Per-
sistent diarrhea, enterocolitis, and pruritus
ani. Hemopoietic— Neutropenia, leukopenia,
agranulocytosis, and thrombocytopenic pur-
pura have been reported. Hypersensitivity
reactions— Hypersensitivity reactions such
as angioneurotic edema, serum sickness, and
anaphylaxis have been reported, sometimes
in patients sensitive to penicillin. If allergic
reaction occurs, discontinue drug. Have
epinephrine, corticosteroids, and antihista-

mines available for emergency treatment
Skin and mucous membranes— Skin rashes:
urticaria, vaginitis, and rare instances of ex
foliative and vesiculobullous dermatitis havi
been reported. Liver— Although no direct re
lationship to liver dysfunction is established
jaundice and abnormal liver function test:
(particularly serum transaminase) have beer
observed in a few instances. Cardiovasculai
—Instances of hypotension following paren
teral administration have been reported
particularly after too rapid IV administra
tion. Rare instances of cardiopulmonary ar
rest have been reported after too rapid IV
administration. If 4.0 grams or more admin
istered IV, dilute in 500 ml of fluid anc
administer no faster than 100 ml per hour
Special senses— Tinnitus and vertigo have
been reported occasionally. Local reaction :
—Excellent local tolerance demonstrated tc
intramuscularly administered Lincocir
(lincomycin hydrochloride). Reports of pair
following injection have been infrequent
Intravenous administration of Lincocin ir
250 to 500 ml of 5% glucose in distillec
water or normal saline has produced nc
local irritation or phlebitis.

HOW SUPPLIED: 250 mg and 500 m, f
Capsules— bottles of 24 and 100. Sterile
Soltetion, 300 mg per ml— 2 and 10 ml vial:
and 2 ml syringe. Syrup, 250 mg per 5 rn
—60 ml and pint bottles.

For additional product information, consult
the package insert or see your Upjohn
representative.

MED B-6-S (K.ZL-7) JA71-1631

The Upjohn Company
Kalamazoo, Michigan 49001

Dpjohn

MATERNAL HEALTH DESK REFERENCE CARD NO. 14

(Sponsored and Prepared by the Committee on Maternal and Perinatal Health,
Michigan State Medical Society)

THE HIGH RISK FETUS

Recent advances in our knowledge of placental circulation and fetal physi-
ology have made it possible to correlate certain clinical situations in the mother
with their high perinatal mortality and morbidity rates. It is important that
physicians learn to recognize these high risk situations early and provide the
special care and precautions necessary to prevent fetal and neonatal loss. In
many patients the increased risk is due to the impaired feto-placental circula-
tion prior to the onset of labor. In normal labor, the placental circulation al-
most stops for the duration of the uterine contraction, but promptly returns to
normal between contractions and produces no fetal distress. In abnormal situa-
tions, when the placental circulation is already marginal before the onset of
labor, oxygenation may be severely limited once contractions become frequent.

We can anticipate increased fetal risk in the following conditions:

1. Diabetes mellitus

2. Chronic hypertension

3. Acute toxemia

4. Post-maturity

5. Erythroblastosic fetalis

6. Exhaustion, dehydration and acidosis of prolonged labor

7. Anemia

8. Maternal sepsis (amnionitis, Septicemia, pyclonephrisis, pneumonia)

9. Drug addiction

Early and careful care of these patients should be undertaken in hospitals
staffed and equipped to deal with all obstetrical contingencies as well as the
critically ill newborn.

Some laboratory help in evaluating the well-being of the feto placental unit
prior to the onset of labor is available. Serial measurements of urinary estriol
excretion that remain above baseline levels have correlated well with the favor-
able condition of the fetus. Hopefully, the future will bring better, more specific
placental function tests.

When a trial of labor is elected in these patients, recognition of fetal dis-
tress requires careful observation of the fetal heart rate by frequent auscultation
or fetal monitoring equipment. (See subsequent “fetal distress” card.)

Treatment of fetal distress arising in labor includes: I) changing the pa-
tient’s position from supine to lateral to eliminate any compression of abdom-
inal and pelvic vessels, 2) oxygen given to the mother by mask at 6 liters/min.,
3) intravenous hydration and glucose administration to correct maternal and
fetal acidosis. If these simple measures fail to reverse the abnormal fetal brady-
cardia, immediate steps should be taken to deliver the infant vaginally or by
Cesarean section.

Welcome to £MSMS

Members of the Michigan State Medical Society
join in welcoming the following new members into
a progressive state medical organization. MSMS is
dedicated to promoting the science and art of
medicine, the protection of the public health, and
the betterment of the medical profession. Each new
member is encouraged to join with other MSMS
members at both the local and the state levels in
achieving these goals.

Manuel A. Airala, MD, 1554 E. Michigan, Albion
49224

Sabah H. Atchu, MD, 21240 Virginia, Southfield
48075

John J. Back, MD, 21701 W. 11 Mile Rd., South-
field 48076

Barry F. Bates, MD, Dept, of Radiology, St. Joseph
Mercy Hospital, Ann Arbor 48104
Billy B. Baumann, MD, 2021 Klingensmith #7,
Pontiac 48053

Ferdinand M. Bumagat, MD, Metropolitan Hospital,
Detroit 48206

Vicente T. Castillo, MD, 3901 Beaubein, Detroit

48201

Luis A. Chavez, MD, 690 Mullett St., Detroit 48226
Yoon Ha Cho, MD, 1400 Chrysler Expwy., Detroit
48207

Ralph R. Cook, MD, W-5641 University Hosp., Ann
Arbor 48104

Douglas E. Cox, MD, 2355 Monroe, Dearborn 48124
Ben Droblas, MD, 8233 W. Chicago, Detroit 48204
Milagros T. Ebreo, MD, 31772 Allerton Dr., Birm-
ingham 48009

Daniel C. English, MD, Dept, of Surgery, MSU Col-
lege of Human Med., East Lansing 48823
Abdul Fayyad, MD, 1322 E. Michigan #318, Lan-
sing 48912

Julian Go., Jr„ MD, 27537 Parkview, Warren 48092
Alfred C. Hanscom, MD, 197 N. Washington, Battle
Creek 49017

Karl R. Herwig, MD, Dept, of Urology, Univ. Medical
Center, Ann Arbor 48104

Eugene Ho, MD, Wyandotte General Hosp., Wyan-
dotte 48192

Paul Hollister, MD, Dept, of Medicine, Mich. State
Univ., East Lansing 48823

Elizabeth A. Hutchinson, MD, 2909 E. Grand River
#208, Lansing 48912

Arturo D. Imperial, MD, 770 Fisher Building, Detroit

48202

Milo L. Johnson, MD, Sparrow Hospital, Radiology
Dept., Lansing 48902

Samba Jung, MD, 5571 Parkview Dr. C-1 #304,
Clarkston 48016

Andrea C. Jungwirth, MD, Physical Medicine, Uni-
versity Hosp., Ann Arbor 48104
E. Patrick Juras, MD, 2036 Stone Hollow Ct.,
Bloomfield Hills 48013

Adrian Kantrowitz, MD, Sinai Hospital, Detroit
48235

G. Howard Kent, MD, 8300 Mack Ave., Detroit
48207

John R. Kirkpatrick, MD, Wayne State University,
Detroit 48201

Fatella L. Lessani, MD, St. Mary’s Hospital, Livonia
48154

Frederick S. Lim, MD, 806 W. Sixth Ave., Flint
48503

K. Z. Masud, MD, 2355 Williamson, Saginaw 48601

Charles A. Main, Jr., MD, 2143 Brenthaven Dr.,
Bloomfield Hills 48013

James E. McCourt, MD, 915 Almira St., Saginaw
48602

Lawrence Mendelsohn, MD, 10601 W. Seven Mile
Rd., Detroit 48221

Dwijendra K. Misra, MD, 828 Fisher Bldg., Detroit
48202

Sunghee Nam, MD, Kirwood Hospital, Detroit 48238

Ahmed N. M. Nasr, MD, 1352 McIntyre, Ann Arbor
48105

Baha Onder, MD, 23023 Orchard Lake Rd., Farm-
ington 48024

Mohammad Riahi, MD, 456 Cherry St., S.E., Grand
Rapids 49506

Waldomar M. Roeser, MD, 1660 Arlington, Ann
Arbor 48104

Robert R. Ross, Jr., MD, 540 E. Canfield, Detroit
48201

David R. Rovner, Dept, of Medicine, MSU College
of Human Medicine, East Lansing 48823

Benedicto A. Ruiz, MD, 3001 Miller Rd., Ford Motor
Co., Dearborn 48124

Charles R. Schmitter, Jr., MD, 2825 Sequoia Park-
way, Ann Arbor 48103

Ramesh C. Shah, MD, Hurley Hospital, Radiology
Dept., Flint 48502

Joseph T. Stroyls, MD, 3800 Woodward Ave., De-
troit 48201

E. M. Tendero, MD, 1151 Taylor, Detroit 48202

Richard A. Wetzel, MD, Dept, of Nuclear Medicine,
Wm. Beaumont Hospital, Royal Oak 48072

Robert M. Zimmerman, MD, 555 E. Williams, Ann
Arbor 48108

Glenn A. Zimmermann, MD, 100 Michigan St., N.E.,
Grand Rapids 49503

DRUG ABUSE AND
ALCOHOLISM CONTROL
PROGRAM DIRECTOR

$25,000 — $30,000

Sought by major public employer.

Detail resume' requested.

Box 1, 120 W. Saginaw
East Lansing, Ml 48823

MICHIGAN MEDICINE JANUARY 1972 71

Classified Advertising

$5.00 per insertion of 50 words or less, with an additional 10 cents per word in excess of 50.

Are you tired of the smog, traffic congestion, sociolog-
ical problems, crime and other irritations which have
become part of today’s urban living? Well then DIS-
COVER WATERTOWN, WISCONSIN. Exchange
all the big city unpleasantries for the peaceful en-
vironment and easy going pace of a residential city.
Watertown, a progressive community is ideally lo-
cated equidistant between Milwaukee and Madison
in Southeastern Wisconsin’s lake district. 1 he com-
munity has a trade (and medical practice) area serv-
ing 40-50,000 people. Many new schools, parks, trees
and recreational opportunities. A stable economy.
Our new Community Health Care Center with its
beautiful 110-bed general hospital, connecting ('but
separate) 24-unit Medical-Dental Office Building
(choice of suites still avilable), and connecting 130-
bed Nursing Home, was completed in the Spring of
1971. WE URGENTLY NEED another Internist, an
Otolaryngologist, an Ophthalmologist, Obstetrician-
Gynecologist, and Family Practitioners to join exist-
ing medical staff. An immediate successful practice
assured. Excellent rapport with the University of
Wisconsin Medical School at Madison, and the Med-
ical College of Wisconsin (formerly Marquette Uni-
versity School of Medicine) at Milwaukee. Medical
Staff leading and supporting recruitment effort. Write
or call Dr. Paul Glunz, Watertown Memorial Hos-
pital, Watertown, Wise. 53094. Telephone (404)
261-4210.

PSYCHIATRIC RESIDENCIES— Excellent, approved
psychiatric training; both demanding and clinically
rich with a stimulating, well-balanced program. Af-
filiated with Michigan State University’s College of
Human Medicine. The setting is a culturally satisfy-
ing community; the serene, scenic Grand Traverse
Bay area. Three-year plan: $12,215 to $13,885; five-
year plan: $13,927 to $26,121. Contact Dr. Paul E.
Kauffman, Director of Psychiatric Training, Room
165, Traverse City State Hospital, Traverse City,
Michigan 49684. Phone: (616) 947-5550. An equal

opportunity employer.

CIVIL SERVICE: Prison Physician $30,735. Formal
vacation and sick leave plan plus other fringe bene-
fits in excess of $4,700 annually, under state civil
service. Regular hours. Must possess a license to
practice medicine or osteopathic medicine and sur-
gery in Michigan and have five (5) years of ex-
perience. Send resume to Richard Crable, Chief,
Recruitment Section, Michigan Dept, of Civil Service,
Lansing, Michigan 48913. An equal opportunity
employer.

PSYCHIATRISTS— Ann Arbor Area: Board eligible or
board certified to join staff of newly established 50-
bed forensic center. Active inpatient and outpatient
diagnostic program with court experience. Excellent

paramedical staff with opportunity for varied treat-
ment of patients in milieu program, teaching, and
research in all areas of forensic psychiatry. Private
practice allowed. Salary: $23,531 to $30,735; liberal
fringe benefits. Write: Lynn W. Blunt, M.D., Clin-
ical Director, Center for Forensic Psychiatry, Box
2060, Ann Arbor, Michigan 48106. (313) 429-2531.

ANN ARBOR-YPSLANTI AREA: 3 year approved,
university affiliated, psychiatric residency at mental
health center offering comprehensive services to SE
Michigan; teaching faculty and supervisors include
University of Michigan faculty, private psychiatrists
and analysts as well as hospital staff; resident’s time
divided approximately equally between didactic sem-
inars (including supervision) and clinical experience;
first year ADM and intensive treatment units; second
and third year assigned community psychiatry and/or
OPC and/or Children’s Unit; additional experience
in psychosomatic medicine, University Mental Hy-
giene Clinic and neurology. 3 years: $12,215 to $13,-
893; 5 years: $13,927 to $18,708 (4th and 5th year
salaries negotiable) . All Michigan Civil Service ben-
efits. Contact: W. Bogard, M.D., Ypsilanti State Hos-
pital, Ypsilanti, Michigan 48197. An Equal Oppor-
tunity Employer.

PSYCHIATRIC RESIDENCY. Three years fully ap-
proved program in a large university affiliated gen-
eral hospital. We provide closely supervised training
in dynamic psychiatry, child psychiatry, medicolegal
experience, and basic neurology. Salary to $15,000
plus benefits. For further details and consideration
submit your resume to Dr. Robert Schopbach, Di-
rector of Psychiatric Training, Henry Ford Hospital,
2799 W. Grand Blvd., Detroit, Michigan 48202.

INTERNIST AND GENERAL PRACTITIONER ur-
gently needed. Practice in community of Charlevoix,
population 4,000. Modern, fully accredited hospital,
47 beds, CCU-ICU started. Serves population of 16,-
000. Office available, rent free until established. Nine
member Medical Staff actively assisting in recruit-
ment. Ideal area for really living without big city
problems. Beyond compare for recreation year
around. Two junior colleges close by. Excellent
schools. Reply to: Administrator, Charlevoix Hos-

pital, Charlevoix, Michigan 49720.

GP’s, Internists, Pediatricians— The Family Health Cen-
ter, Inc. is about to begin providing health services
to an underserved area of Kalamazoo. Advantages
of joining staff include: a chance to develop an
exciting medical program; income of $25,000-$40,000/
year plus fringe; a sophisticated medical community;
and two fine general hospitals. Contact John Vogt,
418 W. Kalamazoo Ave., Kalamazoo, Michigan 49006.
(616) 342-0204 #18 collect. An equal opportunity

employer.

72 MICHIGAN MEDICINE JANUARY 1972

CITY PHYSICIAN: for employment exam center and
public health consultation. Attractive to physician
who wants activity limited to a standard work week.
Contact D. L. Sherman, Personnel Director, City
Hall, Dearborn, Michigan 48126 (313) LU 4-1200.

FOR SALE: Medical Equipment suitable for use by
internist of F.M.D.: X-Ray, Diathermy, examining
tables, treatment tables, instrument and supply cab-
inets, surgical instruments, cautery, centrifuge, office
furniture, steel hies and many other items. Will sell
at appraised value. Reply Box #10, 120 West Sag-
inaw St., East Lansing, Mi 48823.

CHILD PSYCHIATRY RESIDENCIES OFFERED:
MICHIGAN— ANN ARBOR, YPSILANTI: “Where
it’s at.” New Child Psychiatry Residencies offered in
an innovative, established clinical program. Commu-
nity Child Psychiatry, Day Treatment, Out-Patient
and Residential Treatment offer opportunities for a
variety of treatment techniques. Crisis intervention
(“life-space” interview) ; behavioral therapy pharma-
cotherapy, individual, group and family treatment
methods; dynamic, social and developmental psychiatry
taught. Learning by independent study, seminars, su-
pervised experiences. Multi-disciplinary staff including:
six child psychiatrists, pediatrician, pediatric neurolo-
gist, psychologists, social workers, special education
teachers, speech therapists, occupational therapist, rec-
reational therapists, etc. Program affiliated with the
University of Michigan and a variety of clinical set-
tings including: community mental health centers,
guidance clinics, etc. Salaries negotiable. Contact:
Elissa P. Benedek, M.D., York Woods Center, Box A,
Ypsilanti, Michigan 48197. Phone: (313) 434-3666.
An Equal Opportunity Employer.

FOR LEASE: In the Prairie Professional Building, lo-
cated in the City of Grandville, Michigan. With the
construction of phase 3 nearly complete, we have
choice suites available. Will be developed to your
exact requirements. Suitable for medical, dental or
related professions. Also, lower level suite available
at reduced rates. Lease rentals include heat, electric,
air conditioning, snow removal, paved parking, built-
in vacuum system, music, attractive landscaping. This
location is convenient and desirable. Reply to Prairie
St. Realty Corp., 2700 28th St., S.W., Grand Rapids,
Michigan or phone (616) 538-9000 days or evenings
(616) 457-9645.

OPPORTUNITY for Internist or Family Physician to
take over thirty year old practice in splendid loca-
tion. Hospital privileges assured. Less than ten min-
utes drive to three local hospitals. Excellent hospital
and office facilities in city of 125,000 population.
Will introduce. Retiring. Reply Box #9, 120 W.
Saginaw St., East Lansing, Mi 48823.

GENERAL PRACTITIONERS - Community of Mt.
Pleasant, Michigan desirous of securing 4 general
practitioners. Good hospital privileges available. 125
bed, fully accredited. Excellent consultants available
in community. Mixed M.D., D.O. Staff. Active staff
of 28 physicians. Community of 22,000. Site of Cen-
tral Michigan University. 14,500 students. Four season
area. Metropolitan areas within 50 miles. Service area
of 75,000. Five G.P.’s in active practice. Community
will assist actively in helping you get established.
Call collect R. E. Pieratt, Adm. (517) 773-7941 or
Frank Johnson, M.D., Chairman Recruitment Com-
mittee, area (517) 772-4846.

PROFESSIONAL
PERSONNEL RECRUITMENT

FOR

HOSPITALS CLOIICS UNIVERSITIES

Administrators, Physicians,

Dept. Heads

PHYSICIANS— ALL SPECIALTIES

At no financial obligation, send us your resume
if you would like a fine full-time position with
one of our Clients:

HOSPITALS: Full-time Chiefs of Services, Di-
rectors of Medical Education (General
and Specialty).

MULTI-SPECIALTY CLINICS: General Practice
and all Specialties.

SINGLE-SPECIALTY GROUPS. General Practice
and all Specialties.

MEDICAL SCHOOLS: Teaching and Research
appointments — all Disciplines.

DRUG FIRMS: Basic Science and Clinical Trials
Research

INDUSTRIAL FIRMS: Employee Health Care.
COLLEGES and UNIVERSITIES: Student Health
Care.

In addition to our service to Client organizations, we
assist physicians in considering relative merits of a va-
riety of fine opportunities. No financial obligation at any
time to the candidate. Appointments can be made as
much as a year or more in advance. Send complete
resume plus your professional objectives and geographic
preferences in confidence to Arthur A. Lepinot.

INDEX TO ADVERTISERS

American Cancer Society . .

Arch Laboratories

Battle Creek Sanatorium . .

Bristol Laboratories

Brown Pharmaceuticals . . .
Burroughs-Wellcome & Co.

Campbell Soup Co

Chicago Medical Society . .

Classified Advertising

Employment Opportunity . .
Geigy Pharmaceuticals . . .
Hospital Planning, Inc. . .
Import Motors Limited, Inc.

Lilly, Eli and Co

MD PAC

Mead-Johnson

Medical Protective Co. . . .
Medicenter of America . .

Medidinics

Mercywood Hospital

Merrell National

Michigan Heart Association

Pfizer Laboratories

Poythress, Wm. P. & Co. .
Professional Management .

Roche Laboratories

Scientific Sessions

Searle, G. D. & Co

Stratton, Ben P. Agency . .
Stuart Pharmaceuticals . . . .

Upjohn

U. S. V. Pharmaceutical . .

Walker Corp. & Co

Wallace

Willingway

45

55

55

11

53

6

39

49

72, 73

71

5

73

35

14

3

56, 57

60

Cover III

36

53

43, 44

13

62, 63

42

61

1, Cover II, Cover IV

36

40, 41

74

46, 47

... 8, 9, 66, 67, 68

65

7, 59

51

37

We hope you will visit our new main office when you are
in the Lansing area. It was designed to provide for efficient
service and for our growing staff.

0

il

bps

BEN P. STRATTON AGENCY, INC.

MSMS Insurance Administrators
Serving the Michigan
State Medical Society
Since 1954

BRANCH OFFICE

19400 West Ten Mile Road
Southfield, Michigan 48075
(313) 357-5083

MAIN OFFICE

5848 Executive Drive
Lansing, Michigan 48910
(517) 393-7660

74 MICHIGAN MEDICINE JANUARY 1972

G§ouijd Off

Why does Michigan
need a foundation?

By Brooker L. Masters, MD
Chairman, MSMS Council

There are at least 12 proposals before Congress at
the present time which deal with the provision and
financing of health care. Although it seems certain
that not one of these bills will become law this
year, and possibly not next year, it is inevitable
that Congress will, sooner or later, vote on a meas-
ure for national health insurance — probably one
that includes specific features of several different
bills already introduced.

The one thing that most all of these bills have in
common is the demand for cost and quality control
of health care services through peer review.

True “peer” review requires that the work of physi-
cians be reviewed by other physicians, not by bu-
reaucratically-appointed representatives of labor,
business, government, or the public, who have no
qualifications for this task. MSMS has an operating
peer review program and is, in fact, ahead of some
of its sister state organizations in this area. In real-
ity, however, Michigan has only scratched the sur-
face in this relatively new concept.

Local and regional peer review committees must do
more than merely exist. Their members must be
trained in the methods of operation. Hospital util-
ization review must be encouraged and stimulated
to reach its peak of effectiveness. It must be con-
vincingly demonstrated to the physicians of Mich-
igan that peer review is not a punitive mechanism,
but rather an educational program which will en-
courage physicians who have not “kept up,” to
take the necessary remedial steps.

There are strong indications from Washington that
medical associations themselves would not be
authorized to perform this review function, but that
a separate organization (foundation) sponsored by
a state association could be awarded contracts to
carry out this responsibility.

With this issue of MICHIGAN MEDICINE, MSMS
members will find greater emphasis on the view-
points of Michigan physicians. On these pages we
begin a new, four page, monthly section in which
the state’s doctors may “sound off.”

The demand for experimentation in alternate sys-
tems of health care delivery is present and growing
stronger every day. The physicians in Michigan
need to keep abreast of these developments, ad-
vise and consult with those who promote them, and
make very sure that their voice is heard so that
they may maintain some control over their own
destiny. We must guard against those organiza-
tional patterns which suggest non-medical control
over medical services.

* * *

These things an individual physician cannot do for
himself. Nor can his medical association legally be-
come involved in many of these areas without plac-
ing its tax exempt status in jeopardy. A foundation
can do these things for him.

Many health insurance policies sold in this State,
in many instances, offer substandard coverage.
Physicians should be interested in seeing that this
situation is corrected. A foundation could develop
minimum standards of coverage for health insur-
ance and use its influence and good offices to see
that substandard policies are upgraded or removed
from the market.

Some foundations are designed to contract with
government and insurance carriers to administer
programs, including the processing of claims and
writing checks. Others have (entered) contracts to
set up prepaid group health organizations. These
are not our purposes, but the beauty of the founda-
tion concept is that it can be set up to accomplish
whatever purpose its members direct.

* ★ *

The purpose envisioned for our Foundation is to
contract with health insurers and governmental
agencies to perform effective peer review by (1)
establishing guidelines that insure quality medical
care at a reasonable cost and (2) reviewing cases
based upon exception reporting that fall outside
established norms. The actual peer review work
will be done by local and area review committees.

MICHIGAN MEDICINE JANUARY 1972 75

SOUND OFF/Continued

The Foundation should, however, have freedom of
action and purpose to allow it, within all legal
bounds, to engage in such activities as may be
necessary to maintain our position of leadership in
health matters in Michigan in keeping with devel-
opments in the legislative, social or medical fields.

The Bylaws for the proposed MSMS Foundation
have been carefully drawn to insure that the con-
trol of its activities remain with physicians:

1. Members of the Michigan State Medical So-
ciety and the Michigan Association of Osteo-
pathic Physicians and Surgeons are auto-
matically participating members of the Foun-
dation. There is no coercion because a par-
ticipating member may resign his membership
in the Foundation at any time.

2. There are 18 administrative members who
control the activities of the Foundation.
Twelve are provided by MSMS and six are
provided by the MAOPS.

3. The twelve M.D. administrative members are
composed of MSMS officers plus the Chair-
man and Vice-Chairman of The Council and
six members elected at large by the MSMS
membership.

4. The eighteen administrative members elect
the Foundation nine member Board of Trus-
tees. Six trustees must be participating mem-
bers from MSMS and three from MAOPS.

5. Any trustee may be removed from office by
the affirmative vote of two-thirds of the ad-
ministrative members or two-thirds vote of the
trustees.

6. Officers of the Foundation are elected by and
serve at the pleasure of the Board of Trus-
tees.

7. A majority of participating members may re-
scind any prior policy decision of the officers
or trustees.

8. Twenty or more participating members may
petition the corporation to amend its Bylaws
and these petitions must be considered and
voted upon by the administrative members.

9. The corporation at any time may be dissolved
by a two-thirds vote of the participating mem-
bers at a meeting of 49% of the total mem-
bership.

The Foundation approach is medicine’s best hope
of shaping a future that will afford freedom to de-
liver quality health services and provide consumer
safeguards. Several state medical societies with
large physician population, including Illinois and
Pennsylvania, have already established their state
foundations. We must act now before it is too late.

Press kudos

for Kent physicians

It was no remarkable coincidence that on the
front page of last Monday’s Press there appeared
two stories, almost side by side recounting the ef-
forts of local doctors aiding the police in two res-
cue attempts. Less than a week before the twin
incidents, the Patrolman’s Wives Club singled out
20 Grand Rapids physicians for special commenda-
tion for similar activities.

The letters that went to the 20 doctors cited
them for “making the Grand Rapids police emer-
gency units and first-aid training the best in the
country.” They then went on to express the hope
of not only the policemen’s wives but of the Police
Department and the public generally that the doc-
tors would continue their close association with the
policemen “to fulfill the never-ending need for the
best emergency first-aid training and services.”

In the two most recent cases of doctor-police
cooperation, one of the most active members of
the police emergency unit program, Dr. Lee Pool,
hurried to the scene of a shooting on Franklin St.,
SW, in answer to a police call. His efforts to restart
the heart of a man who had been shot three times
failed, but Pool gave it his best. Not many hours
later, Dr. John Wilson, another active member of
the unit, proved more successful when, answering
a police call, he hastened to Bridge St. bridge,
where, at some peril to his own life, he helped the
police to prevent a woman from leaping into the
river.

Drs. Pool and Wilson are among the 20 or so
local physicians who regularly ride with the police
emergency vehicles on weekends and often on
other nights, who have two-way police radios in
their cars and even offices and who almost auto-
matically respond to any police pleas for their
services. They are not paid for their efforts.

The doctor emergency service was conceived by
Dr. C. Mark Vasu, who, of course, deserves a large
measure of the credit for its success. But never has
it been more true than in this instance that it takes
many willing hands to make such a program work.
And this program requires not only willing but ex-
traordinary skilled hands that are not in abundant
supply in any community. The Patrolman’s Wives
Club says this program is the best of its kind in the
country. We don’t think there is any doubt on that
score. In fact, there are few communities that can
boast anything similar to it.

Grand Rapids Press, October 28, 1971
(Editorial, reprinted by permission)

76 MICHIGAN MEDICINE JANUARY 1972

Hello, Doctor Coye;
Thank you.

Doctor Evans

By Edward J. Tallant, MD

MSMS Publication Committee Chairman

Michigan’s medical doctors extend a warm, wel-
coming handshake to the new dean of the Wayne
State University School of Medicine, Robert D.
Coye, MD.

At the same time, we are quick to congratulate
and praise those men who have led the WSU med-
ical school during the two years since the resigna-
tion of former dean Ernest D. Gardner, MD, in
March, 1970.

Tommy N. Evans, MD, acting dean, has ably
commanded the day-to-day work of the medical
school, and presided over such high points as the
construction of the new Scott Hall of Basic Med-
ical Sciences, the ground-breaking and early con-
struction of the C. S. Mott Center for Human
Growth and Development and a 50 percent in-
crease in the number of entering freshmen medical
students at WSU.

For his work as WSU acting dean, Doctor Evans
was awarded a 1971 MSMS Certificate of Com-
mendation.

We offer our support and cooperation to you,
Dean Coye, as you begin your work in a challeng-
ing time when medical schools are being called
upon to produce more and better physicians to
meet the rising demand for medical care across
the nation.

In 1971, the WSU entering freshman class num-
bered 208 students, placing it among the top 10 in
size among the medical schools in the country. If
finances are made available soon to acquire addi-
tional faculty, the WSU entering medical class
could rise to 256 by 1973, placing it among the
top two or three in the nation.

We are pleased with your qualifications as for-
mer assistant and then associate dean of the Uni-
versity of Wisconsin Medical School.

Doctor Coye comes to Michigan with high qual-
ifications. From 1966-70 he served as associate
dean of the University of Wisconsin Medical
School. From 1960 until 1966 he was assistant dean.
He has been a full professor of pathology at Wis-
consin since 1968.

Certified in pathological anatomy in 1958, Doctor
Coye is a member of the American Society of Ex-
perimental Pathology and the American Association
of Pathologists and Bacteriologists.

He and his wife, Janet, have two daughters,
Carol, 19, and Joel, 23, and a son, Peter, 21.

When Doctor Coye accepted his new position, he
said he was impressed with the basic science, clin-
ical and research facilities at the medical school.

“The WSU School of Medicine and the develop-
ing Detroit Medical Center are contributing much
to the teaching, research, and health care needs of
Detroit, the State of Michigan and the nation at
large,” he said. “I know they will continue to play
a major role in helping to solve many of the health
care problems confronting us today.”

We look forward to working with you to solve
these problems, Dean Coye.

Doctor McGrath

We do not belong
to the organization;
it belongs to us

By William B. McGrath, MD
Phoenix, Ariz.

The following article is reprinted with permis-
sion, from the September issue of Arizona Med-
icine.

The structure of an organization is the sum of
the individuals who comprise it. The function of an
organization is to lessen individuality in the pursuit
of cooperation and efficiency. It is true of any so-
ciety: the stronger the organization, the weaker its
members. This is a looming dilemma which con-

MICHIGAN MEDICINE JANUARY 1972 77

SOUND OFF/Continued

fronts every one of us, in any trade or profession
and in government.

A man cannot make a living without belonging
(sic) to some organization, thereby relinquishing
some of his independence. Count, for illustration,
the number of associations which a licensed physi-
cian has to join — ingratiating himself, submitting
his qualifications, taking examinations, requesting
“privileges,” attending mandatory meetings, paying
dues and special assessments, accepting the by-
laws and a hundred restrictive rules and regula-
tions; dreading that at any time his fitness and
therefore his very livelihood will be brought into
question by self-appointed peers or anonymous
committees.

He will be graded and stamped and certified like
beef in a packing house. Above him in the vertical
pecking order will be the courtesy staff, the honor-
ary staff, the consulting staff, the visiting staff, the
active staff, the teaching staff, and finally the
“chiefs” of services, the real in-group, employed
by the hospital.

There is no grading without degrading. Subordi-
nation of the individual is perhaps even worse in
the military and in industry and commerce. An em-
ployee had better contribute a specified amount to
a “voluntary” charity drive. The board arrogates
the right to require a teacher to take a loyalty
oath. An executive must be willing (a contradiction
in terms) to undergo psychological testing, and his
whole personal life will come under evaluative in-
vestigation. Everyone rises at the entrance of the
judge in his medieval robes, and we address him
as “your honor,” but he must “run” for office.

Organization for the sake of efficiency is wit-
lessly dragging mankind back to feudalism: people
become serfs and vassals, paying homage and fees
and service for the “privilege” of working.

Impotent and oppressed, the individual cannot
resist the emasculating power of organization. He
has to join and submit. Repressing the instinctive
(stallion) goal of self-determination and free enter-
prise, he will ignore his serfdom or rationalize. So
he will forgive us, sweetly, and protest that an ef-
fective team must have pyramidal organization,
must have’ leadership and followers, a hierarchical
system.

We have no real proof that this is so since any
other approach has never had sufficient trial. In
either case our technologies are advancing so
overwhelmingly that we could afford to sacrifice a
little efficiency in the interest of individual integ-
rity. We had better! Machismo is not measured by
status or proven on the golf course.

Organized medicine at any level ought not lead
or follow the subservient inclinations of the masses.
The hackneyed phrase, “delivery of health serv-
ices,” suggests that medicine is a commodity —
perhaps to be sold or traded for coupons in a
chain of supermarkets? It is the same old episte-
mological error: Medicine is not a service; it is a
positive function.

And the function of organized medicine is to
preserve and enrich the health of society. When
organization itself begins to undermine the health
of society, then it is our duty to attack organiza-
tion.

Any illness of society can hardly be different
from the illness of an individual. Our country seems
to be organically sound. We can defend ourselves
against invasion; the drinking water is pure and
our sewage systems are better than average; we
have more than our share of food and housing.

But no one would dispute that collectively as
well as individually we are nervous.

Now in any functional disorder, in any case of
nervousness, what does the psychiatrist look for?
Invariably he will find a basic loss of self-esteem.
All the symptoms and all the defense mechanisms
seem to derive from the losing of self-esteem.

It is up to the professions to set the restorative
example. Our own societies and associations
should be as loosely knit as possible, freely co-
operative, never intimidating or coercive. The phy-
sician’s connection with the hospital, for example,
could well do without most of the ranking and
regulating. The fact of being on a staff (just yes or
no) should presume the individual’s good judgment
and he should be quite free to work according to
his abilities.

In almost every issue and at every opportunity
the educated person should stand and vote against
more administration, more management, more regi-
mentation. He should vigorously oppose anything
that smacks of rigidity or grading or group coer-
cion.

The lifeblood of mental health is self-esteem.
When we are mindful of this, then both profession-
ally and privately each of us will always discourage
any kind of subordination. We will not invite or
permit any human being to enter a master-servant
relationship which would allow him to be obse-
quious, subservient.

It is not just a play on words to insist that the
individual does not belong to the organization or
work for it. He works for himself and the organiza-
tion belongs to him. He must never be treated or
view himself as a member, in the sense of an arm
or leg. He is a whole man. In or out of the organ-
ization a man can work for himself in whatever job,
using his own skills and resources. He must get
back the feeling that he is tilling his own small
plot of land. When he cooperates with his fellows
it is because they are his fellows, and they and he
are scornful of status or rank. Such a subtle
change of attitude will help to restore the self-
esteem of the individual and of the society to
which he belongs — no; which belongs to him!

Doctor McGrath is a member of the Publish-
ing Committee and Editorial Board of the Ari-
zona Medical Association, Inc.

78 MICHIGAN MEDICINE JANUARY 1972

I EPIGRAMS

ATE NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

«•». o/iiv

■At.

J- If ?'■ f: - p f ,0,0 A

-outrt LIBRARY

Ft'B 1 0 IS72

January 28, 1972, Volume 71, Number 3
Michigan State Medical Society
Reading Time: 2 Mins. 45 Seconds

FFORTS ARE UNDERWAY to tell Governor Milliken and the State Legislature
bout the MSMS Council's "extreme displeasure" over the Governor's budget
lessage proposal to discount all Medicaid payments to physicians by 3%
f paid in 30 days. The matter was discussed by The Council Jan. 26 and
four-step action program to protest the proposed cut was approved.

The entire MSMS membership will be sent a special mailing with per-
inent data and with suggestions for individual action. Watch for the
tailing.

The Governor alleges this discounting proposal can reduce state costs
y $2 million and federal costs by a further $2 million. If approved by
he Legislature, the cut would become effective with the next fiscal year,
uly 1, 1972.

MEMBERS OF THE MSMS House of Delegates will receive Draft #7 of the pro-
posed bylaws for a MSMS-sponsored foundation early in February for study
before the spring meeting of the House. The MSMS Committee on Utilization
Review and Health Insurance Problems developed Draft //7 after reactions
from various delegates and component societies to Draft #6. The MSMS
Council on Jan. 26 received Draft #7 and voted to "present it to the House
of Delegates for approval."

XPLANATION OF PRICE COMMISSION 2.5% CEILING:

The government has published fee-freeze regulations ordered by the
rice Commission under Phase II of the President's new economic policies
nd the MSMS Bureau of Economic Information provides these interpretations:

1. Physicians are held to fees in effect on Nov. 14, 1971. Any in-
:reases in fees up to a maximum of 2.5% must be justified on the basis of
illowable cost (overhead) increases. Such ‘increases are permissible only
,f they don't increase the doctor's profit margin (the difference between
he practice's gross income and net income) and only to the extent they
Lre not offset by increased productivity.

2. Requests for exceptions to the guidelines may be directed to:

District Director

Economic Stabilization Program of the IRS
2011 Park Avenue Building
Detroit, Michigan 48226

3. Incorporated physicians' salaries (including benefits) cannot be
.ncreased more than 5.5%. Exempt from the 5.5% ceiling are automatic or
ilanned "longevity" increases in salaries for physicians in medical cor-
>orations, provided this salary plan existed before Nov. 14, 1971. But,

:he corporation is restricted to the 2.5% fee guidelines.

4. The individual's request must state the reason for the request,
md indicate to the Commission that a serious hardship or gross inequity
-S in effect with the guidelines.

The AMA has protested the fee-freeze regulations as being "discriminatory
>y singling out providers of health care. The AMA declares that the guidelines
'violate the principles of equal treatment and fair play."

COMPONENT SOCIETY SECRETARIES are being invited to a special workshop at
MSMS on March 1. A similar workshop for presidents-elect of the county
societies on Dec. 9 was rated very informative.

MSMS COUNCIL on Jan. 26 received a comprehensive report from Chairman
Brooker L. Masters, MD, about his testimony before the national Democratic
Policy Council’s Subcommittee on Health in Detroit, Jan. 12. (A copy of
the testimony was sent to all MSMS members as Vol. 71, Issue //I of Mi chigan
Medicine.) Doctor Masters reported that "there was a parade of providers
and consumers at the hearing who argued for pluralism, new ideas, flex-
ibility, medical education, more physicians and better distribution of
doctors." One Democratic congressman who testified supported the Kennedy-
Griffiths bill. Doctor Masters told The Council that "the only comments
I have received from fellow doctors since the hearing have been favorable."

I

MSMS WILL PRESENT A STATEMENT at a "Hearing on Malpractice Insurance Prob-
lems" being called at the request of MSMS by the State Insurance Commission:
in Lansing, Feb. 28. The hearing will bring together medical, legal and
insurance interests to express views. MSMS Councilor Frank Bicknell, MD,
Detroit, and Fredrick Weissman, MD, Detroit, chairman of the MSMS Committee
on Professional Insurance, will represent MSMS. Insurance Commissioner Vai
Hooser says the hearing "could also establish a sound foundation for evalu-
ating future changes in the area of malpractice insurance."

THE REPORT OF the Phase II membership opinion survey is being completed
now by the Alexander Grant Company and will be submitted to the MSMS Council
and House of Delegates. The Council will refer the report to appropriate
committees to evaluate the conclusions and recommendations. Ten members of
the MSMS Council met with survey directors Jan. 25 to discuss the findings
and preliminary draft of the report.

-

PARTICIPATION IS NOW being sought for the 1972 Student American Medical
Association-Medical Education and Community Orientation summer project
which again will place medical students in community hospitals for 10-week
periods. The program is designed to provide students with valuable learning
experiences and introduce them to medical practice in Michigan communities.!
For additional information about the SAMA-MECO program, contact the MSMS
Education Liaison Committee.

A NINE-MEMBER board to review requests by hospitals and other health care
institutions to exceed the 6% price limit established by the Price Commission
has been appointed by the Governor. He selected members of the present State
Comprehensive Health Planning Council as the review group.

THE MICHIGAN DEPARTMENT of Social Services recently contracted with the
Model Neighborhood Comprehensive Health Program, Inc. (Detroit) to provide
comprehensive, preventive medical and health services to 10,000 Group I
Medicaid beneficiaries. The program commences on March 1 as a demonstra-
tion project. Details will be in the Mar. issue of Michigan Medicine.

Jan. 28, 1972 Vol. 71, No. 3

MICHIGAN STATE MEDICAL SOCIETY

Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

UNIVERSITY OF CAL
LIBRARY SCH OF MED
THIRD 8 PARNASSUS AVE
SAN FRANCISCO CAL 94122

EDITOR: HERBERT A. AUER

(fMichigari £Mediciqe

OFFICIAL JOURNAL OF THE MICHIGAN STATE MEDICAL SOCIETY . VOLUME 71, NUMBER 4 . JANUARY, 1972

oster of MSMS members by component societies

Officers of the Michigan State Medical Society

PRESIDENT

Sidney Adler, MD

Detroit

PRESIDENT-ELECT

John J. Coury, MD

Port Huron

SECRETARY

Kenneth H. Johnson, MD

Lansing

TREASURER

John R. Ylvisaker, MD

Pontiac

SPEAKER

Vernon V. Bass, MD

Saginaw

VICE SPEAKER

James I). Fryfogle, MD

Detroit

PAST PRESIDENT

Harold H. Hiscock, MD

Flint

Officers and Members of The Council

CHAIRMAN

Brooker L. Masters, MD

Fremont

VICE CHAIRMAN

Robert M. Leitch, MD

Battle Creek

SECRETARY

Kenneth H. Johnson, MD

Lansing

TREASURER

John R. Ylvisaker, MD

Detroit

Frank B. Bicknell, MD

1st

Detroit

Brock E. Brush, MD

1st

Detroit

Ralph R. Cooper, MD

1st

Detroit

Edward J. Tallant, MD

1st

Detroit

Louis R. Zako, MD

1st

Allen Park

Ross V. Taylor, MD

2nd

Jackson

Robert M. Leitch, MD

3rd

Battle Creek

W. Kaye Lock 1 in, MD

4th

Kalamazoo

Noyes L. Avery, MD

5 tit

Grand Rapids

Ernest P. Griffin, Jr., MD

6th

Flint

James H. Tisdel, MD

7th

Port Huron

William A. DeYoung, MD

8th

Saginaw

Adam C. McClay, MD

9th

Traverse City

Robert C. Prophater, MD

1 Oth

Bay City

Brooker L. Masters, MD

11th

Fremont

Raymond Hockstad, MD

12th

Escanaba

Donald T. Anderson, MD

13th

Kingsford

Donato F. Sarapo, MD

14th

Adrian

Sydney Seller, MD

15th

Mt. Clemens

Executive Staff

Tryloff, Warren F., Director

Ambrose, Bruce W., Manager, Department of Government Relations

Auer, Herbert A., Manager, Department of Communications and Professional Information

Campau, Richard M., Manager, Department of Operations and Economics

Administrative Staff

Anthony, John H. — Chief, Bureau of Economic Information
Berry, Margaret J. — Secretary, Accounting and Membership

Brewbaker, Mary K. — Committee and Exhibits Coordinator, Division of Scientific Affairs
Davis, Vada L. — Administrative Assistant to Director

Decker, Sherry L. — Secretary, Department of Communications and Professional Information
Evey, Lenora M. — Secretary, Department of Government Relations

Hall, Sherry L. — Special Assistant, Legislative Liaison, Department of Government Relations
Hoover, Maynard J. — Reproduction Operator, Department of Operations and Economics
Irish, Mary V. — Secretary to Manager, Department of Operations and Economics

Marr, Judith E. — Managing Editor, Michigan Medicine, Communications and Professional Information
May, Lois — Receptionist

Mehler, Herbert — Chief, Research and Analysis, Governmental Medical Care Programs
Roney, Robert J. — Controller, Accounting and Membership
Schulte, Helen A. — Chief, Division of Scientific Affairs

Smith, Jeanne — Assistant, Department of Communications and Professional Information
VanDeventer, Jacqueline — Coordinator of Women’s Activities
Zaletskis, Maija — Secretary, Division of Scientific Affairs

Advisory Staff

Lester P. Dodd — General Counsel

Clyde T. Hardwick, PhD — Economic Consultant

A. Stewart Kerr — Legal Counsel

John W. Moses, MD — Scientific Editor, Michigan Medicine

MICHIGAN STATE MEDICAL SOCIETY DIRECTORY

CONTENTS

This Directory lists the membership of each component medical society and
therefore the tptal membership of the Michigan State Medical Society.

Page

Alcona County ( Alpena-Alcona-Presque Isle) 6

Alger County (Marquette-Alger) 35

Allegan County 6

Alpena County (Alpena-Alcona-Presque Isle) 6

Antrim (Northern Michigan) 39

Arenac ( Bay-Arenac-Iosco ) 7

Lake County ( Mecosta-Osceola-Lake )

Lapeer County

Leelanau County (Grand Traverse-Leelanau-

Benzie )

Lenawee County

Livingston County

Luce County

Page
. 36
. 31

, . 16
. 32
. 32
. 33

Baraga County ( Houghton-Baraga-Keweenaw ) 17

Barry County 6

Bay County (Bay-Arenac-Iosco) 7

Benzie County (Grand Traverse-Leelanau-Benzie ) ... 16

Berrien County 8

Branch County 9

Calhoun County 9

Cass County 11

Charlevoix County (Northern Michigan) 39

Cheboygan County ( Northern Michigan ) 39

Chippewa County (Chmpewa-Mackinac) 11

Clare County ( Gratiot-Isabella-CIare ) 16

Clinton County 11

Crawford (North Central Counties) 36

Delta County ( Delta-Schoolcraft ) 11

Dickinson County (Dickinson-Iron) 11

Mackinac County ( Chippewa-Mackinac ) 11

Macomb County 33

Manistee County 35

Marquette County (Marquette-Alger) 35

Mason County 36

Mecosta County (Mecosta-Osceola-Lake) 36

Menominee County 36

Midland County 36

Missaukee County ( Wexford-Missaukee ) 58

Monroe County 37

Montcalm County ( Ionia-Montcalm ) 21

Montmorency (North Central Counties) 36

Muskegon County 38

Newaygo County 39

North Central 39

Northern Michigan Counties ( Antrim-

Charlevoix-Cheboygan-Emmet) 40

Eaton County 12

Emmet County (Northern Michigan) 39

Genesee County 12

Gladwin (North Central Counties) 36

Gogebic County 16

Grand Traverse County (Grand Traverse-

Leelanau-Benzie) 16

Gratiot County ( Gratiot-Isabella-CIare ) 17

Oakland County 40

Oceana County 48

Ogemaw (North Central Counties) 36

Ontonagon County 49

Osceola County (Mecosta-Osceola-Lake) 36

Oscoda (North Central Counties) 36

Otsego (North Central Counties) 36

Ottawa County 49

Presque Isle County (Alpena-Alcona-Presque Isle) ... 6

Hillsdale County 17

Houghton County (Houghton-Baraga-Keweenaw) .... 17
Huron County IS

Ingham County 18

Ionia County ( Ionia-Montcalm ) 22

Iosco County (Bay-Arenac-Iosco) 7

Iron County (Dickinson-Iron) 11

Isabella County (Gratiot-Isabella-CIare) 16

Jackson County 22

Kalamazoo County (Kalamazoo Academy of

Medicine ) 23

Kalkaska (North Central Counties) 36

Kent County 26

Keweenaw County (Houghton-Baraga-Keweenaw) .... 17

Roscommon (North Central Counties) 36

Saginaw County 49

St. Clair County 51

St. Joseph County 52

Sanilac County 53

Schoolcraft County ( Delta-Schoolcraft ) 11

Shiawassee County 53

Tuscola County 53

Van Buren County 53

Washtenaw County 54

Wayne County 59

Wexford County (Wexford-Missaukee) 90

Published four times a month in December and January, three times all other months, 38 issues, by the Michigan State
Medical Society as its official journal. Second class postage paid at East Lansing, Mich., and at additional mailing offices.
Yearly subscription rate, $9.00; single copies, 80 cents. Additional postage: Canada, $1.00 per year. Printed in USA. All
communications relative to manuscripts, advertising, news, exchanges, etc., should be addressed to Judith Marr, Managing
Editor, Michigan State Medical Society, 120 West Saginaw Street, East Lansing, Michigan 48823. Phone Area Code 517, 337-1351.
© 1972 Michigan State Medical Society. Directory artwork of MSMS Headquarters by Maripat Kreski, junior art student at
Eastern Michigan University.

JANUARY, 1972/Michigan Medicine 3

Guide to Help Locate Cities withir

This guide matches up the counties for Michigan communities

Ada (Kent)

Addison (Lenawee)

Adrian (Lenawee)

Albion (Calhoun)

Algonac (St. Clair)

Allegan (Allegan)

Allendale (Ottawa)

Allen Park (Wayne)

Alma (Gratiot)

Almont (Lapeer)

Alpena (Alpena)

Ann Arbor (Washtenaw)
Augusta (Kalamazoo)

Bad Axe (Huron)

Baldwin (Lake)

Bangor (Van Buren)

Baraga (Baraga)

Bark River (Delta)

Battle Creek (Calhoun)

Bay City (Bay)

Bay View (Emmet)

Bear Lake (Manistee)
Belding (Ionia)

Bellaire (Antrim)

Belleville (Wayne)

Benton Harbor (Berrien)
Berkley (Oakland)

Berrien Center (Berrien)
Berrien Springs (Berrien)
Bessemer (Gogebic)

Beulah (Benzie)

Big Rapids (Mecosta)

Birch Run (Saginaw)
Birmingham (Oakland)
Blanchard (Isabella)
Blissfield (Lenawee)
Bloomfield Hills (Oakland)
Bloomingdale (Van Buren)
Boyne City (Charlevoix)
Branch (Mason)
Breckenridge (Gratiot)
Bridgeport (Saginaw)
Bridgman (Berrien)
Brighton (Livingston)
Bronson (Branch)

Brooklyn (Jackson)

Brown City (Sanilac)
Buchanan (Berrien)

Byron Center (Kent)

Cadillac (Wexford)
Caledonia (Kent)

Calumet (Houghton)
Camden (Hillsdale)

Capac (St. Clair)

Carleton (Monroe)

Caro (Tuscola)

Caseville (Huron)

Cass City (Tuscola)
Cassopolis (Cass)

Cedar Springs (Kent)
Center Line (Macomb)
Centreville (St. Joseph)
Champion (Marquette)
Charlevoix (Charlevoix)
Charlotte (Eaton)

Chassell (Houghton)
Cheboygan (Cheboygan)
Chelsea (Washtenaw)
Chesaning (Saginaw)

Clare (Clare)

Clarkston (Oakland)

Clawson (Oakland)

Clinton (Lenawee)

Clio (Genesee)

Coldwater (Branch)

Coleman (Midland)

Coloma (Berrien)

Colon (St. Joseph)
Columbiaville (Lapeer)
Concord (Jackson)

Constantine (St. Joseph)
Coopersville (Ottawa)

Corunna (Shiawassee)

Croswell (Sanilac)

Crystal Falls (Iron)

Custer (Mason)

Daggett (Menominee)

Davison (Genesee)

Dearborn (Wayne)

Dearborn Heights (Wayne)
Decatur (Van Buren)
Deckerville (Sanilac)

Deerfield (Lenawee)

Delton (Barry)

Detroit (Wayne)

Dewitt (Clinton)

Dexter (Washtenaw)

Douglas (Allegan)

Dowagiac (Cass)

Drayton Plains (Oakland)
Drummond Island (Chippewa)
Dundee (Monroe)

Durand (Shiawassee)

Eagle Harbor (Keweenaw)

East Detroit (Macomb)'

East Jordan (Charlevoix)

East Lansing (Ingham)

East Tawas (Iosco)

Eaton Rapids (Eaton)

Ecorse (Wayne)

Edmore (Montcalm)
Edwardsburg (Cass)

Elk Rapids (Antrim)

Elkton (Huron)

Eloise (Wayne)

Elsie (Clinton)

Engadine (Mackinac)

Escanaba (Delta)

Essexville (Bay)

Evart (Osceola)

Fairgrove (Tuscola)
Farmington (Oakland)

Farwell (Clare)

Fennville (Allegan)

Fenton (Genesee)

Fenwick (Montcalm)

Ferndale (Oakland)

Flat Rock (Wayne)

Flint (Genesee)

Flushing (Genesee)

Fowlerville (Livingston)
Frandor (Ingham)
Frankenmuth (Saginaw)
Frankfort (Benzie)

Franklin (Oakland)

Fraser (Macomb)

Freeland (Saginaw)

Fremont (Newaygo)

Galesburg (Kalamazoo)
Garden City (Wayne)

Gaylord (Otsego)

4 JANUARY, 1972/Michigan Medicine

i the Counties

containing doctors.

Gladstone (Delta)

Gladwin (Gladwin)

Glen Arbor (Leelanau)

Gobles (Van Buren)

Goodrich (Genesee)

Grand Beach (Berrien)

Grand Blanc (Genesee)

Grand Haven (Ottawa)

Grand Ledge (Eaton)

Grand Marais (Alger)

Grand Rapids (Kent)

Grandville (Kent)

Grant (Newaygo)

Grayling (Crawford)

Greenville (Montcalm)

Grosse lie (Wayne)

Gwinn (Marquette)

Hamburg (Livingston)

Hamilton (Allegan)

Hamtramck (Wayne)

Hancock (Houghton)

Hanover ( Jackson)

Harbert (Berrien)

Harbor Beach (Huron)

Harbor Springs (Emmet)

Harper Woods (Wayne)

Harrison (Clare)

Harrisville (Alcona)

Harsens Island (St. Clair)

Hart (Oceana)

Hartford (Van Buren)

Haslett (Ingham)

Hastings (Barry)

Hazel Park (Oakland)

Hemlock (Saginaw)

Hessel (Mackinac)

Hickory Corners (Barry)
Highland (Oakland)

Highland Park (Wayne)

Hillsdale (Hillsdale)

Holland (Ottawa)

Holly (Oakland)

Holt (Ingham)

Homer (Calhoun)

Horton (Jackson)

Houghton (Houghton)

Howell (Livingston)

Hudson (Lenawee)

Hudsonville (Ottawa)
Huntington Woods (Oakland)

Imlay City (Lapeer)

Indian River (Cheboygan)
Inkster (Wayne)

Ionia (Ionia)

Iron Mountain (Dickinson)

Iron River (Iron)

Ironwood (Gogebic)

Ishpeming (Marquette)

Ithaca (Gratiot)

Jackson (Jackson)

Jamestown (Ottawa)

Jonesville (Hillsdale)

Kalamazoo (Kalamazoo)
Kalkaska (Kalkaska)

Keego Harbor (Oakland)

Kent City (Kent)

Kinde (Huron)

Kingsford (Dickinson)

Lake City (Missaukee)

Lakeland (Livingston)

Lake Odessa (Ionia)

Lake Orion (Oakland)

Lakeview (Montcalm)
Lambertville (Monroe)

LAnse (Baraga)

Lansing (Ingham)

Lapeer (Lapeer)

La Salle (Monroe)

Lathrup Village (Oakland)
Laurium (Houghton)

Lawrence (Van Buren)

Lawton (Van Buren)

Leonidas (St. Joseph)

Leslie (Ingham)

Lincoln Park (Wayne)

Linden (Genesee)

Litchfield (Hillsdale)

Livonia (Wayne)

Lowell (Kent)

Ludington (Mason)

Luther (Lake)

Luzerne (Oscoda)

Mackinaw Island (Mackinac)
Madison Heights (Oakland)
Manchester (Washtenaw)
Manistee (Manistee)

Manistiquc (Schoolcraft)
Manitou Beach (Lenawee)
Marcellus (Cass)

Marine City (St. Clair)

Marion (Osceola)

Marlette (Sanilac)

Marquette (Marquette)

Marshall (Calhoun)

Martin (Allegan)

Marysville (St. Clair)

Mason (Ingham)

Mecosta (Mecosta)

Melvindale (Wayne)

Memphis (St. Clair)

Menominee (Menominee)
Merrill (Saginaw)

Metamora (Lapeer)

Michigan Center (Jackson)
Middleville (Barry)

Midland (Midland)

Milan (Washtenaw)

Milford (Oakland)

Millington (Tuscola)

Mio (Oscoda)

Monroe (Monroe)

Montague (Muskegon)
Montrose (Genesee)

Morenci (Lenawee)

Mount Clemens (Macomb)
Mount Morris (Genesee)

Mount Pleasant (Isabella)

Muir (Ionia)

Mullet Lake (Cheboygan)
Munising (Alger)

Muskegon (Muskegon)
Muskegon Heights (Muskegon)

Nashville (Barry)

Negaunee (Marquette)
Newaygo (Newaygo)

Newberry (Luce)

New Buffalo (Berrien)

New Era (Oceana)

New Port (Monroe)

Niles (Berrien)

North Branch (Lapeer)

North Muskegon (Muskegon)

North port (Leelanau)

Northville (Wayne)

Norway (Dickinson)

Oak Park (Oakland)

Okemos (Ingham)

Olivet (Eaton)

Onaway (Presque Isle)

Onsted (Lenawee)

Ontonagon (Ontonagon)

Orchard Lake (Oakland)

Oscoda (Iosco)

Ossineke (Alpena)

Otisville (Genesee)

Otsego (Allegan)

Ovid (Clinton)

Owosso (Shiawassee)

Oxford (Oakland)

Parchment (Kalamazoo)

Parma (Jackson)

Paw Paw (Van Buren)

Pentwater (Oceana)

Petoskey ("Emmet)

Pigeon (Huron)

Pinckney (Livingston)

Pinconning (Bay)

Plainwell (Allegan)

Pleasant Lake (Jackson)

Pleasant Ridge (Oakland)

Plymouth (Wayne)

Pontiac (Oakland)

Portaee (Kalamazoo)

Port Huron (St. Clair)

Portland (Ionia)

Potterville (Eaton)

Prudenville ("Roscommon)

Pullman (Allegan)

Quincy (Branch)

Reading (Hillsdale)

Reed City (Osceola)

Reese (Tuscola)

Remus (Mecosta)

Richland ("Kalamazoo)

Richmond (Macomb)

River Rouge (Wayne)

Riverview (Wayne)

Rives Junction ("Jackson)

Rochester (Oakland)

Rockford ("Kent)

Rockwood (Wayne)

Rogers City (Presque Isle)

Romeo (Macomb)

Romulus (Wayne)

Roscommon (Roscommon)

Rosebush (Isabella)

Roseville (Macomb)

Royal Oak (Oakland)

Saginaw (Saginaw)

Sagola (Dickinson)

Saline (Washtenaw)

Sandusky (Sanilac)

Sanford (Midland)

Saranac (Ionia)

Saugatuck (Allegan)

Sault Sainte Marie (Chippewa)

Sawyer (Berrien)

Schoolcraft (Kalamazoo)

Scottville (Mason)

Sebewaing (Huron)

JANUARY,

Shelby (Oceana)

Sidney (Montcalm)

Southfield (Oakland)

Southgate (Wayne)

South Haven (Van Buren)

South Lyon (Oakland)

Sparta (Kent)

Spring Lake (Ottawa)

Stambaugh (Iron)

Standish (Arenac)

Stanton (Montcalm)

St. Charles (Saginaw)

St. Clair (St. Clair)

St. Clair Shores (Macomb)
Stephenson (Menominee)

Sterling Heights (Macomb)

St. Ignace (Mackinac)

St. James (Charlevoix)

St. Johns (Clinton)

St. Joseph ("Berrien)

St. Louis (Gratiot)

Stockbridge (Ingham)

Sturgis (St. Joseph)

Sunfield (Eaton)

Suttons Bay (Leelanau)

Swartz Creek (Genesee)

Tawas City (Iosco)

Taylor (Wayne)

Tecumseh (Lenawee)
Temperance (Monroe)

Three Rivers (St. Joseph)
Traverse City (Grand Traverse)
Trenton (Wayne)

Troy (Oakland)

Trufant (Montcalm)

Ubly (Huron)

Union City (Branch)

Union Lake (Oakland)

Utica (Macomb)

Vandalia (Cass)

Vassar (Tuscola)

Vicksbure (Kalamazoo)

Vulcan (Dickinson)

Wakefield (Gogebic)

Walkerville (Oceana)

Walled Lake (Oakland)

Warren (Macomb")

Waterford (Oakland)

Watervliet (Berrien)

Wayland ("Allegan)

Wayne (Wayne)

Weidman ("Isabella)

Wellston (Manistee)

West Branch (Ogemaw)
Westland (Wayne)

Westphalia ("Clinton)

White Cloud (Newaygo)
Whitehall (Muskegon)

White Pigeon (St. Joseph)

White Pine (Ontonagon)
Whitmore Lake (Washtenaw)
Williamston (Ingham)

Wixom (Oakland)

Wyandotte (Wayne)

Wyoming (Kent)

Yale (St. Clair)

Ypsilanti (Washtenaw)

Zeeland (Ottawa)

1972/Michigan Medicine 5

Directory, Listed by Component
Medical Societies

Special memberships are indicated as follows: “L” for Life Member;
“M” for Military Members; “N” for Non-Resident Members; “R” for
Retired Members; “A” for Associate Members; “O” for Osteopathic
Associate Members; all others are Active Members.

ALLEGAN

WILLIAM H SCHOCK MD
315 MAPLE ST
SAUGATUCK MICH

*9*53

JAMES GREENWOOD MD
115 N FIRST ST
ALPENA MI

*9707

A PETER BRACHMAN JR
222 TROWBRIDGE ST
ALLEGAN MICH

MD

*9010

ELWIN W TOPP MD
353 NAOMI ST
PLAINWELL MICHIGAN

*9080

ALI GUNER MD
115 N FIRST AVE
ALPENA MI

*9707

WALTER E CHASE MO
223 W BRIDGE
PLAINWELL MICHIGAN

*9080

ORHAN A TUGRUL MD
*25 CUTLER ST
ALLEGAN MI

*9010

EDWARD A HIER MO
125 N SECONO AVE
ALPENA MICH

*9707

JAMES I CLARK MD
ROUTE 1 BOX 25D
FENNVILLE MICH

*9*08

WILLARD R VAUGHAN MD
PLAINWELL MI

L

*9080

WM F JACKSON MD
RFD 1 HURON SHORE DR
ROGERS CITY MI

*9779

HARLAND C DANGLE MD
3650 LARCHMONT DR
ANN ARBOR MI

*8105

BERTHA C WISEMAN MD
R R ** BOX 1*3
ALLEGAN MICH

*9010

W F KUTSCHE MD
208 LAKE ST
OSCODA MICH

*8753

G B GODDARD MD
218 E ORLEANS
OTSEGO MICH

*9078

C R YANG MD
*12 WATER ST
ALLEGAN MI

*9010

W K LEHMANN MD
ALPENA GEN HOSP
ALPENA MI

*9707

JAMES D HAYS MD
DOUGLAS MICHIGAN

*9*06

ALPENA

J M LEOPARO MD
312 E CHISHOLM
ALPENA MICH

*9707

ELWIN B JOHNSON MD
ROUTE 1
PULLMAN MI

L

*9*50

PETER ALIFERIS MO
ALPENA GENERAL HOSP
ALPENA MICHIGAN

*9707

C L MCOOUGALL MD
601 W CHISHOLM ST
ALPENA MI

*9707

MARIETTA J KAYLOR MD
500 LINN ST
ALLEGAN MI

*9010

SURINDAR S BEDI MD
FINCH CLINIC
ONAWAY MI

*9765

WM E NESBITT MD
123 N 2NO AVE
ALPENA MICH

*9707

VAN 0 KEELER MD
30* DIX ST
OTSEGO MI

*9078

JOHN W BUNTING MD
P 0 BOX 5*2
ALPENA MI

R

*9707

F C 0 DELL JR MD
615 W CHISHOLM ST
ALPENA MICH

*9707

LAWRENCE LAGATUTTA MD

H J BURKHOLDER MD

L

BRUCE R OHMART MD

560 LINN ST
ALLEGAN MI

*9010

122 N SECOND AVE
ALPENA MICH

*9707

108 SO FIRST ST
ALPENA MI

*9707

JAMES E MAHAN MD

L

STUART L COHN MD

ELBERT S PARMENTER MD L

*02 TROWBRIDGE ST
ALLEGAN MICH

*9010

1253 W WASHINGTON
ALPENA MICH

*9707

*13 E FIRST ST
DIXON ILLINOIS

61021

KENNETH C MILLER MD
SAUGATUCK MI

*9*53

AENEAS CONSTANTINE MD
HARRISVILLE MI *87*0

ROBT C RIES MD
573 N BRADLEY HWY
ROGERS CITY MI

*9779

R L PLAGENHOFF MD
30* OIX ST
OTSEGO MI

*9078

THOMAS J COOK MD
312 E CHISHOLM ST
ALPENA Ml

*9707

JOHN L RIKER MD
601 N SECONO
ALPENA MICHIGAN

*9707

JANIS PONE MD
MARTIN MICH

*9070

CHARLES T EGLI MD
312 E CHISHOLM ST
ALPENA MI

*9707

PAUL A SCHOLTENS MD
ALPENA GEN HOSP
ALPENA MI

*9707

MICHAEL SYED OUADIR
P 0 BOX 326
FENNVILLE MI

MD

*9*08

DONALD E FINCH MD
ONAWAY MI

*9765

JAMES E SPENS MD
123 N SECOND AVE
ALPENA MICH

*9707

GLADWIN E RAMSEYER MD
125 E BRIDGE

PLAINWELL MICH *9080

RICHARD FOLEY MD
ROGERS CITY MICH

*9779

HENRY B STIBIT2 MO
1065 US 23 NORTH
ALPENA MI

*9707

HARRY E SCHNE ITER MD
*25 CUTLER ST
ALLEGAN MICH

*9010

WILLIAM L FOX MD
601 W CHISHOLM ST
ALPENA MI

*9707

DANA A TOMPKINS MD
POSEN MICH

*9776

DARWIN E WAGONER MD
5007 N CEDAR LAKE RD

OSCODA MICHIGAN *8753

T M WATKINS MD

312 E CHISHOLM ST

ALPENA MICHIGAN *9707

T W WIENC2EWSKI MD
919 N 2ND AVE

ALPENA MICH *9707

CARLOS S WILLIS MD
113 STATE AVE

ALPENA Ml *9707

RICHARD F WILLIS MD

312 E CHISHOLM

ALPENA MI *9707

CHAS S WILSON MD L

730 STATE AVE

ALPENA MICH *9707

BARRY

JAMES E ATKINSON MD

523 E CHARLES ST

HASTINGS MI *9058

WM D BAXTER MD

1005 W GREEN ST

HASTINGS MI *9058

LARRY BLAIR MD
1005 W GREEN

HASTINGS MI *9058

JACK A BROWN MD
535 FRANCIS

HASTINGS MI *9058

DOUGLAS H CASTLEMAN MD

607 N BROADWAY

HASTINGS MICHIGAN *9058

RAYMOND G FINNIE MD A

535 E FRANCIS

HASTINGS MICH *9058

ALEXANDER B GWINN MD L

860 OAK ST P0 BOX 307
BALDWIN MI *930*

JOS 0 HEASLIP MD R

100 BLUFF VIEW DR

BELL E A I R BLUFFS FL 335*0

R J HUEBNER MD

1005 W GREEN ST

HASTINGS MI *9058

STEWART L0FDAHL MD R

R 1 BOX 172

ST CHARLES IL 6017*

WESLEY G LOGAN MD

1005 W GREEN ST

HASTINGS MICHIGAN *9058

6 JANUARY, 1972/Michigan Medicine

49058

49073

49058

49058

48849

R

48706

48706

L

48706

48706

48706

R

85201

48706

45206

I

48706

10

48706

48730

L

48706

48650

48706

48732

48706

48706

Bay County

RAYMOND R COOK MD
1115 FIFTH STREET
BAY CITY MICHIGAN 48706

STANLEY A COSENS MD
101 W JOHN ST

BAY CITY MICH 48706

ROBT R CRISSEY MD

1405 CENTER AVE

BAY CITY MICH 48706

ROBT H CRISWELL MD L

3419 PORTAGE BLVD #43
FT WAYNE INDIANA 46804

NICHOLAS CSONKA MD

1308 COLUMBUS AVE

BAY CITY MICHIGAN 48706

MICHAEL J DARDAS MO

1413 CENTER AVE

BAY CITY MICHIGAN 48706

JAMES H DAVIS MD
1308 COLUMBUS

BAY CITY MICHIGAN 48706

MALCOLM K DOLBEE MD
BOX 518

STANDI SH MICHIGAN 48658

JAMES L FENTON MD

701 N GRANT ST

BAY CITY MI 48706

ROBERT FERGUSON MD
101 W JOHN ST

BAY CITY MICHIGAN 48706

HANS FISCHER MD

ST AN DI SH MICHIGAN 48658

MARTIN D JAFFE MD

2110 1 6TH STREET

BAY CITY MICHIGAN 48706

RICHARD L JANKOWSKA MD

303 DAVIDSON BLDG

BAY CITY MI 48706

OTTO F JENS MD L

ROUTE #1

WHITTEMORE MI 48770

ORLEN J JOHNSON MD L

105 PARKWOOD

BAY CITY MI 48706

M CULVER JONES MD
900 N JACKSON

BAY CITY MICH 48706

TYRE K JONES I I I MD
1639 CARLA CT

ESSEXVILLE MI 48732

LARRY STANLEY KELLY MD

TAWAS CITY MICHIGAN 48763

SABINA KESSLER FRUX MD L

504 W MIDLAND ST

BAY CITY MI 48706

HOWARD T KNOBLOCH MD

1102 COLUMBUS

BAY CITY MICH 48706

MARTA SZEGO KOLTAY MD

3439 HIGHLAND WOODS

BAY CITY MI 48706

OSCAR P KOLTAY MD

3439 HIGHLAND WOODS

BAY CITY MI 48706

ALLEN B MOORE MD

1106 S MADISON ST

BAY CITY MI 48706

NEAL R MOORE MD

2138 FIFTH STREET

BAY CITY MICH 48706

DWIGHT J HOSIER MD
101 W JOHN ST

BAY CITY MICH 48706

SEZAI OLGAC MD
101 W JOHN ST

BAY CITY MI 48706

NORMAN P PAYEA MD

1198 COURT DRIVE

EAST TAWAS MI 48730

STANLEY M PEARSON MD
101 W JOHN ST

BAY CITY MICH 48706

B L PEDERSON MO
2108 16TH ST

BAY CITY MI 48706

WALTER E PELCZAR MD

1308 COLUMBUS AVE

BAY CITY MICH 40706

ROBT C PROPHATER MD

202 BOEHRINGER CT

BAY CITY MICHIGAN 48706

ALAN A RE I 0 INGE R MD M

4307 ELMWOOD

ROYAL OAK MI 48073

E H RODDA MD
101 W JOHN ST

BAY CITY MICH 48706

WM M POLL I S MD
101 W JOHN

BAY CITY MICH 48706

WM G GAMBLE JR MD L

2010 5TH AVE

BAY CITY MICH 48706

JOHN T GENECZKO MD

1308 COLUMBUS AVE

BAY CITY MICH 48706

JOHN W GRIGG MD

515 MULHOLLAND ST

BAY CITY MICHIGAN 48706

MONO GUERAMY MD
1411 CENTER AVE
BAY CITY MI 48706

ROBERT C HAFFORD MD

101 W JOHN ST

BAY CITY MICH 48706

GAYLAND L HAGELSHAW MD
101 W JOHN ST

BAY CITY MICH 48706

HAROLD H HEUSER MD
916 WASHINGTON AVE
BAY CITY MICH 48706

S AML F HOROWITZ MD

1415 CENTER AVE

BAY CITY MICH 48706

WALTER L HOWLAND MD

2110 E 16TH ST

BAY CITY MI 48706

MAURICE E HUNT MD
5000 MAPLE ST

FAIRGROVE MI 48733

J E JACQUES MD

TAWAS CITY MICHIGAN 48763

LASZLO KOVACSI MD
820 N JOHNSON

BAY CITY MICHIGAN 48706

EUGENE J KULINSKI MD
2110 1 6TH ST

BAY CITY MICHIGAN 48706

LESLIE A LAMBERT MD R

ROUTE #2

EAST TAWAS MICHIGAN 48730

JOHN L LANGIN MD

100 15TH ST

BAY CITY MICH 48706

JOHN A LEY MD

101 W JOHN ST

BAY CITY MI 48706

G B LOAN M D
ESSEXVILLE MDCL BLDG
ESSEXVILLE MI 48732

JOSEPH LOREE MD
2110 16TH ST

BAY CITY MICHIGAN 48706

JOHN C MAYNE M 0
2108 16TH ST

BAY CITY MICH 48706

HARRY B MC GEE MD
101 W JOHN

BAY CITY MICHIGAN 48706

PETER L MC GEE M 0
2110 16TH ST

BAY CITY MICH 48706

LEO B MC SHERRY JR MD

1308 COLUMBUS AVE

BAY CITY MICH 48706

ARLYN MOELLER MD

700 BORTON AVE

ESSEXVILLE MICHIGAN 48732

CHARLES S ROGERS MD
101 W JOHN ST

BAY CITY MICHIGAN 48706

PAUL W ROWE MD
MERCY HOSPITAL
BAY CITY MICHIGAN 48706

WM J SCHMELZER MD
602 MERCER ST PO 746

PINCONNING MICHIGAN 48650

HAROLO C SHAFER MD
101 W JOHN ST

BAY CITY MICH 48706

HUBERT L SHIELDS MD
101 W JOHN ST

BAY CITY MICH 48706

L I V I US N STROIA MD
101 W JOHN ST

BAY CITY MICH 48706

R L SUTTON JR MD

116 W STATE ST

EAST TAWAS MICH 48730

Z I A E TAHERI MD

1411 CENTER AVENUE

BAY CITY MICHIGAN 48706

NASIT TANAL MD
101 W JOHN ST

BAY CITY MI 48706

CLYDE S TARTER MD R

ROUTE 5

ALPENA MI 49707

BERHAN I TOSUNER MD

1106 S MADISON

BAY CITY MI 48706

GAYLORD TREADWAY MD
900 N JACKSON

BAY CITY MICH 48706

JANUARY, 1972/Michigan Medicine 7

LISTED BY COMPONENT MEDICAL SOCIETIES

Bay County

HARRY F VAIL MO
564 W HAMPTON RO
ESSEXVILLE MI

48732

JOHN R BRUNI M 0
1 SOUTH FIFTH ST
NILES MICH

49120

MARSHALL J FEELEY MO
2516 NILES AVE
ST JOSEPH MICH

49085

P VANASUPA MO
101 W JOHN ST
BAY CITY MICHIGAN

48706

FRANK H BUNKER MD
7770 RIVERVIEW OR #108
BENTON HARBOR MI 49022

MORRIS E FRIEOMAN MD
115 N BARTON ST
NEW BUFFALO MI

49117

JOHN H WAY MO
101 W JOHN ST
BAY CITY MI

48706

HALE W CADIEUX MO
645 RIVERVIEW DR
BENTON HARBOR MICH

49022

JAMES 0 GALLES MD
PAW PAW ISLAND
COLOMA MI

49038

THOS G WILSON MO
210 PHILADELPHIA CT
PALM HARBOR FL

R

33563

OONALD C CAMP MD
8 N ST JOSEPH AVE
NILES MICH

49120

SAMUEL H GOULD MO
1850 COLFAX AVE
BENTON HARBOR MICH

49022

JOHN WINBURNE MD
101 W JOHN ST
BAY CITY MI

48706

JOHN H CARTER MO
687 E EMPIRE AVENUE
BENTON HARBOR MICH

49022

BARBARA G GREEN MO
2600 MORTON STREET
ST JOSEPH MICH

49085

HARRIS L WOOOBURNE MD

1420 CENTER ST

BAY CITY MICH 48706

HAROLD J CAWTHORNE MO R

R 4 BOX 201

COLOMA MI 49038

ROBT L GREEN MD
2600 MORTON STREET
ST JOSEPH MICH

49085

THOMAS B WRIGHT MO
101 W JOHN ST
8AY CITY MICH

48706

WM A CHICKERING MO
2016 LAKE V I EW
ST JOSEPH MI

49085

JAMES H GROVE MD
102 NO 4TH ST
NILES MI

49120

ALOIS L ZILIAK JR MD
3447 HIGHLANO WOODS
BAY CITY MICH

48706

S G C1LELLA M 0
PAWATING HOSPITAL
NILES MICH

49120

HAROLD M GRUNOSET MO
61 N ST JOSEPH AVE
NILES MICHIGAN

49120

BERRIEN

JOS CONWAY MD
358 N MAIN
WATERVLIET MI

49098

RALPH 0 GUSTIN MO
PO BUX 159
BERRIEN SPRINGS MI

49103

OEAN R ASSELIN MO
2817 S STATE ST
ST JOSEPH MICHIGAN

49085

ROBT C CONYBEARE MD
7770 RIVERVIEW DR
BENTON HARBOR MICH

49022

HERALO A HABENICHT MD
ANDREWS UN I V MED CTR
BERRIEN SPRINGS MI 49103

ROBERT L ATKINSON MO
777-0 RIVERVIEW OR
BENTON HARBOR MI

49022

WELDON COOKE MO
BERRIEN GENERAL HOSP
BERRIEN CENTER MICH

49102

ARTHUR S HAIGHT MO
645 RIVERVIEW DR
BENTON HARBOR MI

49022

RUDOLFO 8 8AC0L0R MD
687 E EMPIRE AVE
BENTON HARBORN HI

49022

WM L COOPER MO
ROUTE 4 BOX 78
COLOMA MI

49038

0 KENT HASSAN MD
802 E FRONT ST
BUCHANAN MICH

49107

JOHN H BAILEY MO
2150 SAMUEL AVE
BENTON HARBOR MICH

49022

RUSSELL T COSTELLO MO

645 RIVERVIEW DR

BENTON HARBOR MI 49022

EDWARD C HAUPT MO
7770 RIVERVIEW DR
BENTON HARBOR MICH

49022

GERALD N BEAL MO
2817 S STATE ST
ST JOSEPH MICH

49085

WALTER S DAILEY MD
122 GRANT ST
NILES MICHIGAN

49120

FRED C HENDERSON MO
703 E MAIN
NILES MICH

49120

WM H BENNER MD
960 AGARO ST LAB
BENTON HARBOR MI

49022

ARCHIE J DALGLEISH MO
373 N MAIN ST

WATERVLIET MICH 49098

NOEL J HERSHEY MO
PO BOX 222
NILES MICH

49120

HECTOR BENSIMON MD
777-0 RIVERVIEW OR
BENTON HARBOR MI

49022

JOHN E DOOLITTLE MD
9 S ST JOSEPH AVENUE
NILES MICHIGAN

49120

DAVID W HILLS MO
2821 STATE ST
ST JOSEPH MICHIGAN

49085

I AM P BHISITKUL MO
1903 OAK ST
NILES MI

49120

HAZEL 0 EIOSON M 0
413 N BLUFF
BERRIEN SPRINGS MI

L

49103

FRANK W HOWARD MO
756 PIPESTONE
BENTON HAR80R MICH

49022

DIXON L BIERI MO
645 RIVERVIEW OR
BENTON HARBOR MICH

49022

RICHARD M ELGHAMMER
1850 COLFAX AVE
BENTON HARBOR MICH

MO

49022

DEAN HUONUTT MO
807 MYRTLE ST
ST JOSEPH MI

49085

AUGUST F BLIESMER MO
505 PLEASANT ST
ST JOSEPH MICH

49085

CLAYTON S EMERY MO
1329 LAKE BLVD
ST JOSEPH MI

L

49085

HAROLD 0 HUFF MD
126-1/2 E MAIN ST
NILES MICH

R

49120

WILLIAM C BOCK MO
645 RIVERVIEW DR
BENTON HARBOP MI

49022

WM K EMERY MD
1020 NILES AVE
ST JOSEPH MICH

49085

EDWIN R IRGENS MD

11 PEOPLES ST BK BLDG

ST JOSEPH MICH 49085

CHARLES E BOONSTRA MO
MERCY HOSPITAL LAB
BENTON HARBOR MI 49022

MICHAEL FABER MO
756 PIPESTONE ST
BENTON HARBOR MICH

49022

WADI J JIBRAIL MD
2912 S STATE ST
ST JOSEPH MI

49085

JOHN W BRINK MD
807 MYRTLE ST
ST JOSEPH MI

49085

ROLANDO M FAJARDO MD
429 PAW PAW

COLOMA MI

49038

WM H JOHNSTON MD
715 MARKET ST
ST JOSEPH MICH

49085

JACK BRONFENBRENNER
687 E EMPIRE AVE
BENTON HARBOR MICH

MO

49022

GROVER R FATTIC JR MD

61 N ST JOSEPH AVE

NILES MICHIGAN 49120

HARVEY I KELSALL MD
1600 NILES AVE
ST JOSEPH MICH

49085

W J KENFIELD MO
P 0 BOX 6

ST JOSEPH MI 49085

F ALAN KENNEDY MO
315 FIDELITY BLDG
BENTON HARBOR MICH 49022

ORHAN KILIC MO

8 N ST JOSEPH ST

NILES MI 49120

FRANK A KING JR MO
858 PIPESTONE

BENTON HARBOR MICH 49022

HENRY J KLOS MO

777-0 RIVERVIEW OR

BENTON HARBOR MI 49022

R08T L LANDGRAF MO
PO BOX 222

NILES MICH 49120

K ROBERT LANG MO
ANDREWS UN I V MED CTR
BERRIEN SPRINGS MI 49103

DAVID W LEARNED MO

645 RIVERVIEW DR

BENTON HARBOR MICH 49022

BYUNG HOON LEE MO

925 PIPESTONE ST

BENTON HARBOR MI 49022

HA I SOON LEE MO

711 BEECHWOOD DRIVE

NILES MICHIGAN 49120

JOHN B LEVA MO
1122 SALEM AVE
BENTON HARBOR MICH 49022

FREDK H LINDENFELD MO
8 N ST JOSEPH AVE

NILES MICH 49120

RICHARO E LININGER MO
2712 HIGHLAND CT
ST JOSEPH MICH 49085

FRANK LINN MD
2522 NILES

ST JOSEPH MICH 49085

AQUILES G LIRA MO
PAWATING HOSP

NILES MI 49120

GENE E MAOOOCK MO
MERCY HOSP X-RAY DEPT
BENTON HARBOR MI 49022

J T MC LELLANO MD
MERCY HOSP X RAY DEPT
BENTON HARBOR MICH 49022

STANLEY M MESIROW MO

777D RIVERVIEW OR

BENTON HARBOR MICH 49022

T SCOTT MOORE MO

24 NO ST JOSEPH

NILES MICH 49120

CHAN NAMTZE MD
302 BROADWAY

NILES MICHIGAN 49120

JOHN J 0 TOOLE MD
133 E NAPIER

BENTON HARBOR MICH 49022

CHAS J OZERAN MO
127 E NAPIER

BENTON HARBOR MICH 49022

WM J PAOELFORD MD

206 WHIPPLE BLVD

SOUTH LYON MI 48178

8 JANUARY, 1972/Michigan Medicine

49085

49120

49022

49022

49106

49085

49022

49085

49085

49022

49102

49085

49022

49022

49120

ID

49102

49085

49022

i

49117

49117

49107

49085

49102

MEMBERS

Calhoun County

H 0 WESTERVELT MD L

539 PEARL ST

BENTON HARBOR MI 49022

DEAN WILLSON MD

777D RIVERVIEW DR

BENTON HARBOR MICH 49022

CLINTON W WILSON MD

925 PIPESTONE ST

BENTON HARBOR MICH 49022

WARREN A WISE MD

777D RIVERVIEW DR

BENTON HARBOR MI 49022

BRANCH

NAPIER S ALDRICH MD

162 MARSHALL ST

COLDWATER MICH 49036

CHARLES R BACON MD
300 E CHICAGO ST
COLDWATER MICH 49036

JAMES E BAILEY JR MD
300 E CHICAGO ST
COLDWATER MICH 49036

JAMES R BAKER MD
ROUTE 7 BOX 239B
COLDWATER MI 49036

VANGALA P REODY MD
292 E CHICAGO ST
COLDWATER MI 49036

FREDERICK C REIGLE MD

LITCHFIELD MICHIGAN 49252

JOHN J RICK MD

61 E CHICAGO ST

COLDWATER MICHIGAN 49036

H K SCHILLINGER MD
300 BERKLEY

DEARBORN MI 48124

CARL A SHURTZ MD
56 BISHOP AVE

COLDWATER MI 49036

MALCOLM D STEIDER MD
ROUTE 7 BOX 248
COLDWATER MI 49036

WILLIAM K STEWART MD
403 ANN ST

UNION CITY MICHIGAN 49094

JAMES A THOMAS MD L

1200 NO SHORE OR #108
ST PETERSBURG FL 33701

F P VALDERRAMA MD
235 E CHICAGO

COLDWATER MI 49036

ROY H BAR I BEAU MD L

1003 CAPITAL AVE SW
BATTLE CREEK MI 49015

GEORGE H BARTELS MD
151 NORTH AVE

BATTLE CREEK MI 49017

JOHN BERGHORST MD A

89 S LAVISTA BLVD

BATTLE CREEK MI 49015

PHILIP P BONIFER JR MD
131 E COLUMBIA #213
BATTLE CREEK MI 49015

PHILIP P BONIFER MD
231 NORTH AVE

BATTLE CREEK MICH 49017

ROBT W BROWN MD

231 NORTH AVENUE

BATTLE CREEK MICH 49017

MARTIN F BUELL MD A

V A HOSPITAL

FT CUSTER MICHIGAN 49016

ALICE F CAMPBELL MO

103 E MULBERRY ST

ALBION MICH 49224

RICHARD J CAMPBELL MD R
BOX 158 CAPE HAZE
PLACIDA FL 33946

DEAN T CULVER MD
173 E CHICAGO ST
COLDWATER MICH

49036

NATHANIEL J WALTON MD
BOX 148

COLDWATER MICHIGAN 49036

MARCELO CANLAS MD
LEILA HOSPITAL
9 EMMETT ST

ROBT J FRASER MD
52 FAIRFIELD DR
COLDWATER MICH 49036

ORMOND 0 GEIB MO L

133 WALNUT BLVD
ROCHESTER MI 48063

JACK GIFT MO
274 E CHICAGO ST
COLDWATER MI 49036

HENRY C GOMLEY MD

108 E CHICAGO ST

BRONSON MICH 49028

JOHN C HEFFELFINGER MD
292 E CHICAGO AVE
COLOWATER MICH 49036

RONALD H HOEKSEMA MD
292 E CHICAGO ST
COLDWATER MICH 49036

ROBT M LEITCH MD

719 CAPITAL AVE SW

BATTLE CREEK MI 49015

RALPH W LENZ MD
235 E CHICAGO

COLDWATER MI 49036

HAROLD J MEIER MD L

87 W PEARL ST

COLDWATER MI 49036

HENRY R MOO I MD
292 E CHICAGO ST
COLDWATER MICH 49036

HARVEY L MOSS MD
47 CARLYLE

COLDWATER MICHIGAN 49036

CHI EH-CHENG WU MD
235 E CHICAGO ST
COLDWATER MI 49036

CALHOUN

MANUEL A AIRALA MD

1554 E MICHIGAN

ALBION MI 49224

MARTA S AIRALA MD
1554 E MICHIGAN AVE
ALBION MI 49224

ARNOLD A ALBRIGHT MD
R 1 BOX 300

BATTLE CREEK MI 49017

R H ALLEN M D
191 COLLEGE

BATTLE CREEK MICH 49017

NORMAN H AMOS MD R

ROUTE 1 BOX 450

AUGUSTA MI 49012

NORMAN 0 AMOS MD
710 NORTH AVENUE
BATTLE CREEK MI 49017

HAROLD E ANDERSON MD

131 E COLUMBIA AVE

BATTLE CREEK MI 49015

VICTOR AZUELA MD
124 LAKEVIEW AVE
BATTLE CREEK MI 49015

JAMES E BAKER MD A

VA HOSPITAL

BATTLE CREEK MI 49016

BATTLE CREEK MI 49016

M J CAPRON JR MD
806 SECURITY BK BLDG
BATTLE CREEK MICH 49014

L HAROLD CAVINESS MD

185 N WASHINGTON

BATTLE CREEK MICH 49017

PAULINO CHAN MD
105 N JEFFERSON ST
MARSHALL MI 49068

EOWARD M CHANDLER MD
411 MICH NAT BK BLDG
BATTLE CREEK MICH 49014

CHARLES CHEN MD
167 COLLEGE

BATTLE CREEK MI 49017

WM R CHYNOWETH MD L

207 POST BLDG

BATTLE CREEK MICH 49017

JACK E COAKES MD A

716 GORHAM ST

MARSHALL MI 49068

GRAHAM F COLQUHOUN MD

188 COLLEGE ST

BATTLE CREEK MICH 49017

WILLIAM B COMA I MD
710 NORTH AVE

BATTLE CREEK MI 49017

RALPH A CRAM MD

500 S IONIA ST

ALBION MICH 49224

ROBT K CURRY MD

WM E NETTLEMAN MD
87 W PEARL ST

COLDWATER MICHIGAN 49036

KENNETH L OLMSTED MD
675 MONROE

COLDWATER MICHIGAN 49036

RICHARD L BAKKEN MD

200 COLLEGE ST

BATTLE CREEK MICH 49017

STUART P BARDEN MD
LEILA HOSP

BATTLE CREEK MICH 49014

HOMER MI 49245

HAROLD L DALY JR MD

500 S IONIA ST

ALBION MICHIGAN 49224

MARY V DALY MD
201 RIVER ST

ALBION MI 49224

JANUARY, 1972/Michigan Medicine 9

Calhoun County

LISTED BY COMPONENT MEDICAL SOCIETIES

MIRIAM S DALY MO

500 S IONIA ST

ALBION MICH *9224

PAUL J DIAMANTE MD

710 NORTH AVENUE

BATTLE CREEK MICH 49017

M EKREM DIMBILOGLU MD

10 1 B NORTH AVE

BATTLE CREEK MI 49017

LIONEL E DORFMAN MD

1018 NORTH AVE

BATTLE CREEK MI 49017

ROBERT EDWARDS MD A

CHIEF OF STAFF
VA HOSPITAL

BATTLE CREEK MI 49016

STEPHEN FAIRBANKS MD R

WELLSTON MI 49689

F V FEATHERSTONE MD A

400 NORTH AVE

BATTLE CREEK MI 49017

PATRICK S FERAZZI M D

1018 NORTH AVE

BATTLE CREEK MICH 49017

FELIPE B FIGURACION MD
133 PLEASANT VIEW DR
BATTLE CREEK MI 49017

DUWARD L FINCH MD R

719 CAPITAL AVE S W
BATTLE CREEK MICH 49015

ROBT E FISHER MD
1501 W MICHIGAN AVE
BATTLE CREEK MICH 49017

ROBT H FRASER MO L

1112 SECURITY BK BLDG
BATTLE CREEK MI 49014

WM G FRITSCHEL MD
109 W ERIE ST

ALBION MI 49224

L D FUNK MD L

133 W BURR OAK

ATHENS MICHIGAN 49011

A M GIDDINGS MD L

BATTLE CREEK SAN

BATTLE CREEK MI 49017

E PAUL GIESER JR MO
188 COLLEGE

BATTLE CREEK MICH 49017

JOHN G GIRARDOT MD
713 CAPITAL AVE SW
BATTLE CREEK MICH 49015

PHILIP R GLOTFELTY MD

123 S JEFFERSON

MARSHALL MICHIGAN 49068

FRANKLIN L GRAUBNER MD
BOGAR THEATER BLDG
MARSHALL MICH 49068

J ALAN GRAY MD

309 MICH NATL BK BLDG

BATTLE CREEK MICH 49014

HAROLD E GREEN MD
P 0 BOX 1518

BATTLE CREEK MI 49016

JACK C GRIFFITH MD
616 MICH NAT BNK BLDG
BATTLE CREEK MICH 49014

MEHMET E HALAC MD
231 NORTH AVE

BATTLE CREEK MI 49017

ALFRED HAMADY MD

1018 NORTH AVE

BATTLE CREEK MICH 49017

ALFRED C HANSCOM MD

197 N WASHINGTON

BATTLE CREEK MI 49017

HARVEY C HANSEN MD
231 NORTH AVE

BATTLE CREEK MICH 49017

DONALD M HARRIS MD

517 E ROOSEVELT

BATTLE CREEK MI 49017

PHILIP M HENDERSON MD
109 W ERIE

ALBION MICH 49224

J D HENRIKSEN MD A

119 ST PETERS ALBANS
HERTS ENGLAND

MARJORIE J HICKMAN MD A

216 NORTH AVE

BATTLE CREEK MI 49017

C C HIGGINS MD
710 NORTH AVE

BATTLE CREEK MI 49017

GABRIEL 0 HOLLIS MD

124 LAKEVIEW AVE

BATTLE CREEK MI 49015

LEONARD R HOWARD MD
1506 SECURITY TOWER
BATTLE CREEK MI 49014

ARCHIE E HUMPHREY MD

122 N MADISON ST

MARSHALL MI 49068

ARTHUR A HUMPHREY MD
P 0 BOX 1518

BATTLE CREEK MICH 49016

HERBERT E HUMPHREY MD
122 N MAO I SON ST
MARSHALL MICHIGAN 49068

JOHN HUNTINGTON MD
710 NORTH AVE

BATTLE CREEK MICH 49017

ALI ISMAILOGLU MD

242 PARKSHORE DR

BATTLE CREEK MI 49017

DWIGHT JACOBSON MD
411 MICH NATL BANK
BATTLE CREEK MI 49014

JAMES R JEFFREY MO L

62 ANN AVE

BATTLE CREEK MI 49017

MELVIN JOHNSON JR MD

710 NORTH AVENUE

BATTLE CREEK MI 49017

AUBREY H JONES MD A

513 W MICHIGAN AVE
MARSHALL MI 49068

TYRE K JONES MD L

118 W GREEN

MARSHALL MICH 49068

GEO T KELLEHER MD
235 NORTH AVE

BATTLE CREEK MICH 49017

JAMES D KIESS MD
710 NORTH AVE

BATTLE CREEK MI 49017

MATTHEW R KINDE MD A

400 NORTH AVE

BATTLE CREEK MI 49016

PAUL C KINGSLEY MD
191 COLLEGE

BATTLE CREEK MICH 49017

EDWARD J KLOPP MD

173 COLLEGE ST

BATTLE CREEK MICH 49017

GORDON W LAKKE MD
151 NORTH AVE

BATTLE CREEK Ml 49017

FRANCIS L LAM MD
408 CAPITAL AVE S W
BATTLE CREEK MICH 49015

VANCE B LANCASTER MD
710 NORTH AVE

BATTLE CREEK MI 49017

FRANK LANUTI MD
216 NORTH AVE

BATTLE CREEK MI 49017

JOS LEVY JR MD
231 NORTH AVE

BATTLE CREEK MICH 49017

WALTER B LONG MD

HOMER MICH 49245

KENNETH H LOWE MD R

141 PLEASANTVI EW

BATTLE CREEK MICH 49017

STANLEY T LOWE MD R

12 HIAWATHA DR

BATTLE CREEK MI 49015

CAE LUND MO L

226 DOGWOOD TRAIL

BATTLE CREEK MI 49017

JAMES J MAURER MO
616 MICH NATL BK BLOG
BATTLE CREEK MICH 49014

ALFRED G MC CUAIG MD

719 CAPITAL ST S W

BATTLE CREEK MICH 49015

JOHN W MCGEE MD
105 IRWIN AVE

ALBION MICHIGAN 49224

FREDK J MELGES MD
1506 SECURITY TOWER
BATTLE CREEK MICH 49014

HUGH K MOIR MD A

2731 W MICHIGAN

BATTLE CREEK MI 49017

DONALD B MORRISON MD R

719 CAPITAL ST S W
BATTLE CREEK MICH 49015

H F MULLENME I S TER MD

614 N E CAPITAL

BATTLE CREEK MICH 49017

CASMIR MURILLO MD

21136 WAUBASCON RD

BATTLE CREEK MI 49017

JULES L NETREBA MO
112 W MANSION

MARSHALL MI 49068

ANNE F NORGAN MD
131 E COLUMBIA #207
BATTLE CREEK MI 49015

SUSAN J PATRICK MD

181 LAKEWAY DRIVE

BATTLE CREEK Ml 49017

ALBERT J PATT MO
154 WEST ST

BATTLE CREEK MI 49017

DONALD J PEARSON MD
255 NORTH AVE

BATTLE CREEK MICH 49017

CLARENCE T PIER MD A

P 0 BOX 1536

HOLMES BEACH FL 33509

LAWRENCE D PIPE MD

LEILA HOSPITAL

BATTLE CREEK MI 49014

C E POWELL MD
632 NORTH AVE

BATTLE CREEK MI 49017

OONNA POWELL MD A

V A HOSPITAL

FT CUSTER MI 49016

JOHN R POWER MD
154 WEST ST

BATTLE CREEK MICH 49017

ALVIN J RATZLAFF MD

197 N WASHINGTON

BATTLE CREEK MI 49017

F H REGUALOS JR MD
1331 W MICHIGAN AVE
BATTLE CREEK MI 49017

WILMA C W RORICH MD R

164 N DIVISION ST

BATTLE CREEK MI 49017

RUSSELL C ROWAN MD

500 S IONIA ST

ALBION MICHIGAN 49224

CLARK W ROYER MD R

10624 TROPICANA CIR

SUN CITY ARIZ 85351

CHAS J RYAN MD
LEILA HOSP

BATTLE CREEK MICH 49014

FREDERICK J SAWCHUK MD

191 COLLEGE ST

BATTLE CREEK MI 49017

CHARLES L SEIFERT MD
632 NORTH AVE

BATTLE CREEK MI 49017

PEDRO A SEVIDAL JR MD

1018 NORTH AVE

BATTLE CREEK MI 49017

H M SHELLENBERGER MD R

131 W HANOVER

MARSHALL MI 49068

A CLARK SIBILSKY MD A

281 HONEY LANE

BATTLE CREEK MI 49015

ROBT S SIMPSON MD

700 CAPITAL AVE SW

BATTLE CREEK MICH 49015

GEO W SLAGLE MD L

203 CAPITAL AVE NE
BATTLE CREEK MI 49017

RUSSELL T SMITH MD

7864 T DR NORTH

BATTLE CREEK MI 49017

COLL IS M SPENCER MO
308 1/2 S SUPERIOR ST
ALBION MICH 49224

WENDALL H STAOLE MD R

607 JENNINGS LANOING
GOUGAC LAKE

BATTLE CREEK MI 49014

PETER J STEPHENS MD

175 COLLEGE ST

BATTLE CREEK MI 49017

C D STEPHENSON M D
154 WEST ST

BATTLE CREEK MICH 49017

RICHARD A STIEFEL MD L

260 WAHWAHTAYSEE WAY
BATTLE CREEK MICH 49015

10 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Dickinson County

FRANK J STROHMENGER MD

500 S IONIA ST

ALBION MICHIGAN 49224

CLIFFORD B TAYLOR MD

500 S IONIA ST

ALBION MI 49224

MYRON A TAZELAAR MD

219 N MADISON ST

MARSHALL MICH 49068

HARRY VANDER KAMP MD A

V A HOSPITAL

BATTLE CREEK MICH 49016

A GLENN VAN NOORD DDS A
131 E COLUMBIA AVE 210
BATTLE CREEK MI 49015

LLOYD E VERITY MD R

212 HOURGLASS WAY
SARASOTA FL 33581

GUNNAR VETNE MD

725 CAPITAL SW

BATTLE CREEK MICH 49015

CHAS S WALKER MD L

709 W VAN BUREN ST

BATTLE CREEK MICH 49017

JOHN F WALTERS MD
163 NORTH AVE

BATTLE CREEK MICH 49017

WM D WALTERS MD
P 0 80X 1518

BATTLE CREEK MICH 49016

KEITH S WEMMER MD
1472 W MICHIGAN AVE
BATTLE CREEK MICH 49017

SHERWOOD B WINSLOW MD

710 NORTH AVE

BATTLE CREEK MICH 49017

S A YANNITELLI MD
710 NORTH AVE

BATTLE CREEK MI 49017

JOHN R YOUNG MD

719 CAPITAL AVE SW

BATTLE CREEK MICH 49015

MALCOLM C YOUNG MD
P 0 BOX 1518

BATTLE CREEK MI 49016

R B ZAPLITNY MD

1018 NORTH AVE

BATTLE CREEK MI 49017

SOPHIA ZAPLITNY MD A

1018 NORTH AVE

BATTLE CREEK MI 49017

BERTRAM ZHEUTLIN MD
50 ADAMS ST

BATTLE CREEK MI 49015

GEO A ZINDLER MD

1201 SECURITY BNK BLDG

BATTLE CREEK MICH 49014

CASS

URIAH M ADAMS MD

MARCELLUS MI 49067

RUDOLPH I CLARY MD R

204 JAMAICA WAY

PUNTA GORDA FL 33950

JUSTO DEVARONA MD
420 W HIGH ST

DOWAGIAC MI 49047

HENRY V GUZZO MD
515 MAIN ST SUITE 1

DOWAGIAC MI 49047

JOHN K HICKMAN MD R

P 0 BOX 226

DOWAGIAC MICH 49047

KENNETH C PIERCE MD
417 W HIGH ST

DOWAGIAC MICHIGAN 49047

LOWELL D SMITH MD
109 SCHOOL ST

CASSOPOL I S MI 49031

AARON K WARREN MD
109 SCHOOL ST

CASSOPOL I S MICHIGAN 49031

MOHAMMED ZAMAN MD

515 MAIN ST #3

DOWAGIAC MI 49047

CHIPPEWA

HUGH R ALLOTT MD
816 ASHMUN ST

SAULT STE MARIE MICH 49783

H MILTON BLAIR MD

300 COURT ST

SAULT STE MARIE MICH 49783

CLAIRE H CLAUSEN MD L

1110 LUCERNE AVE

CAPE CORAL FL 33904

WM J COULTER MD

DRUMMOND ISLAND MI 49726

DONALD 0 FINLAYSON MD

301 E SPRUCE ST

SAULT STE MARIE MI 49783

MARIE A HAGELE MD
126 PARK PL

SAULT STE MARIE MI 49783

HERBERT E HAMEL MD

220 BURDETTE ST

ST IGNACE MI 49781

ROBERT D HEILMAN MD

WAR MEMORIAL HOSP

SAULT STE MARIE MI 49783

DONNELL C HOWE JR MD
300 COURT ST

SAULT STE MARIE MICH 49783

THOS B MACK I E MD

300 COURT ST

SAULT STE MARIE MICH 49783

WM F MERTAUGH MD

104 W SPRUCE ST

SAULT STE MARIE MICH 49783

BEN J T MONTGOMERY MD L

P 0 BOX 39

SAULT STE MARIE MI 49783

EARL S RH1ND MD

SAULT POLYCLINIC

SAULT STE MARIE MICH 49783

DALE SCOTT MD
816 ASHMUN ST

SAULT STE MARIE MICH 49783

THOMAS SLOUGH MD

301 E SPRUCE ST

SAULT STE MARIE MI 49783

CHAS F THOMPSON MO L

DRUMMOND ISLAND MI 49726

TONY J TRAPASSO MD
816 ASHMUN

SAULT STE MARIE MICH 49783

ANTON G VENIER MD
816 ASHMUN ST

SAULT STE MARIE MI 49783

ERLING S WEDDING MD
203 HUDSON DR

SAULT STE MARIE MI 49783

CLINTON

GEO W BENNETT MD
203 W MAIN ST

ELSIE MI 48831

BRUNO C COOK MD

WESTPHALIA MI 48894

JAMES M GROST MD
PARK AVENUE

ST JOHNS MI 48879

SHERWOOD R RUSSELL MO

210 E WALKER ST

ST JOHNS MI 48879

VICTOR L SHELINE MD

MEDICAL CENTER

ITHACA MICH 48847

EARL M SLAGH MD

ELSIE MI 48831

WESLEY F STEPHENSON MD

510 £ WALKER ST

ST JOHNS MICH 48879

DELTA

FRANCIS C ANDERSON MD
218 S 10TH ST

ESCANABA MICH 49829

THEODORE L BASH MD

BARK RIVER MICHIGAN 49807

ROLAND E BERRY MD

ST FRANCIS HOSP

ESCANABA MI 49829

MARY CRETENS MD DIR
DELTA-MENOM HLTH DEPT
DELTA COUNTY BLDG

ESCANABA MI 49829

JAMES R DEHLIN MD
8 S 11TH ST

GLADSTONE MI 49837

DONALD N FITCH MD
DOCTORS PARK

ESCANABA MI 49829

JAMES H FYVIE MD

202 S CEDAR ST

MANISTIQUE MI 49854

E JAMES GORDON MD
DEER PARK

ESCANABA MI 49829

LOUIS P GROOS MD

1015 S 1ST AVE

ESCANABA MICH 49829

RAYMOND L HOCKSTAD MD
DOCTORS PARK

ESCANABA MI 49829

OTTO S HULT MD
1005 DELTA AVE
GLADSTONE MICH 49837

JOHN LE MIRE MD
DOCTORS PARK

ESCANABA MI 49829

WM A LE MIRE III MD
DOCTORS PARK

ESCANABA MI 49829

WILLIAM A LE MIRT MD
DOCTORS PARK

ESCANABA MICH 49829

GEO MAN I AC I MD
8 SOUTH 11TH ST
GLADSTONE MICH 49837

THOS A MC INERNEY MD
1221 LUDINGTON ST
ESCANABA MICH 49829

CARL J OLSON MD
8 S 11TH ST

GLADSTONE MICH 49837

HOWARD J PARKHURST MD H

1551 DOUSMAN ST

GREEN BAY W I SC 54303

A LESLIE ROSE MD
DOCTORS PARK

ESCANABA Ml 49829

ROBT E RYDE MD
1221 LUDINGTON
ESCANABA MICH 49829

LAWRENCE SELL JR MD
MANISTIQUE CLINIC
MANISTIQUE MI 49854

NIKOLAUS J THE I SEN MD
1400 16TH AVENUE S
ESCANABA MI 49829

DUANE L WATERS MD

200 S CEDAR ST

MANISTIQUE MICH 49854

MERLE E WEHNER MD
131 RIVER ST

MANISTIQUE MICH 49854

DICKINSON

EARL R ADDISON MD

412 SUPERIOR AVE

CRYSTAL FALLS MICH 49920

WM H ALEXANDER MD L

411 EAST C ST

IRON MOUNTAIN MI 49801

DONALD T ANDERSON MD

408 HAMILTON AVE

K 1 NGSFORD MICH 49801

ROBERT ANDERSON MD
DICKINSON MEM CO HOSP
IRON MOUNTAIN MI 49801

GEORGE H BOYCE JR MD A

VA HOSPITAL

IRON MOUNTAIN MI 49801

ROBERT CALDERWOOD DDS A

1ST NATL BANK BLDG

IRON MOUNTAIN MI 49801

RALPH E CARLSON MD
500 STEPHENSON AVE
IRON MOUNTAIN MICH 49801

R D CECCONI M D
COMMERCIAL BANK BLDG
IRON MOUNTAIN MICH 49801

JOYCE GENDZWELL MD

805 VULCAN STREET

IRON MOUNTAIN MICH 49801

WM R GLADSTONE JR MD
804 MAIN ST

NORWAY MI 49870

WILLARD N HAYES MD
720 N MAIN ST

NORWAY MICH 49870

JANUARY, 1972/Michigan Medicine 11

49801

L

49935

49801

49801

49801

49801

10

49935

A

49801

ID

49801

49801

49920

49801

54121

49801

49920

49801

A

49892

48890

48813

48813

49076

A

49076

48827

►/Micl

LISTED BY COMPONENT MEDICAL SOCIETIES

FRED C GARLOCK MO

406 E JEFFERSON ST

GRAND LEDGE MICH 48837

GORDON R HARROD MD

11653 S HARTEL RO

GRAND LEDGE MI 48837

DANIEL 0 JOSEPH MD
202 S COCHRAN

CHARLOTTE MICHIGAN 48813

ROBERT L LEESER MD
202 S COCHRAN

CHARLOTTE MI 48813

ALBERT H MEINKE JR MO

800 CUMBERLAND DR

EATON RAPIDS MICH 48827

ALBERT W MYERS MO

POTTERVILLE Ml 48876

S R ROBINSON MD

11653 S HARTEL RD

GRAND LEDGE MICH 48837

LESTER G SEVENER MO
236 S MAIN ST

CHARLOTTE MICH 48813

DAVIO A BARBOUR MD

5369 BRIARCREST

FLINT MICHIGAN 48504

FLEMING A BARBOUR MD

2015 LINCOLN DR

FLINT MI 48503

FRANKLIN W BASKE MD L

923 MAXINE ST

FLINT MI 48503

JOSEPH T BATDORF MD
8483 HOLLY RO

GRAND BLANC MI 48439

LAWRENCE G BATEMAN MD
1928 LEWIS ST

FLINT MI 48506

MARTIN L BEARD MD
6606 N SAGINAW ST
FLINT MI 48505

DOUGLASS R BECK MD

5445 FERNWOOD OR

FLINT MI 48504

EUGENE B BECKER MD

2849 MILLER RD

FLINT MI 48503

ROY G BRAIN MD L

460 S SAGINAW ST

FLINT MI 48502

HIRA E BRANCH MD

817 MOTT FDTN BLDG

FLINT MICHIGAN 48502

OONALD R BRASIE MD R

R 2 BOX 436

ROSCOMMON MI 48653

GUY 0 BRIGGS MD L

224 E COURT ST

FLINT MI 48503

CLARENCE A BROWN MD

2765 FLUSHING RD

FLINT MI 48504

HOWARD C BRUCKNER MD

109 FAIRMOUNT AVE

CHATHAM N J 07928

DONALD R BRYANT MD

621 MOTT FON BLDG

FLINT MICHIGAN 48502

GERALD S BUCHANAN MD
3471 GRANGE HALL RO
HOLLY MICH 48442

EBER B SHERMAN MD

501 CARLISLE ST

EATON RAPIDS MI 48827

HERMAN F VAN ARK MD
410 BLAKE ST

EATON RAPIDS MI 48827

CLAYTON 0 WILL I TS MD
R R XI

NASHVILLE MI 49073

GENESEE

R RODERICK ABBOTT MD

420 S BALLENGER HWY
FLINT MI 48504

ALBERT C ADAMS MD

5210 LAPEER RD

FLINT MI 48503

BURNELL H ADAMS MD

609 S LYNCH ST

FLINT MI 48503

LEROI J ALEXANDER MD

915 W PASADENA

FLINT MI 48504

DONALD J ALLCORN MD

1279 COLDWATER RD

FLINT MI 48505

HARLEY H ANDERSON MD

11820 N SAGINAW

MT MORRIS MICH 48458

I TURAN BENGISU MD
1615 GENESEE TOWERS

FLINT MI 48502

JACK BENKERT MD

6384 KINGS POINTE

GRAND BLANC MICH 48439

JOHN C BENSON MD

639 MOTT FDTN BLOG

FLINT MI 48502

HARRY BERMAN MD

3309 FENTON RD

FLINT MI 48507

GERALD P BERNER MD

2765 FLUSHING RD

FLINT MICHIGAN 48504

ELI N BERNSTEIN MD

1201 FLUSHING RD

FLINT MICHIGAN 48504

J A BEST M D
3801 CLIO RD

FLINT MI 48504

GEO 0 BEYER MD

G 3337 W VIENNA

CLIO MICHIGAN 48420

GREGOIRE BOLDUC MD

325 E FIRST ST

FLINT MICHIGAN 48502

WM P BOLES MD L

714 BEACH ST

FLINT MI 48502

WM F BUCHANAN MD

238 W CAROLINE

FENTON MICH 48430

LESLIE V BURKETT MO L

618 OOUGHER T Y PL

FLINT MI 48504

DONALD R CANADA MD
1207 N BALLENGER HWY
FLINT MI 48504

NORMAN A CARTER MD

1201 FLUSHING RD

FLINT MI 48504

MYRTON S CHAMBERS MD L

3402 WESTWOOD PKWY

FLINT MI 48503

EUGENE N CHARDOUL MD

202 PATERSON BLDG

FLINT MI 48502

WM D CHASE MD L

1190 RIV VALLEY DR #5
FLINT MI 48504

RONALD CHEN MD
432 N SAGINAW

FLINT MI 48502

MINOO B CHINOY MD

325 E FIRST ST

FLINT MI 48502

JOHN C CHOGICH MD

1245 DUPONT ST

FLINT MI 48504

JOHN L ANDERSON MD

2765 FLUSHING RD

FLINT MI 48504

VIRGILIO BONET MO

2765 FLUSHING RD

FLINT MI 48504

ROB T L CLARK MD

1301 FLUSHING RD

FLINT MI 48504

RICHARD A ANTELL MD
3402 SANTA CLARA CT
FLINT MICHIGAN 48504

DONALD BOSKER MD

1818 LONGWAY BLVD #302

FLINT MI 48506

GERALD G COLE MD

1818 LONGWAY BLVD

FLINT MI 48501

GEO E R ANTHONY MD R

RR1 PORT LAMBTON
ONTARIO CANADA

ROBERT A BOTA MD

1623 MONTCLAIR

FLINT MICHIGAN 48503

JAMES I COLLINS MD

G 1128 N DYE ROAD

FLINT MICHIGAN 48504

ROBERT M ARMBRUSTER MD
626 MOTT FDTN BLDG
FLINT MI 48502

DUANE J BAILEY MD
238 W CAROLINE ST
FENTON MI 48430

PETER R BOYER MD

2510 NERREOI A #103

FLINT MI 48504

ROBT M BRADLEY MD

1112 MOTT FND BLDG

FLINT MI 48502

CLIFFORD W COLWELL MD

328 S SAGINAW ST

FLINT MI 48502

DAVIO E CONGDON MD

9190 PINE BLUFF

FLUSHING MI 48433

W CLAIRE BAIRD MD

2765 FLUSHING RD

FLINT MICHIGAN 48504

JOHN L BRADY MD

302 KENSINGTON

FLINT MI 48502

MCCLELLAN 8 CONOVER MD
1209 KENSINGTON AVE
FLINT MI 48503

Medicine

DIRECTORY OF MSMS MEMBERS

Genesee County

FRANK W COOK MD

MEHMET EKINCI MD

EVELYN GOLDEN MD

410 S BALLENGER

2279 GRAND BLANC RD

218 E COURT ST

FLINT MICHIGAN

48504

GRAND BLANC MI

48439

FLINT MICH

48503

JOHN L COOK MD

HARD I E B ELLIOTT MD

H MAXWELL GOLDEN MD

GENESEE BANK BLDG #208

503 S SAGINAW ST

218 E COURT ST

FLINT MI

48502

FLINT MI

48502

FLINT MI

48503

CORY E COOK INGHAM MD

RAYMOND M ENGELMAN MD

SAUL S GORNE MD

214 MEDICAL ARTS BLDG

808 N GRAND TRAVERSE

619 CLIFFORD ST

FLINT MICHIGAN

48501

FLINT MI

48503

FLINT MI

48503

LOUIS B CORIASSO MD

ALI A ESFAHANI MD

GEO H GRE I DINGER MD

9224 HAPPY HOLLOW CT

710 MOTT FDTN BLOG

ST JOSEPH HOSPITAL

GRAND BLANC MI

48439

FLINT MI

48502

FLINT MI

48502

KENNETH M COYNE MD

RALPH D ETTINGER MD

ERNEST P GRIFFIN JR

MD

325 E FIRST ST

238 W CAROLINE ST

1505 ARROW LANE

FLINT MICHIGAN

48503

FENTON MICHIGAN

48430

FLINT MI

48507

ROBERT L CROSS MD

JOHN F FAILING JR MD

JACK R GROMMONS MD

5221 WOODHAVEN DR

HURLEY HOSPITAL

721 W SIXTH AVE

FLINT MICHIGAN

48504

FLINT MICHIGAN

48502

FLINT MICHIGAN

48503

G CAMPBELL CUTLER M

D

Q C FAN MD

HAROLD F GROVER MD

L

420 S BALLENGER

2002 E COURT ST

3433 FENTON RD

FLINT MI

48504

FLINT MICH

48503

FLINT MI

48507

JOHN R DAMM MD

BEN S FARAH MD

GURDON S GUILE MD

A

8483 HOLLY RD

2765 FLUSHING RD

1621 DUPONT ST

GRAND BLANC MI

48439

FLINT MI

48504

FLINT MI

48504

ROBT C DAVIS MD

MAYNARD M FARHAT MD

EDWIN H GULLEKSON MD

G 3029 FLUSHING RD

505 W COURT ST

2765 FLUSHING RD

FLINT MI

48504

FLINT MICH

48503

FLINT MI

48504

RALPH E DAWSON MD

CYRUS FARREHI MD

C R GUMPPER MD

721 W SIXTH AVE

302 KENSINGTON

4437 MORRISH RD

FLINT HI

48503

FLINT MI

48503

SWARTZ CREEK MICH

48473

JOHN MURRAY DAY MO

HANSON G FEE MD

GEO L GUNDRY MD

L

1919 GENESEE TOWERS

108 E KEARSLEY ST

8030 GREEN VALLEY DR

FLINT MI

48502

FLINT MI

48502

GRAND BLANC MI

48439

NICHOLAS DELZINGRO MD L

JOSE A FERNANDEZ MD

ISADORE H GUTOW MD

328 N MAIN ST

2510 NERREDIA

2765 FLUSHING RD

DAVISON MI

48423

FLINT MI

48504

FLINT MI

48504

CARLTON K DETTMAN MD

JAMES W FERRIS MD

JULIUS J GUTOW MD

10512 MCKINLEY RD

1005 LEITH ST

726 CHURCH STREET

MONTROSE MICH

48457

FLINT MI

48505

FLINT MICHIGAN

48503

BERNARD DICKSTEIN MD

THEO FINKELSTEIN MD

ERWIN GUTOWITZ MD

605 NATIONAL BLDG

1415 BROADWAY BLVD

420 S BALLENGER HWY

FLINT MI

48502

FLINT MI

48506

FLINT MICHIGAN

48504

ROY D DIGGS JR MD

RICHARD 0 FLETT MD

RICHARD 0 HACKLEY MD

4250 N SAGINAW ST

1368 KRA-NUR DR

1818 R T LONGWAY BLVD

FLINT MI

48505

DAVISON MI

48423

FLINT MI

48501

SAMUEL R DISMOND MD

GRAYDON R FORRER MD

ROBT F HAGUE MD

L

1402 S SAGINAW ST

2279 E GRAND BLANC RO

2745 LAKEWOOD OR

FLINT MICHIGAN

48503

GRAND BLANC MICH

48439

FLINT MI

48507

MAX E DODDS MD

LEON FRIEDMAN MD

JOHN WM HALLITT MD

625 S GRAND TRAVERSE

2765 FLUSHING RD

102 MEDICAL ARTS BLDG

FLINT MICHIGAN

48503

FLINT MI

48504

FLINT MI

48501

JAMES F DOOLEY MD

HARVEY T FULLER MD

R

ROBT H HARPER MD

3210 S DORT HWY

2700 N HAYDEN RD

713 THOMSON ST

FLINT MI

48507

SCOTTSDALE ARIZ

85257

FLINT MI

48503

WILLIAM F DWYER MD

ALBERT J GASIS MD

BERNARD J HARRIS MD

625 S GRAND TRAVERSE

1201 FLUSHING RD

1750 LYNBROOK

FLINT MICHIGAN

48503

FLINT MI

48504

FLINT MICHIGAN

48507

RICHARD A DYKEWICZ MD

SABAH K GEORGE MD

DONALO R HARRIS MD

2744 FLUSHING RD

721 W 6TH AVE

2429 WELCH BLVD

FLINT MI

48504

FLINT MI

48503

FLINT MICHIGAN

48504

WAYNE L EATON MD

GEORGE Z GERRAS MD

FREDK V HAUSER MD

1703 CRESCENT DR

1334 N DYE ROAD

1015 MOTT FNDN BLDG

FLINT MI

48503

FLINT MICHIGAN

48504

FLINT MI

48502

ERNEST M E ICHHORN MD

JAMES J GIBBONS MD

JAMES E HAWKINS MD

2765 FLUSHING RD

101 MEDICAL ARTS BLDG

4618 ROBERTS ST

FLINT MI

48504

FLINT MI

48501

FLINT MI

48501

THOS N EICKHORST MD

RUDOLPH GOETZ MD

PHYLLIS 0 HELCHER MD

2765 FLUSHING RD

1221 CHURCH STREET

420 S BALLENGER

FLINT MI

48504

FLINT MICHIGAN

48503

FLINT MI

48504

DOUGLAS D EITZMAN MD

E MARSHALL GOLDBERG MD

ROBERT D HELFERTY MD

2765 FLUSHING RD #302

HURLEY HOSPITAL

1116 ANN ARBOR STREET

FLINT MI

48504

FLINT MI

48502

FLINT MI

48503

FREDRIC A HELHER HD
2765 FLUSHING RD »315

FLINT MI 48504

CHARLES R HENNESSY HD
917 MOTT FNDN BLDG
FLINT MICH 48502

HAROLD H HISCOCK MD L

1315 MOTT FDTN BLDG
FLINT MI 48502

THOMAS A HOCKMAN MD
11125 OLD BRIDGE RD
GRAND BLANC MICHIGAN 48439

FRANK V HODGES MD

HURLEY HOSPITAL

FLINT MI 48502

VIRGIL R HOOPER MD
4230 TRUMBULL

FLINT MICHIGAN 48504

ROBERT J HOUSE MD
915 S GRAND TRAVERSE
FLINT MICHIGAN 48503

WM C HUBBARD MD

302 PATERSON BUILDING

FLINT MICHIGAN 48502

WILFRID L HUFTON MD

2765 FLUSHING RD

FLINT MI 48504

RICHARD J HUNT MD

2025 CRESTBROOK LN

FLINT MI 48507

CLAYTON E HURD MD

205 LINCOLN ST

FENTON MICHIGAN 48430

LAWRENCE R IRISH MD

6146 SIERRA PASS

FLINT MICHIGAN 48504

ORESTES I UNG MD
2710 W COURT ST
FLINT MI 48503

ROBT E JAMES MD
1860 HAMPDEN

FLINT MI 48507

WALTER H JANKE MD

710 MOTT FNDTN BLDG

FLINT MI 48502

A H JOHNSON JR MD R

429 NORTH ST SW #506
WASHINGTON D C 20024

RAYMOND E JOHNSON MD

5173 W REID RD

SWARTZ CREEK MICH 48473

ALVIN E JUDD MO
1620 N FRANKLIN
FLINT MI 48506

T A I K KANG MD

432 N SAGINAW ST #707

FLINT MI 48502

PAUL H KARR MD
1818 R T LONGWAY BLVD
FLINT MICHIGAN

LEWIS D KAUFMAN MD
4002 N SAGINAW ST
FLINT MI

JAMES E KELLY MD
2765 FLUSHING RD
FLINT MICHIGAN

DONALD M KENNETT MD
315 BELLA VISTA DR
GRAND BLANC MICHIGAN 48439

C 8 KIMBROUGH MD

1402 S SAGINAW ST

FLINT MI 48503

48503

48505

48504

JANUARY, 1972/Michigan Medicine 13

Genesee County

LISTED BY COMPONENT MEDICAL SOCIETIES

0 F KLINE MD

SYONEY N LYTTLE MD

H H MENDREK MD

2765 FLUSHING RO

1207 N BALLENGER HWY

2765 FLUSHING RD

FLINT MI

48504

FLINT MI

48504

FLINT MI

48504

JAMES G KNAGGS MD

J W MAC KENZIE JR MO

ROBT M MICHELS MD

500 S GR TRAVERSE ST

4437 MORRISH RD

2702 FLUSHING RD

FLINT MI

48503

SWARTZ CREEK MICH

48473

FLINT MICHIGAN

48504

WM D KNAPP MD

ALBERT J MACKSOOD MD

RICHARD B MICHELSON MD

503 S SAGINAW ST

3169 W PIERSON RD

2014 ROBT T LONGWAY

FLINT MI

48502

FLINT MICHIGAN

48504

FLINT MI

48503

CHESTER S KOOP MD

JOHN M MACKSOOD MD

KURT W MIKAT MD

1 SAC ST

3169 W PIERSON RD

6061 ROLLING GREEN OR

FRANKFORT MI

49635

FLINT MI

48504

GRAND BLANC MI

48439

ARTHUR H KRETCHMAR MD L

JOS A MACKSOOD MD

L

LOREN E MILLER MO

481 ST ANDREWS DR

3169 W PIERSON RD

2645 CORUNNA RD

APTOS CALIF

95003

FLINT MI

48504

FLINT MI

48503

CARROLL J LA VIELLE MD

WILLIAM E MACKSOOD MD

ANTHONY J MILTICH MD

1135 N DYE RD

3169 W PIERSON RD

915 S GRAND TRAVERSE

FLINT MI

48504

FLINT MICHIGAN

48504

FLINT MI

48503

J LEONIDAS LEACH MD

L

ALBERT A MACPHAIL MD

JAN C MOELLER MD

5014 N SAGINAW ST

3302 HAWTHORNE DR

3102 WESTWOOD PKY

FLINT MI

48505

FLINT MICHIGAN

48503

FLINT MICHIGAN

48503

LESLIE L LE MIEUX MD

C H MANGEL SDORF MD

BEHROUZ MOGHTASSED MD

701 W DAYTON ST

G3393 CLIO RD

1818 R T LONGWAY BLVD

FLINT MI

48504

FLINT MICHIGAN

48504

FLINT MI

48503

MARK C LEVINE MO

JOHN T MANWARING MD

GLENN E MOORE MD

G3083 FLUSHING RD

G5432 CALKINS RD

323 W SECOND

FLINT MI

48504

FLINT MI

48504

FLINT MI

48503

BILLIE LEWIS MD

RUBEN J MARCHI SANO MD

WILLIAM H S MOORE MD

739 MOTT FON BLDG

3507 SUNSET DRIVE

1201 FLUSHING RD

FLINT MICHIGAN

48502

FLINT MI

48503

FLINT MI

48504

JOHNNY F LEWIS MD

A

PAUL J MARKUNAS MD

ALAN L MORGAN MD

1318 W GENESEE St

4002 N SAGINAW ST

3169 W PIERSON RD

FLINT MI

48504

FLINT MICH

48505

FLINT MI

48504

THOS E LEWIS MO

JAMES A MARTIN MD

PAUL MORIN MD

4071 RICHFIELD RD

812 S ADELAIDE ST

1968 MILLER RD

FLINT MICHIGAN

48506

FENTON MICH

48430

FLINT MICHIGAN

48503

VIVIAN M LEWIS MD

HELIO B F MARTINS MD

VAUGHN H MORRISSEY MD

1618 KENSINGTON

1179 N BALLENGER

101 STOCKDALE ST

FLINT MICHIGAN

48503

FLINT MI

48504

FLINT MI

48503

ROBT W LIEBER MD

BERTON J MATHIAS MO

EDWARD C MOSIER MD

6144 PEBBLESHIRE CIRC

1301 FLUSHING RD

1730 OVERHILL DR

FLINT MICHIGAN

48507

FLINT MI

48504

FLINT MI

48503

ARTHUR S LIGHTFOOT MD

J D MC ALINDON MD

WILLYS F MUELLER MD

4500 DETROIT ST

1423 OX YOKE DR

13335 PAMONA DR

FLINT MICHIGAN

48505

FLINT MICHIGAN

48504

FENTON MI

48430

FREDERICK S LIM MD

JUNIUS W MC CLELLAN MD

E GRANT MURPHY MD

806 W SIXTH AVE

BUICK MOTOR DIVISION

118 MEDICAL ARTS BLDG

FLINT MI

48503

FLINT MI

48505

FL INT MI

48504

DAVID R LIMBACH MD

EARL J MCGARVAH MO

S H NASSAR MD

900 BEGOLE ST

410 S BALLENGER HWY

8483 HOLLY RD

FLINT MI

48503

FLINT MI

48504

GRAND BLANC MI

48439

THOMAS C LINDMAN M 0

JOHN D MCGRAE JR MD

ALFRED E NEUFFER MD

2484 NOLEN DR

2433 WELCH BLVD

5384 TERRITORIAL RD

FLINT MICH

48504

FLINT MICHIGAN

48504

GRAND BLANC MI

48439

ERNESTO 0 LIS MD

ALLAN R MCGREGOR MD

WM W NICHOLLS MD

703 E COURT ST

G 3337 W VIENNA RD

806 W SIXTH AVE

FLINT MI

48503

CLIO MICHIGAN

48420

FLINT MI

48503

JACKSON E LIVESAY MD

L

THOMAS A MC LENNAN MD

DONALD A NITZ MD

503 S SAGINAW ST

913 MOTT FNDTN BLDG

1818 ROBERT T LONGWAY

FLINT MI

48502

FLINT Ml

48502

FL INT MI

48503

E R LUMAQUE MD

KENNETH W A MC LEOD MD

DAVID E OJEDA MD

6474 KINGS PTE RD

6078 WINGED FOOT DR

3169 W PIERSON RD

GRAND BLANC MI

48439

GRANO BLANC MI

48439

FL INT MI

48504

ROSIE M LUMAQUE MD

RICHARD J MC MURRAY MD

MARY RUTH OLDT MD

6474 KINGS PTE RD

2765 FLUSHING RD

602 S LYNCH ST

GRANO BLANC MI

48439

FLINT MICH

48504

FLINT MI

48503

RICHARD M LUNDEEN MD

D W MCNAUGHTON MD

ROBT S ORMOND MD

3393 CLIO

2437 PINEWOOD CT

HURLEY HOSPITAL

FLINT MICH

48504

FLUSHING MI

48433

FLINT MI

48502

JOHN A LUSK MD

DAVID MC TAGGART M D

SEYMOUR L OSHER MD

9233 W DAVISON RD

625 S GRAND TRAVERSE

315 E COURT ST

DAVISON MICHIGAN

48423

FLINT MICHIGAN

48503

FLINT MI

48503

MARJORIE OTERO MO A

307 SUNNY S l OE DR
FLUSHING MI 48433

RUITSON OUYANG MO

3083 FLUSHING RD

FLINT MI 48504

HEEOONG PARK MD

3169 W PIERSON RO

FLINT MI 48504

JOON H PARK MD

1708 GENESEE TOWERS

FLINT MI 48502

BURT A PARLIAMENT MD

5126 DYEHILL COURT

FLINT MI 48504

RICHARD 0 PELHAM MD

3306 FLUSHING RD

FLINT MI 48504

ARCHIBALD C PFEIFER MD L
9798 PALMETTO CLUB DR
MIAMI FL 33157

LYNN A PHELPS MD
10122 JANAROY CT
GOODRICH MICH 48438

A F PHILLIPS MD
X RAY DEPT HURLEY HOSP
FLINT MICHIGAN 48502

WOODROW H PICKERING MD
1602 BALLENGER HWY
FLINT MI

B P I ETRUSZKA MD
5210 LAPEER RD
FLINT MI

WALLACE W PIKE MD
7514 MILLER RD
SWARTZ CREEK MI

ALICE LEE PLATT MD
5551 TERRITORIAL RD
GRAND BLANC MI

JACK E PORTNEY MD
725 STEVENS ST
FLINT MI

W 0 POUGNET MD
6155 MAPLE RIDGE
FLINT MI

OTTO J PRESTON MC
1315 MAXINE
FLINT MI

JACK R PRICE MD
410 S BALLENGER HWY
FLINT MICHIGAN

RICHARD W PRIOR M D
1266 S LE ROY
FENTON MICHIGAN

JOHN QUIN JR MD
2765 FLUSHING RD
FLINT MI

FOUAD RABIAH MD
1608 GENESEE TOWERS
FLINT MI

HELEN RADCENKO MD
302 W PIERSON RD
FLINT MI

LEONID RADCENKU MD
302 W PIERSON RD
FL INT MI

OGUZ K RAMADAN MD
8483 HOLLY RD
GRAND BLANC MI

D S RAO MO
2765 FLUSHING RD #301
FLINT MI 48504

48504

48503

48473

A

48439

48503

48504

48503

48504
48430

48504
48502

48505
48505
48439

14 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Genesee County

RICHARD L RAPPORT MD

PHILLIP G SEVEN M D

PHILIP K STEVENS MD

808 N GRAND TRAVERSE

2301 CUMMINGS

1116 MOTT FDTN BLDG

FLINT MI

48503

FLINT MICH

48503

FLINT MICH

48502

ROBERT J RATHBURN MD

GEO D SEYMOUR MD

RUDOLPH W STREAT MD

L

1706 LAUREL OAK

G7237 N SAGINAW

8100 DAVISON RD

FLINT MICH

48507

MT MORRIS MICHIGAN

48458

DAVISON MI

48423

J MOTT RAWLINGS MD

RAMESH C SHAH MD

CLAYTON K STROUP MD

8505 OLD PLANK RD

HURLEY HOSP RADIOLOGY

2002 E COURT ST

GRAND BLANC MI

48439

FLINT MI

48502

FLINT MI

48503

JOHN H REID M D

LEIGHTON 0 SHANTZ MD

L

M R SULLIVAN MD

1301 FLUSHING RD

1497 COUNTRY VIEW LANE

5352 PEPPERMILL RD

FLINT MI

48504

FLINT MI

48504

GRAND BLANC MICHIGAN

48439

GEORGE H REYE MD

JAMES P SHEEHY MD

JAMES K SUTHERLAND MD L

2279 E GRAND BLANC RD

503 S SAGINAW ST

402 E 3RD ST

GRAND BLANC MICH

48439

FLINT MI

48502

FLINT MI

48503

EDWARDO L REYES MD

DANL H SHEERAN MD

GEO 0 SUTTON MD

L

420 S BALLENGER

610 S VERNON AVE

303 W COURT ST

FLINT MI

48504

FLINT MI

48503

FLINT MI

48503

ALAN K RICE MD

FREDERICK SHERWOOD MD

GENE D TANG MD

A

2008 ROBT T LONGWAY

1207 N BALLENGER HWY

MUNSON MED CTR PATH

FLINT MICHIGAN

48503

FLINT MI

48504

TRAVERSE CITY MI

49684

GEO F RIETH MD

LEWIS E SIMONI MD

JOHN W TAUSCHER MD

1406 DAVISON ST

3210 S DORT HGWY

2016 R T LONGWAY BLVD

FLINT MI

48506

FLINT MI

48507

FLINT MICHIGAN

48503

WM J ROBERSON MD

SARJ IT SINGH MD

WALTER I THEUERLE MD

3455 LIPPINCOTT BLVD

839 MOTT FNDTN BLDG

3117 CLIO RD

FLINT MI

48507

FLINT MI

48502

FLINT MI

48504

M L ROBITAILLE MD

J BERNARD SLOAN MD

CHARLES A THOMPSON MD

2765 FLUSHING RD

3169 W PIERSON RD

1201 SAN JUAN

FLINT Ml

48504

FLINT MI

48504

FLINT MI

48504

JOHN B ROWE MD

R H SMALLEY MD

JACK W THOMPSON MD

653 SAGINAW ST

4437 MORRISH RD

2702 FLUSHING RD

FLINT MI

48502

SWARTZ CREEK MI

48473

FLINT MI

48504

WALTER Z RUNDLES MD

EUGENE C SMITH MD

PETER S THOMS MD

500 GRAND TRAVERSE ST

606 STEVENS

1368 W COLDWATER RD

FLINT MI

48503

FLINT MICHIGAN

48503

FLINT MICH

48505

RUSSELL G SANDBERG MD

HAROLD 0 SMITH MD

ELMER H TOFTELAND MD

5431 FERNWOOD DR

3769 SUNSET DR

2765 FLUSHING RD

FLINT MI

48504

FLINT MICHIGAN

48503

FLINT MI

48504

FREDK E SANOCKI MD

MAURICE J SMITH MD

RITA B TOWER MD

L

2700 W COURT ST

804 METROPOLITAN BLDG

ELMS TRAILER PARK D4

FLINT MI

48503

FLINT MI

48502

2801 S DORT HWY

SIRUN SARAFIAN MD

SIDNEY E SMITH MD

FLINT MI

48507

6820 CLIO RD

5220 PASADENA

FLINT MI

48504

FLUSHING MI

48433

ALLEN F TURCKE MD
1245 DUPONT ST

CHAS J SCAVARDA MD

BEN J F SNIDERMAN MD

FL INT MI

48504

1106 MAXINE

727 BEACH ST

FLINT MICHIGAN

48503

FLINT MI

48502

MERALD G TURNER MD
G 3169 W PIERSON

RICHARD K SCHAEFER MD

A E SOUK MD

FLINT MI

48504

3248 VAN SLYKE RD

1201 FLUSHING RD

FLINT MI

48507

FLINT MICHIGAN

48504

ARTHUR L TUURI MD
MOTT CHILDREN CLINIC

NELSON S SCHAFER MD

FREDRIC M SOMACH MD

FLINT MICH

48502

721 W 6TH AVE

2765 FLUSHING RD

FLINT MI

48503

FLINT MI

48504

EROL UCER MD
801 S SAGINAW

BENTON A SCHIFF MD

MORRIS L SORKIN MD

FLINT MI

48502

323 W 2ND ST

718 BEACH ST

FLINT MI

48503

FLINT MI

48502

VERNON URICH MD
3169 W PIERSON RD

ROBT W SCHMIDLIN MD

S AML S SORKIN MD

FLINT MICHIGAN

48504

3710 DAVISON RD

718 BEACH ST

FLINT MI

48506

FLINT MI

48502

DOUGLAS VANBROCKLIN MD

1300 N DORT HWY

E OSKAR SCHREIBER MD

WARREN E SOUTHALL MD

FLINT MI

48506

2765 FLUSHING ROAD

4250 N SAGINAW ST

FLINT MI

48504

FLINT MICHIGAN

48505

J D VANBROCKLIN MD
2620 FLUSHING RD

PAUL E SCHROEDER MD

HARVEY V SPARKS MD

FLINT MI

48504

1673 N CHEVROLET

2765 FLUSHING RD

FLINT MICHIGAN

48504

FLINT MI

48504

FREDK W VAN DUYNE MD
2849 MILLER RD

JOHN M SCHWARTZ MD

RALPH S STEFFE MD

FLINT MICHIGAN

48503

1300 N DORT HWY

2765 FLUSHING RD

FLINT MICHIGAN

48506

FLINT MI

48504

RAYMOND S VAN HARN MO

808 N GRAND TRAVERSE

HEINZ H SCHWARZ

FLOYD H STEINMAN MD

FLINT MICHIGAN

48503

5551 TERRITORIAL RD

503 S SAGINAW ST

GRAND BLANC MI

48439

FLINT MI

48502

S VARJAVANDI HO

3169 W PIERSON RO

FLINT MI 48504

HOWARD L VARNEY MO
1818 ROUT LONGWAY BLVD
FLINT MICHIGAN 48503

ADNAN 0 VAROL MD

2279 GRAND BLANC RD

GRAND BLANC MI 48439

NICHOLAS N VELARDE MO

3083 FLUSHING RD

FLINT MI 48504

L WILLIAM VERGITH MD

2765 FLUSHING RD

FLINT MI 48504

DAVID L VER LEE MD

503 S SAGINAW ST

FLINT MI 48502

V VILLARREAL MD

1374 COUNTRYVIEW LANE

FLINT MI 48504

FRANKLIN V WADE MD
808 N GRAND TRAVERSE
FLINT MICHIGAN 48503

CARVER G WALCOTT MD

201 E CAROLINA ST

FENTON MICH 48430

JAMES D WALKER MD
8483 HOLLY RD

GRAND BLANC MI 48439

DANIEL L WALTER MD
9311 ROUNO HILL CT
GRAND BLANC MI 48439

RICHARD E WEBER MD

420 S BALLENGER HWY

FLINT MI 48504

ROBT M WEBER MD
3710 DAVISON RO
FLINT MI 48506

WILLIAM J WEBER MD
721 W 6TH AVE
FLINT MI

48503

JOHN E WENTWORTH MD

420 S BALLENGER

FLINT MI 48504

SOLOMON C WERCH MD

7320 S STATE RO

GOODRICH MI 48438

INGA W WERNESS MO L

220 EAST FOURTH ST

FLINT MI 48503

GEORGE A WEST MD

4250 N SAGINAW

FLINT MI 48505

J D WHEELER M D

118 MEDICAL ARTS BLDG

FLINT MI 48504

CARL H WHITE MD
106 RIVER ST

FENTON MICH 48430

FRANK T WHITE MD

9244 LAPEER RD

DAVISON MI 48423

ROBT H WILLARO MD
718 BEACH ST
FLINT MI

A

48502

L

WM S WILLIAMS MD
12025 S SAGINAW BLDG 7
GRAND BLANC MI 48439

THOS N WILLS MD R

2760 N E 29TH

POMPANO BEACH FL 33064

JANUARY, 1972/Michigan Medicine 15

Genesee County

DALE A WILSON MO
2765 FLUSHING RD
FLINT MI *850*

NAN D WOLCOTT MD R

7506 LAPEER RO

DAVISON MI *8423

MELVYN 0 WOLF MD

G3083 FLUSHING RD

FLINT MI *8503

GEO W WRIGHT JR MD
6820 CLIO RD

FLINT MI *850*

MYRON G ZEIS MO

336 W FIRST ST

FLINT MI *8502

DANIEL M ZELKO MO
*071 RICHFIELD RD
FLINT MICHIGAN *8506

GOGEBIC

SAML G ALBERT MD

103 SUFFOLK ST

IRONWOOD MICH *9938

DONALD L DAVIDSON MO

200 S SOPHIE ST

BESSEMER MICH *9911

JOHN R FRANCK JR MD

*01 SUNOAY LAKE

WAKEFIELD MICH *9968

BELA GALLO MD

NEWPORT CLINIC

IRONWOOD MICH *9938

MICHAEL A GERTZ MD L

109 E AURORA ST

IRONWOOD MICH *9938

ALLEN C GORRILLA MD

210 SUFFOLK ST

IRONWOOD MI *9938

REX R HARRINGTON JR MD

10* E RIDGE ST

IRONWOOD MICH *9938

M J LIEBERTHAL MD L

P 0 BOX *00

IRONWOOD MI *9938

PAUL R LIEBERTHAL MD L

BOX *00

IRONWOOD MI *9938

LESTER MEDFORD MD
306 SUNDAY LAKE ST
WAKEFIELD MICH *9968

FLORIAN J SANT I N I MD

109 E AURORA ST

IRONWOOD MICH *9938

GRAND TRAVERSE

RICHARD G BARSTOW MD A

2 JASMINE ST
CRESTMOOR PARK

OENVER CO 80220

JOHN R BARTONE MD
217 S MADISON

TRAVERSE CITY MI *968*

JOHN G BEALL MD
1105 E FRONT ST
TRAVERSE CITY MICH *968*

HARRY M BLOUNT MO

1122 E FRONT ST

TRAVERSE CITY MI *968*

LISTED BY COMPONENT MEDICAL SOCIETIES

ELLIS S J BOLAN MD
BOX 67

SUTTONS BAY MI

*9682

JEROLO R HARWOOD MO
1100 SIXTH ST
TRAVERSE CITY MI

*968*

CLARK D PHELPS MD
1321 PENINSULA DR
TRAVERSE CITY MI

*968*

KNEALE M BROWNSON MD
116 CASS ST
TRAVERSE CITY MICH

*968*

MILDRED L HERKNER MD
1206 PENINSULA CT
TRAVERSE CITY MI

A

*968*

DONALD G PIKE MD
1209 E 8TH ST
TRAVERSE CITY MICH

*968*

BEN J B BUSHONG MD

R

READER J HUBBELL MD

L

FRANK H POWER MD

116 CASS ST
TRAVERSE CITY MICH

*968*

317 WESTLAKE TERR
PALM SPRINGS CA

92262

116 CASS ST
TRAVERSE CITY MICH

*968*

THOMAS D CAMPBELL MD
*03 STATE ST
TRAVERSE CITY MICH

*968*

NEVIN HUENE MD
110 E FRONT ST
TRAVERSE CITY MICH

*968*

DAYTON SALON MD
1030 6TH ST
TRAVERSE CITY MICH

*968*

WM H CARTWRIGHT MD

R R HUSTON MD

L

EDW P SCHEIDLER JR

MD

1105 E FRONT ST
TRAVERSE CITY MICH

*968*

ELK RAPIDS MI

*9629

10610 PENINSULA DR
TRAVERSE CITY MI

*968*

FREDK J CHAPIN MO
STATE HOSPITAL
TRAVERSE CITY MI

*968*

ROBERT C JOHNSON MD
116 CASS ST
TRAVERSE CITY MI

*968*

DWIGHT M SCHROEDER
NORTHPORT MICHIGAN

MD

*9670

OSWALD V CLARK MD
1030 SIXTH ST
TRAVERSE CITY MI

*968*

JAMES D JOHNSTON MD
1100 SIXTH ST
TRAVERSE CITY MICH

*968*

CHARLES W SHIPMAN MD
20*0 INDIAN TRAIL BLVD
TRAVERSE CITY MI *968*

THEOOORE N CLINE MO
999 6TH

TRAVERSE CITY MICK

*968*

ROBT L KAMP MD
BEULAH MICH

*9617

L P SKENDZEL MD
MUNSON HOSPITAL
TRAVERSE CITY MICH

*968*

WARREN W CLINE MD
999 6TH

TRAVERSE CITY MICH

*968*

WM W KITTI MD
KALKASKA MI

*96*6

M OUANE SOMMERNESS
BOX C

TRAVERSE CITY MICH

MD

*968*

JOHN F COLEMAN MD
1100 SIXTH ST
TRAVERSE CITY MI

*968*

JAMES A KOLBERG MD
211 S HIGH ST
NORTHPORT MI

*9670

F T SORUM MD
BOX C

TRAVERSE CITY MICH

*968*

ARTHUR F DUNOON MD
1100 SIXTH ST
TRAVERSE CITY MI

*968*

SEIICHI KOMESU MD
BOX C

TRAVERSE CITY MICH

*968*

JOHN R SPENCER MD
112* E FRONT ST
TRAVERSE CITY MICH

*968*

W T EDMONOS MD
CENTRAL MICH
CHILDRENS CLINIC

KEITH G LIEDING MD
1333 WISTERIA DR
ANN ARBOR MI

A

*810*

JOS C STEFFEY MD
116 CASS STREET
TRAVERSE CITY MICH

*968*

MUNSON MED CTR
TRAVERSE CITY MI

CLAUDE I ELLIS MD

*968*

LAWRENCE S LOESEL MD
2829 PRINCETON OR
TRAVERSE CITY MI

*968*

G EDWARD STOKES MO
1100 SIXTH ST
TRAVERSE CITY MICH

*968*

SUTTONS BAY MI

*9682

ROBT T LOSSMAN MD

FRED G SWARTZ M D

L

D W EVERETT MD

J DECKER MUNSON HOSP
TRAVERSE CITY MICH

*968*

612 SIXTH ST
TRAVERSE CITY MI

*968*

TRAV CITY STATE HOSP
TRAVERSE CITY MI

*968*

CHARLES T LOUISELL MD

BERNARD J SWEENEY MO

JACK A FIEBING MD

P 0 BOX 581
TRAVERSE CITY MI

*968*

1100 SIXTH ST
TRAVERSE CITY MICH

*968*

PO BOX 283
TRAVERSE CITY MICH

THOMAS E FINCH MD

*968*

ADAM C MC CLAY M D
217 S MADISON ST
TRAVERSE CITY MICH

*968*

FREDK R THACKER MD
FRONT ST
FRANKFORT MICH

*9635

1122 E FRONT ST
TRAVERSE CITY MI

MAX A FINTON MD

*968*

WM J MCCOOL MO
1100 SIXTH ST
TRAVERSE CITY MI

*968*

LEONARO J THILL MD
BOX C

TRAVERSE CITY MI

*968*

P 0 BOX 368
NORTHPORT MI

*9670

MICHAEL 0 MCMANUS MD

RICHARD L THIRLBY MD

WM A FISHBECK MD

1100 SIXTH ST
TRAVERSE CITY MI

*968*

228 S MADISON
TRAVERSE CITY MICH

*968*

127 S MADISON
TRAVERSE CITY MICH

*968*

STANLEY L MICHAEL MD

CREIGHTON A WAGENER

MD

ROGER C FULMER MD

335 DAVIS ST
TRAVERSE CITY MICH

*968*

1100 SIXTH ST
TRAVERSE CITY MICH

*968*

217 S MADISON ST
TRAVERSE CITY MICH

CHAS R HABERLEIN MD

*968*

JOHN G MILLIKEN MD
22* CIRCLE DR
TRAVERSE CITY MICH

*968*

JACK E WE I H MD
1105 E FRONT ST
TRAVERSE CITY MICH

*968*

1100 SIXTH ST
TRAVERSE CITY MICH

JAMES W HALL MO

*968*

KENNETH H MUSSON MD
9680 PENINSULA OR
TRAVERSE CITY MI

*968*

HARRY L WEITZ MD
MUNSON HOSP
TRAVERSE CITY MICH

*968*

1*31 PENINSULA DR
TRAVERSE CITY MICH

*968*

ROBT E PEARSON MD

A

PAUL H WILCOX MD

THOMAS C HALL MD

611 BIRCHWOOD AVE
TRAVERSE CITY MI

*968*

333 SIXTH ST
TRAVERSE CITY MICH

*968*

1100 SIXTH ST
TRAVERSE CITY MI

EARL E HAMILTON MD

*968*

MAURICE S PELTO MD
MUNSON HOSPITAL
TRAVERSE CITY MICH

*968*

PHIL IP K WILEY MD
116 CASS ST
TRAVERSE CITY MICH

*968*

530 S UNION ST
TRAVERSE CITY MICH

*968*

WM 0 PETERSON MO
876 E FRONT ST
TRAVERSE CITY MICH

*968*

CHAS R WILLIAMS MD
*16 SIXTH ST
TRAVERSE CITY MICH

*968*

16 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Houghton County

GORDON W WILLOUGHBY MD

WM L HARRIGAN MD

R

RICHARD J REMSBERG DO

0

104 5TH ST

90TH AVE 3 SCH SEC LK

309 STATE ST

FRANKFORT MICHIGAN

49635

MECOSTA MI

49332

ALMA MI

48801

LAVERN V WOLFGR AM MD

FRANK W HEDGES MO

WM J ROTH MD

850 E FRONT ST

215 W SAGINAW

255 WARWICK DR

TRAVERSE CITY MI

49684

ST LOUIS MICHIGAN

48880

ALMA MICHIGAN

48801

ROBERT G WONACOTT MD

WM E HERSEE MO

JOHN L ROTTSCHAEFER MD

107 DEXTER ST

306 S COLLEGE

3580 NORTHLAWN PK

ELK RAPIDS MI

49629

MOUNT PLEASANT MICH

48858

ALMA MICH

48801

J K WRIGHT JR MD

A DEANE HOBBS MD

R

WILMER M RUTT MD

1105 E FRONT ST

1506 NE 11TH ST

310 WARWICK DR

TRAVERSE CITY MI

49684

WINTER HAVEN FL

33880

ALMA MI

48801

RICHARD E WUNSCH MD

FRANK 0 JOHNSON MD

A

LEWIS F SANDEL MD

207 CIRCLE DR

914 S KINNEY

245 WARWICK DR

TRAVERSE CITY MICH

49684

MT PLEASANT MICH

48858

ALMA MI

48801

JOHN HARLEY YOUNG MD

PHILIP R JOHNSON MD

JACK F SANDERS MD

CHILDRENS CLINIC

206 S COLLEGE AVE

MICH MASONIC HOME

TRAVERSE CITY MICH

49684

MOUNT PLEASANT MICH

48858

ALMA MICH

48801

IRWIN H ZIELKE MD

ROBERT B JOHNSON MD

LINCOLN B SCOTT JR MD

106 S MADISON

R 1

412 OVERLAND

TRAVERSE CITY MICH

49684

ITHACA MICHIGAN

48847

CHAPEL HILL N C

27514

LE ROY W JUHNKE MD

A A SHEPERDIGIAN MD

GRATIOT

314 S BROWN ST

421 S FANCHER

MT PLEASANT MI

48858

MT PLEASANT MI

48858

ALFRED L ALDRICH MD

JAMES D KLAUER MD

DENNIS V SMITH MD

L

COMMUNITY HOSPITAL

1435 CAMBRIDGE RD

ITHACA MICH

48847

MT PLEASANT MICHIGAN 48858

ANN ARBOR MI

48104

A ROBERT BAUER JR MD

B B KUMAR MD

D A SORIANO MD

412 E BROADWAY

MT PLEASANT STATE HOME

1115 WATSON

MT PLEASANT MICH

48858

MT PLEASANT MI

48858

MT PLEASANT MI

48858

ORHAN BAYBURA MD

MICHAEL R LINN MD

JACK STACK MD

503 E MAIN ST

GRATIOT COMM HOSPITAL

510 PROSPECT

EDMORE MI

48829

ALMA MI

48801

ALMA MICHIGAN

48801

MYRON G BECKER MD

ALEXSANDRS LUSIS MD

R

JAMES F TILDEN MD

1105 SNYDER AVE

GRATIOT COMMUNITY HOSP

EDMORE MI

48829

ANN ARBOR MI

48103

ALMA MI

48801

ANDREW V BEDO MD

STEWART C MC ARTHUR

MD L

ANDREW H VELDHUIS MD

802 GORDON

BOX 32

801 GORDON RD

MT PLEASANT MI

48858

ROSEBUSH MI

48878

MT PLEASANT MICH

48858

JOS H BERGIN MD

EDWIN G MEYER MD

RICHARD L WAGGONER MD

112 E SUPERIOR

712 MICHIGAN AVE

ALMA MICH

48801

ALMA MICHIGAN

48801

ST LOUIS MI

48880

PAUL J BRAT MD

JOHN J MINSTER MD

C HARRY WALLMAN MD

245 WARWICK OR

314 S BROWN ST

901 STATE ST

ALMA MI

48801

MT PLEASANT MI

48858

ALMA MICHIGAN

48801

E J BRENNER MO

R

DONALD F NAGLER MD

LEO R WICKERT MD

1030 NORTH DRIVE

1360 TOMAH DRIVE

1001 WATSON RD

MT PLEASANT MI

48858

MT PLEASANT MI

48858

MT PLEASANT MICH

48858

LOREN G BURT MD

MARION E NANCE MD

REX A WILCOX MD

5878 JEROME RD R#1

P 0 BOX 157

525 STATE ST

ALMA MICHIGAN

48801

WEI OMAN MI

48893

ALMA MICH

48801

RAY W CHAMBERLAIN MD

MARTIN M NOSAN MD

THEODORE WILL MD

608 E CHIPPEWA

1105 KENT DR R#3

314 S BROWN ST

MOUNT PLEASANT MICH

48858

MT PLEASANT MI

48858

MT PLEASANT MI

48858

SOUREN L CHAM ICHI AN

MD

ROBERT M PATTERSON

MD

EARL C WILSON MD

CANAL RD

300 WARWICK DR

MT PLEASANT Ml

48858

ALMA MI

48801

HARRISON MI

48625

LIONEL L DAVIS MD

CARLOS A PHILIPPON

MD

KENNETH P WOLFE MD

GEN DELIVERY

255 WARWICK DRIVE

510 PROSPECT AVE

BLOWING ROCK N C

28605

ALMA MICHIGAN

48801

ALMA MI

48801

DONALD DUNLOP M 0

HAROLD V RACINE MD

CORNELIUS B WOOD MO

R

301 EAST FOURTH ST

BOX 46

ROUTE 2

CLARE MICH

48617

ITHACA MI

48847

MT PLEASANT MI

48858

WM F FISHBAUGH JR MD

RUSSELL M RAGAN MD

JOHN M WOOD MD

245 WARWICK DR

505 HIAWATHA DR

1108 WATSON RD

ALMA MICHIGAN

48801

MT PLEASANT MI

48858

MT PLEASANT MICH

48858

T E HADDAD MD

ROBERT K RANK MD

712 MICHIGAN AVE

CENTRAL COMM HOSPITAL

HILLSDALE

ST LOUIS MI

48880

MT PLEASANT MICHIGAN 48858

KUNO HAMMERBERG MD

HAROLD J REESE MD

MORTON P BATES MD

A

622 MC EWAN

1100 VERNON DR APT

4

1721 ROOSEVELT BLVD

CLARE MICH

48617

MT PLEASANT MI

48858

YPSILANTI MI

48197

WILLIAM B DAVIS MD
55 BARRY

HILLSDALE MICHIGAN

LUTHER W DAY MD
311 E OCEAN AVE
LANTANA FL

EDMOND HENELT MD
32 S BROAD
HILLSDALE MICHIGAN

CHAS L HODGE MD

READING MI

DONALD F LARSON MD
25001 NEWTON
DEARBORN MI

JOHN A MAC NEAL MD
379 S BROAD
HILLSDALE MICH

H FRA2YER MATTSON MD
32 S BROAD ST
HILLSDALE MICH

CARL A PETERSON MD
BOX 46 COCO SOLO
CANAL ZONE

WARD 0 POWERS MD
214 SOUTH ST
JONESVILLE MI

CLARK B SMITH MD
36 HIGHLAND ST
HILLSDALE MI

ARTHUR J STEIN MD
144 BUDLONG ST
HILLSDALE MICH

ARTHUR W STROM MD
32 S BROAD ST
HILLSDALE MICH

JOHN TARR MD

CAMDEN MICHIGAN

DONALD G TRAPP MD
32 S BROAD ST
HILLSDALE MICH

CHARLES T VEAR MD
252 S HOWELL ST
HILLSDALE MI

HOUGHTON

LEONARD C ALORICH MD
301 QUINCY ST
HANCOCK MI

JOSEPH F BARON MD
242 IROQUOIS
LAURIUM MI

HONORATO BARRIOS MD
424 QUINCY ST
HANCOCK MICHIGAN

PETER E CARMODY MD
1019 MAIN ST
L ANSE MI

HUGO H CASTILLA MD
770 N MAIN ST
L ANSE MICHIGAN

WM R CLARK JR MD
MOYER D I AG CLINIC
BARAGA MI

DAVID H GILBERT MD
146 OSCEOLA ST
LAURIUM MI

PAUL G GOODREAU MD
416 SHELDON AVE
HOUGHTON MI

49242

A

33460

49242

49274

48124

49242

49242

A

49250

49242

49242

49242

49232

49242

49242

49930

49913

49930
49946
49946
49908
49913

49931

JANUARY, 1972/Michigan Medicine 17

Houghton County

LISTED BY COMPONENT MEDICAL SOCIETIES

RAYMOND E HILLMER MD L

RT#5 BOX 518 COPRA LN
FT MYERS FL 33901

ANTON J JANIS MD L

200 EAST ST

HANCOCK MI 49930

FREDK E KOLB MO
128 CALUMET AVE
CALUMET MICH 49913

IVAN A LA CORE MD A

368 SHADOW MT DR #1175
EL PASO TEXAS 79912

TAMAS 0 LANCZY MD
BARAGA COUNTY HOSPITAL
LANSE MICHIGAN 49946

FORREST W LARSON MD
322 SHELDEN

HOUGHTON MICH 49931

VICTOR E LEPISTO MD
210 QUINCY ST

HANCOCK MI 49930

MAURICE D MEIER MD
1033 MINE ST

CALUMET MICH 49913

PERCY J MURPHY MD R

121 CALUMET AVE

CALUMET MI 49913

HOWARD OTTO MD
ST JOSEPH HOSPITAL
HANCOCK MI 49930

KENNETH L REPOLA MD
CALUMET PUBLIC HOSP
CALUMET MI 49913

ANDREW M ROCHE MO
221 5TH ST

CALUMET MICH 49913

JOHN C ROWE MD
212 FLORIDA ST
LAURIUM MI 49913

KENNETH E ROWE MD
107 1/2 CALUMET AVE
CALUMET MICHIGAN 49913

WILFRED J ROWELL MD R

EAGLE HARBOR MI 49951

PAUL S SLOAN MD
609 SHELDON AVE
HOUGHTON MICH 49931

CARL 0 SONNEMANN MD
STUDENT HLTH SERV
MICH TECH UNI V

HOUGHTON MI 49931

JOHN A STROUBE MD
522 W THIRD

L ANSE MICH 49946

RUTH M WARING MD
P 0 BOX 199

CHASSELL MI 49916

MARSHALL S WILLIAMS MD
ST JOSEPHS HOSPITAL
HANCOCK MICH 49930

HURON

J N BROUILLETTE MD

125 N HANSELMAN

BAD AXE MI 48413

RALPH C DIXON MD
BOX 77

PIGEON MICH 48755

CHAS S ELLIOTT MD

WALDO 0 BAOGLEY MD
930 N WASHINGTON AVE

PIGEON MI

48755

LANSING MI

48906

C CLARK HERRINGTON MD

MICHAEL D BAILIE MD

125 N HANSELMAN

DEPT OF MEDICINE-MSU

BAD AXE MICHIGAN

48413

EAST LANSING MI

48823

K B HERRINGTON MD

WALTER M BAIRD MD

317 PORT CRESCENT

540 WILDWOOD

BAD AXE MICHIGAN

48413

EAST LANSING MI

48823

KENNETH S KUBE MD

THOS C BAKER MD
930 N WASHINGTON AVE

BAD AXE MI

48413

LANSING MICHIGAN

48906

J M MULLANEY JR MD

A

ROBT C BASSETT MD

1050 WALL ST APT 1C

1322 E MICHIGAN AVE

ANN ARBOR MI

48105

LANSING MI

48912

ROBERT W OAKES MO

RICHARD BATES M D

7890 SAND BEACH RD

2909 E GRAND RIVER

HARBOR BEACH MI

48441

LANSING MICH

48912

CHAS W OAKES JR MO

THEODORE I BAUER MD
810 MICH NAT TOWER

L

HARBOR BEACH MI

48441

LANSING MI

48933

GORDON R RADY MD

OLIVER A BEAMON MD

P 0 BOX 924

701 N LOGAN #510

PORT HURON MI

48060

LANSING MI

48915

CLARE A SCHEURER MD

CHARLES A BEHNEY M D
BOX 4256 SAN JOSE DR

L

PIGEON MI

48755

BISBEE AZ

85603

JOSEPH SIDAGIS MD

ELEANOR A BERDEN MO

6 W MAIN ST

2630 LIBBIE DRIVE

SEBEWAING MI

48759

LANSING MI

48917

MAURICE G SORENSEN MD

HANS BERGEEST MD

P 0 BOX

1980 TAMARISK

ELKTON MICH

48731

EAST LANSING MI

48823

EDWARD E STEINHARDT

MD

MILTON C BERGEON MD
1021 W DANSVILLE RD

BAD AXE MI

48413

MASON MICH

48854

MANUEL L TEVES MD

CHAS J BERGER MD

119 S SECOND ST

BOX 1258

HARBOR BEACH MI

48441

LANSING MI

48904

PHILLIP R TURNER MO

ROLLAND E BETHARDS MD

230 S FIRST ST

SPARROW HOSPITAL

HARBOR BEACH MICH

48441

LANSING MICHIGAN

48902

ROBERT A WILLITS MD

FRANK L BEVEZ MD

193 N MAIN ST

3209 S CAMBRIDGE RD

ELKTON MICHIGAN

48731

LANSING MICH

48910

B WAYNE BINGHAM MD
1034 E SAGINAW

INGHAM

LANSING MI

48906

CHARLES ADAMS MD

GERTRUDE C K BLACK MD

2909 E GRAND RIVER

529 W GRAND RIVER

LANSING MICHIGAN

48912

WILLI AMSTON MICH

48895

MAGNUS H AGUSTSSON MD A

THOMAS C BLAIR MO

701 N LOGAN

1322 E MICHIGAN AVE

LANSING MI

48914

LANSING MICHIGAN

48912

DONALD J AIKEN MD

EUGENE E BLEIL MD

GRANDVIEW £ GRAND RV

1322 E MICHIGAN AVE

OKEMOS MICH

48864

LANSING MICHIGAN

48912

REUBEN G ALEXANDER MD L

CARL W BRADFORD MD

133 CRUM ST

832 WESTLAWN

LAINGSBURG MI

48848

EAST LANSING MICH

48823

ROBERT E ALLEN JR MD

ROBT E BRANTLEY MD

1322 E MICHIGAN #116

SPARROW HOSP X-RAY

LANSING MI

48912

LANSING MI

48902

HARRY 0 ALLIS MD

JAMES BRIGGS MD

A

2909 E GRAND RIVER

811 HULEN DR

LANSING MI

48912

COLUMBUS MO

65201

J K ALTLAND MD

FREDK W BROWN JR MD

ROUTE 2 BOX 178

831 N WASHINGTON AVE

LANSING MI

48917

LANSING MICHIGAN

48906

OAVIO C ASSELIN MD

JOSEPH C BROWN MD

A

1322 E MICHIGAN

2271 N W 2 1 ST PLACE

LANSING MICHIGAN

48912

GAINESVILLE FL

32601

M ARTHUR BUDOEN MD
2909 E GRAND RIVER

LANSING MICHIGAN 48912

TERRY E BURGE MD
BOX 68

HOLT MI 48842

MR RICHARD U BYERRUM A

602 WILDWOOD DR

EAST LANSING MI 48823

DONALD A CAIRNS MD
P 0 BOX 110

MASON MICH 48854

ANTHONY D CALOMENI MD

1850 W MT HOPE

LANSING MICHIGAN 48910

RALPH G CARLSON MD
225 S WAVERLY

LANSING MI 48917

EARL I CARR MD L

1915 MOORES RIVER DR
LANSING MI

JOSEPH A CARUSO MD
701 N LOGAN ST
LANSING MICHIGAN

BYRON L CASEY M D

202 MAC

EAST LANSING MI

THOMAS W CHAFFEE MD
209 ABBOTT RO #204
EAST LANSING MI

MARIAN I G CHASKES MD

701 N LOGAN SUITE 225
LANSING MI 48915

WM D CHENEY MD
SPARROW HOSP X RAY
LANSING MICHIGAN 48902

SEONG H CHI MD
INGHAM MEDICAL HOSP
LANSING MI 48910

JOSEPH R CIPPARONE MD
ST LAWRENCE HOSP
LANSING MICHIGAN 48914

GAIUS D CLARK MD

865 PEBBLEBROOK LN

EAST LANSING MI 48823

WM E CLARK MD
809 E ASH ST

MASON MICH 48854

GEO R CLINTON MD

744 E MAPLE ST

MASON MICHIGAN 48854

FORREST C CLORE MD M

JAMES S CLOSE MD
701 N LOGAN #505
LANSING MI

BEVERLY A COLLIER
1843 MIRABEAU
OKEMOS MI

RICHARD L COLLIER
1843 MIRABEAU
OKEMOS MI

ROBT G COMBS MD
1023 E MICHIGAN AVE
LANSING MI 48912

HOWARD C COMSTOCK MD
2909 E GRANO RIVER
LANSING MI

ERRIKOS CONSTANT MD
1200 MICHIGAN AVE
EAST LANSING MI

48912

48823

48915

MD

48864

MD

48864

48910

48915

48823

48823

18 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Ingham County

J MAXWELL COOK MO
3911 W MICHIGAN AVE

LANSING MICH 48917

HENRY E COPE MD R

605 WESTMORELAND

LANSING HI 48915

JEROME F CORDES MD
2909 E GRAND RIVER
LANSING MICHIGAN 48912

GOLDIE CORNELIUSON MD R
3225 E RIVERSIDE DR
RIV GARDEN APT 58-E

FT MYERS FL 33901

DANIEL COWAN MD
DEPT OF PATH MSU
COLLEGE OF HUMAN MED

EAST LANSING MI 48823

JOHN A COWAN MD

825 TOURAINE AVE

EAST LANSING MI 48823

J RICHARD CROUT MD
PHARMACOLOGY DEPT MSU
EAST LANSING MI 48823

HAROLD E CROW MD
1215 E MICHIGAN AVE
LANSING MICHIGAN 48912

GORDON D DAUGHARTY MD
2909 E GR RIVER #205
LANSING MI 48912

ROBERT M DAUGHERTY MD

1607 STANLAKE DR

EAST LANSING MI 48823

SANDRA DAUGHERTY MD

DEPT OF MED MSU

EAST LANSING MI 48823

DON G OAVIS

1200 MICHIGAN AVE

EAST LANSING MI 48823

C D DAWE MD

1515 W MT HOPE AVE

LANSING MICHIGAN 48910

JOHN DE BRUIN JR HD

4528 S HAGADORN RD

EAST LANSING MI 48823

MARY J B DEXTER MD A

1082 WILLANA CT

MILAN MI 48160

DONALD J DROLETT HD
1322 E MICHIGAN AVE
LANSING MICHIGAN 48912

JOHN F DUNKEL MD

2857 RIVERWOOD COURT

PORT HURON MI 48060

FOREST M DUNN MD
1322 E MICHIGAN AVE
LANSING MICHIGAN 48912

RALPH R_ EDMINSTER MD
SPARROW HOSP PATH DEPT
LANSING MI 48902

ADNAN H ELDAOAH MD
3500 N LOGAN

LANSING MI 48906

BERTHA W ELLIS MD L

P 0 BOX 2327

HOLLYWOOD FL 33022

C WARD ELLIS MD L

P 0 BOX 2327

HOLLYWOOD FL 33022

ALFRED ELLISON JR M D
2909 E GRAND RIVER 202
LANSING MI 48912

ALLEN J ENELOW MD
936 SOUTHLAWN

EAST LANSING Ml 48823

DANIEL C ENGLISH MD

DEPT OF SURGERY

MICH STATE UNIV

COLLEGE OF HUMAN MED

EAST LANSING MI 48823

MATTHIES EVANS MD
1877 WALNUT HEIGHTS DR
EAST LANSING MI 48823

ABDUL R FAYYAD MD
1322 E MICHIGAN #318
LANSING MI 48912

KENNETH J FEENEY MO
1908 MICH NATL TOWER
LANSING MI 48933

ROGER K FERGUSON MO

DEPT OF MEDICINE MSU

EAST LANSING MI 48823

JAMES S FEURIG MD
321 KENSINGTON RD
EAST LANSING MI 48823

CLYDE R FLORY JR MD

201 W HILLSDALE

LANSING MICHIGAN 48933

ARTHUR LEE FOLEY II MD

DEPT OF ANATOMY MSU

EAST LANSING MI 48823

LEONARD M FOLKERS MD

234 MICHIGAN AVE

EAST LANSING MICH 48823

SILVIO P FORTINO MD
2909 E GRANO RIVER
LANSING MICHIGAN 48912

DOUGLAS H FRYER MD

MICH DEPT OF HLTH

LANSING MI 48906

A JOHN GARLINGHOUSE JR
1322 E MICHIGAN AVE
LANSING MICHIGAN 48912

ABRAHAM GELLAR MD
108 DIVISION

EAST LANSING MICH 48823

HARRY C GEORGE MD
909 ABBOTT RD

EAST LANSING MI 48823

RASEM GHANNAM MD

919 CHESTER RD

LANSING MI 48912

L A GINNEBAUGH MD A

1928 S CONWAY RD #24
ORLANDO FL 32806

ROY E GOLDNER MO L

1318 S WASHINGTON AVE
LANSING MI 48910

FLOYD G GOODMAN MD
4528 S HAGADORN RD
EAST LANSING MI 48823

SIDNEY R GOVONS MD
1322 E MICHIGAN AVE
LANSING MICHIGAN 48912

OAVIO GREENBAUM MD
COLLEGE OF HUMAN MED
DEPT OF MED-MSU

EAST LANSING MI 48823

VIRINDER S GREWAL MD
2909 E GRAND RIVER 103
LANSING MI 48912

ANNA B GREY MD L

915 CAJON ST

REDLANDS CA 92373

JOHN A HABRA MD

919 CHESTER ROAD

LANSING MI 48912

THERESA B HADDY MD
DEPT OF HUMAN MED-MSU
EAST LANSING MI 48823

JOHN C HALL MD

1319 E MICHIGAN

LANSING MI 48912

R E HAMES MD

1322 E MICHIGAN AVE

LANSING MICHIGAN 48912

ROGER J HANNA MD R

329 E SOUTH ST

MASON MI 48854

GEORGE C HARDY MD
SPARROW HOSP PTH DEPT
LANSING MI 48902

NORMAN H HAREBOTTLE MD
209 N WALNUT

LANSING MI 48933

LOUIS E HARRINGTON MO
3526 W SAGINAW ST
LANSING MI 48917

HERBERT W HARRIS MD

919 CHESTER RD

LANSING MI 48912

WM H HARRISON MD
834 W ST JOSEPH ST
LANSING MI 48915

JESSE F HARROLD MD
326 W IONIA

LANSING MI 48933

MARK W HARROLD MD

326 W IONIA ST

LANSING MI 48933

RICHARD L HATTON MD
2321 INDIAN HILLS DR
OKEMOS MICHIGAN 48864

KENT R HAY MD

1322 E MICHIGAN AVE

LANSING MICHIGAN 48912

ROBT E HAYES MD
1322 E MICHIGAN AVE
LANSING MI 48912

WM D HAYFORD MD

1028 E SAGINAW ST

LANSING MI 48906

GORDON H HEALD MD

714 ABBOTT ROAD

EAST LANSING MICH 48823

FRANK B HECKERT MD
1105 BNK OF LNSG BLDG
LANSING MI 48933

JOS K HECKERT MD L

1105 BNK OF LNSG BLDG
LANSING MI 48933

MARK E HEERDT MD
810 W SAGINAW

LANSING MICHIGAN 48915

RAY E HELFER MD
DEPT OF HUMAN DEV
MICH STATE UNIV

EAST LANSING MI 48823

THOMAS A HELMRATH MD

227 KEN8ERR Y DR

EAST LANSING MI 48823

DAN M HENSHAW MD
411 RIDGEWATER DR
MARIETTA GA 30060

ALBERT E HEUSTIS MD R

ROUTE #1 BOX 99

THREE RIVERS MI 49093

THOS B HILL MO
554 DURAND ST

EAST LANSING MI 48823

R J HIMMELBERGER MD R

3624 COLCHESTER

LANSING MI 48906

D BONTA HISCOE MD
2909 E GRAND RIVER
LANSING MICH 48912

JACOUE HOCHGLAUBE MD
726 ABBOTT RD

EAST LANSING MI 48823

W E HOFFER MD L

331 SHEPARD STREET
LANSING MI 48912

RAYMOND E HOGG MD
2909 E GRAND RIVER
LANSING MICHIGAN 48912

CHAS F HOLLAND MD
810 W SAGINAW

LANSING MICHIGAN 48915

PAUL HOLLISTER MD
DEPT OF MEDICINE
MICH STATE UNIV

EAST LANSING MI 48823

FRANCIS HORVATH MD
2909 6 GRAND RIVER
LANSING MI 48912

JOHN C HOYT MD
BOX 66

HOLT MI 48842

CLARE C HUGGETT MD
122 W GD RIVER AVE
LANSING MICHIGAN 48906

DONALD H HULDIN MD
241 E SAGINAW # 220
EAST LANSING Ml 48823

ANDREW D HUNT JR MD
COLL OF HUMAN MED MSU
EAST LANSING MI 48823

M S HURTH MD L

1717 JEROME ST

LANSING MICH 48912

E A HUTCHINSON MD
2909 E GR RIVER #208
LANSING MI 48912

ELIZABETH W IMESON MD

1809 CAHILL DRIVE

EAST LANSING MI 48823

J L ISBISTER MD

DEPT HEALTH DE WITT RD

LANSING MICH 48906

OMERO S I UNG MD N

516 TICKNER

LINDEN MI 48451

S SPRIGG JACOB III MD
201 ANN ST

EAST LANSING MICH 48823

JOHN S JACOBY MD
2701 FOURTH ST SO
MINNEAPOLIS MINN 55408

PAUL JAKUBIAK MD

1874 PENOBSCOT

OKEMOS MI 48864

BRUCE S JARSTFER MD M

806 CADDINGTON DR

SILVER SPRING MD 20902

JANUARY, 1972/Michigan Medicine 19

Ingham County

LISTED BY COMPONENT MEDICAL SOCIETIES

HILLIARD JASON MD
OL IN MEM HLTH C TR MSU
EAST LANSING MI 48823

DAVIO B JOHNSON MO
2909 E GRAND RIVER
LANSING MICH 48912

GEORGIA A L JOHNSON MD

2608 DARIEN OR

LANSING MI 48912

KENNETH H JOHNSON MO L

1116 MICH NAT TOWER
LANSING MI

LANNY L JOHNSON MD
4528 S HAGADORN RO
EAST LANSING MI

MILO L JOHNSON MD
SPARROW HOSPITAL
OEPT OF RAOIOLOGY
LANSING, MI

RICHARD JOHNSON MO
2909 E GRAND RIVER 202
LANSING MI 48912

FRANCIS A JONES JR MD R

815 ROYAL PALM PL

VERO BEACH FL 32960

JOHN W JONES MD

DEPT OF MEDICINE-MSU

EAST LANSING MI 48823

LESTER C JONES MD
2909 E GRAND RIVER 203
LANSING MI 48912

MARGARET JONES MD

DEPT OF PATH MSU

EAST LANSING MI 48823

MARTIN F JONES MD
2909 E GRAND RIVER
LANSING MICHIGAN 48912

DAVID KAHN MD
2909 E GRAND RIVER
LANSING MICHIGAN 48912

ROLAND E K ALM8ACH MD L

1322 E MICHIGAN AVE
LANSING MI 48912

STANLEY KATLEIN MO
2231 HERITAGE

OKEMOS MI 48864

HOWARD H KELLERMAN MD

4423 CALGARY BLVD

OKEMOS MI 48864

WILLIAM KELLY M D

IONIA STATE HOSPITAL

IONIA MI 48846

A EDITH HALL KENT MD L

BOX 1167

LANSING MICHIGAN

FANNY H KENYON MD
624 LASALLE 8LVD
LANSING MI

MOHAMED J KHAN MD
2630 RAPHAEL RD
EAST LANSING MI

RAYMOND C KINZEL MD
326 W IONIA ST
LANSING MICH

THOMAS R KIRK MO
252 HOLLISTER BLDG
DEPT OF PUBLIC HLTH

LANSING MI

JAMES C KLOEPFER MD
401 W GREENLAWN
LANSING MI

48904

L

48912

48823

48933

48904

48910

48933

48823

48902

D E KNICKERBOCKER MD

CHAS 0 LONG JR MD

1017 E GRAND RIVER

2909 E GRAND RIVER

EAST LANSING MI

48823

LANSING MICHIGAN

48912

ARTHUR F KOHRMAN MD

MAURICE C LOREE MD

DEPT OF HUMAN DEV MSU

1531 ABBOTT RD

EAST LANSING MI

48823

EAST LANSING MI

48823

JEROME S KOZAK MD

HARRY J LOUGHRIN MD

919 CHESTER RD

1005 ABBOTT RD

LANSING MI

48912

EAST LANSING MI

48823

LESTER C KRAFT MD

KAARE LOVOLL MD

209 S MAIN ST

P 0 BOX 95

LESLIE MICH

49251

HOLT MI

48842

DONALD H KUIPER MD

THOS A LUCAS MD

DEPT OF MED - MSU

1515 W MT HOPE

EAST LANSING MI

48823

LANSING MICHIGAN

48910

SOUNG OH KWOUN MD

A

LEWIS C LUDLUM MO

INGHAM MEDICAL HOSP

1126 W SAGINAW ST

LANSING MI

48910

LANSING MI

48915

ROBT E LANDICK JR MD

EDWARD J LYNN MD

810 W SAGINAW

MSU DEPT - PSYCHIATR

Y

LANSING MICHIGAN

48915

EAST LANSING Ml

48823

JOHN F LANE MD

HENRY E MALCOLM MD

1065 FIVE FORKS RD

1322 E MICHIGAN

VIRGINIA BEACH VA

23455

LANSING MI

48912

PHILIP F LANGE MD

W E MALDONADO MD

1302 PERSHING DRIVE

SPARROW HOSPITAL

LANSING MI

48910

LANSING MICHIGAN

48902

HELEN E P LANTING MD

MARIA B MANDELSTAMM

MD

431 GLENMOOR #201

4583 COMANCHE DR

EAST LANSING MI

48823

OKEMOS MI

48864

PAUL E LARKEY MD

L R MANNAUSA MD

11653 S HARTEL RD

1200 MICHIGAN AVE

GRAND LEDGE MI

48837

EAST LANSING MI

48823

HOMER I LARSON MD

WAYNE 0 MARTIN MD

R

1322 E MICHIGAN AVE

4765 NAKOMA DR

LANSING MI

48912

OKEMOS MICH

48864

VIRGINIA D LAUZUN MD

M FINETTE MARZOLF MD

N

1654 E GRAND RIVER

3315 WISCONSON NW

EAST LANSING MICH

48823

WASHINGTON DC

20016

DON M LE DUC MO

E MAVROMATIS MD

1322 E MICHIGAN AVE

1322 E MICHIGAN AVE

LANSING MICH

48912

LANSING MICHIGAN

48912

JOS C LESHOCK MD

F MAVROMATIS MD

701 N LOGAN ST

1322 E MICHIGAN AVE

LANSING MICHIGAN

48915

LANSING MICHIGAN

48912

EDW 8 LEVERICH MD

STEPHEN G MAY MD

909 ABBOTT RD

202 MAC AVENUE

EAST LANSING MI

48823

EAST LANSING MI

48823

HARRY L LEVETT MD

C RAY MC CORVIE MD

L

2909 E GRAND RIVER AVE

525 NE HAYWORTH RD

LANSING MICHIGAN

48912

PORT CHARLOTTE FL

33950

ALVIN LEWIS MD

DONALD R MC CORVIE M

D

358 GILTNER HALL-MSU

WILLI AMS TON MED BLDG

EAST LANSING MI

48823

WILL IAMSTON MICH

48895

CLAYTON LEWIS JR MD

LELAND R MC ELMURRY

MD

2909 E GRAND RIVER

209 N WALNUT ST

LANSING MICHIGAN

48912

LANSING MI

48933

PAUL C LINNELL MD

DONALD R MCFARLANE MD

1200 MICHIGAN AVE

1322 E MICHIGAN AVE

EAST LANSING MI

48823

LANSING MI

48912

DONALD L LIPSEY MD

0 B MC GILL ICUDDY MD

L

INGHAM MEOICAL HOSP

1816 MICH NATL TOWER

LANSING MI

48910

LANSING MI

48933

JOSE J LLINAS MD DIR

MARVIN J MCKENNEY MD

COMM MENTAL HLTH

1200 MICHIGAN AVE

COMM SERVICES BLDG
300 N WASHINGTON

EAST LANSING MI

48823

LANSING MI

48933

B EDWARD MC NAMARA MD N

BOX 248

GUSTAV M LO MD

FAIRPLAY CO

80440

701 N LOGAN #515
LANSING MI

48915

WM H MEADE MD
1023 E MICHIGAN

LANSING MICHIGAN

48912

RICHARD K MEINKE MD

1322 E MICHIGAN AVE
LANSING MICHIGAN 48912

RICHARD C MELICK MD
326 W IONIA

LANSING MI 48933

WALTER E MERCER MD R

909 GLENHAVEN

EAST LANSING MI 48823

A L MESSENGER MD
1322 E MICHIGAN AVE
LANSING MICHIGAN 48912

J T MILLER JR MD M

4307 ROBERT CT USNR
WHEATON MD 20906

WILLARD J MILLER MD

225 S WAVERLY RD

LANSING MICH 48917

ELBA MOLINA PUNG MD
SPARROW HOSPITAL
OUTPATIENT CLINIC

LANSING MI 48912

ROBT N MONFORT MD R

300 PACIFIC RD

MIAMI FL 33149

CHARLES R MOORE MD
1322 E MICHIGAN AVE
LANSING MICHIGAN 48912

DONALD B MOORE MD
1322 E MICHIGAN AVE
LANSING MI 48912

ROBT J MORROW MD R

741 S W 2ND ST

BOCA RATON FL 33432

EUGENE C NAKFOUR MD

1320 S GENESEE DR

LANSING MI 48915

JAMES C NEERING MD
1322 E MICHIGAN AVE
LANSING MI 48912

JOHN R NEUMAN MD
225 S WAVERLY RD
LANSING MICHIGAN 48917

BARNABAS NEWTON MD

401 W GREENLAWN

LANSING MI 48910

MILDRED V NICHOLAS MD R

5596 PORTAGE LAKE RD
DEXTER MICHIGAN

PAUL T NILAND MD
1322 E MICHIGAN AVE
LANSING MI

PAUL J OCHSNER MD
4741 THORNAPPLE LN
LANSING MI

K I WHAN OH MD
401 W GREENLAWN
LANSING MI

PEDRO OJEDA MD
701 N LOGAN SUITE 212
LANSING MI 48915

FREDRIC J 0 NEILL MD
1322 E MICHIGAN #112
LANSING MI

WM G PAINE MD
1028 E SAGINAW ST
LANSING MICHIGAN

R E PALMER M D
1627 WILDWOOD RD
CLEARWATER FL

48912

48906

L

33516

48130

48912

R

48917

48910

20 jANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Ingham County

THOMAS C PAYNE MD

MARY HARMON RYAN MO

RUTH C E SNYDER MD

2909 E GRAND RIVER AVE

2377 SEMINOLE DR

234 W MICHIGAN AVE

LANSING MICHIGAN

48912

OKEMOS MI

48864

EAST LANSING MICH

48823

RONALD PEETS M D

HUGO R SAENZ MD

ALFREO J SPAGNUOLO MD

GR RIVER 6 GRANDVIEW

1515 W MT HOPE

1418 S LOGAN ST

OKEMOS MICH

48864

LANSING MICHIGAN

48910

LANSING MICHIGAN

48910

ROBERT A PERRY MD

JAMES H SAKER MD

J CLYDE SPENCER MD

701 N LOGAN

201 W HILLSDALE ST

SPARROW HOSPITAL

LANSING MI

48915

LANSING MICHIGAN

48933

LANSING MICHIGAN

48902

ALVIN J PHELAN MD

CHARLES H SANDER MD

PERRY C SPENCER MD

920 TOWNSEND ST

DEPT OF PATHOLOGY MSU

320 TOWNSEND ST

LANSING MI

48921

EAST LANSING MI

48823

LANSING MI

48933

JOHN F PLANT MD

IAN SAYANI MD

ARTHUR L STANLEY MD

2909 E GRAND RIVER

4792 NAKOMA DRIVE

401 W GREENLAWN

LANSING MICHIGAN

48912

OKEMOS MI

48864

LANSING MICHIGAN

48910

WM H PLESSCHER MD

J F SCALLIN M D

ABRAHAM A STEINER MD

R

1322 E MICHIGAN AVE

810 W SAGINAW

ROUTE 3

LANSING MICHIGAN

48912

LANSING MICH

48915

GRAND LEDGE MI

48837

RICHARD W POMEROY MD

R RUDOLPH SCHEIDT MD

WINTON E STEPHAN MD

SPARROW HOSP

201 W HILLSDALE

452 TULIP TREE LANE

LANSING MI

48912

LANSING MICHIGAN

48933

EAST LANSING MI

48823

LUIS POSADA MD

HARRY J SCHMIDT MD

GEO D STILWILL MD

1322 E MICHIGAN #214

2909 E GRAND RIVER

2909 E GRAND RIVER

LANSING MI

48912

LANSING MICHIGAN

48912

LANSING MICHIGAN

48912

GERALD D POWELL MD

ARTHUR E SCHULTZ MD

PAUL R STIMSON MD

1850 W MT HOPE

2700 MT HOPE

119 E GRAND RIVER

LANSING MI

48910

OKEMOS MICH

48864

EAST LANSING MICH

48823

DONALD R QUIGLEY MD

JAMES S SCOTT MD

BEN J J STONE MD

701 N LOGAN ST

607 TURNER ST

1005 ABBOTT RD

LANSING MI

48915

DEWITT MI

48820

EAST LANSING MI

48823

MAURICE S REIZEN MD

HYMAN D SHAPIRO MD

ROBT M STOW MD

3500 NO LOGAN

1327 E MICHIGAN AVE

2909 E GRAND RIVER

MICH DEPT PUBLIC HLTH

LANSING MICH

48912

LANSING MICHIGAN

48912

LANSING Ml

48906

MAHLON S SHARP MD

WALTER F STREMPEK MD

2909 E GRAND RIVER

MICH DEPT PUB HLTH

EDWARD E REYNOLDS MD

LANSING MI

48912

3500 N LOGAN

RT 2 BOX IB

DIV OF ADULT HLTH

WILL IAMSTON MICH

48895

MILTON SHAW MD
320 TOWNSEND ST

L

LANSING MI

48906

R G RICE MD

LANSING MI

48933

C J STRINGER MD

R

3500 N LOGAN ST

425 WAL8RIDGE

LANSING MICHIGAN

48914

JOSEPH L SHEETS MD
2909 E GRAND RIVER

EAST LANSING MI

48823

FRANK D RICHARDS MD

R

LANSING MI

48912

LEIF G SUHRLAND MD

5101 FAIRFAX NW

DEPT OF MED MSU

ALBUQUERQUE N M

87114

GEO A SHERMAN MD
504 COWLEY

L

EAST LANSING MI

48823

EDWARD L RINGER MD

EAST LANSING MI

48823

EDWIN C SUNDELL MD

320 TOWNSEND ST

1322 E MICHIGAN AVE

LANSING Ml

48933

HARPER G SICHLER MD
1476 STONEGATE LANE

R

LANSING MICHIGAN

48912

THOMAS H ROBINSON MD

EAST LANSING MI

48823

FREDK C SWARTZ MD

PO BOX 204

720 SEYMOUR STREET

LANSING MICHIGAN

48901

DAVIO SIEGEL MD
2909 E GRAND RIVER

LANSING MICHIGAN

48906

EDMUND J ROBSON MD

LANSING MICH

48912

SCOTT N SWISHER JR MD

701 N LOGAN

DEPT OF MEDICINE MSU

LANSING MI

48915

ROMULO E SILVA MO
335 SEYMOUR ST

EAST LANSING MI

48823

LEOPOLDO RODRIGUEZ MD

LANSING MI

48933

FREDK W TAMBLYN MD

810 W SAGINAW ST

909 ABBOTT RD

LANSING MI

48915

IRVING E SILVERMAN
2909 E GRAND RIVER

MD

EAST LANSING MI

48823

ROBT A ROLLSTIN MD

LANSING MICHIGAN

48912

D W THADEN MD

920 TOWNSEND ST

909 ABBOTT RD

LANSING MI

48921

WILLIAM J SINCLAIR
1200 MICHIGAN AVE

MD

EAST LANSING MI

48823

LIONEL W ROSEN MD

EAST LANSING MI

48823

ROBT F THIMMIG MD

DEPT OF PSYCHIATRY-MSU

1322 E MICHIGAN AVE

EAST LANSING MI

48823

JUSTIN L SLEIGHT MD
2909 E GRAND RIVER

LANSING MI

48912

DAVID R ROVNER MD

LANSING MICHIGAN

48912

HSIN CHEN TIEN MD

DEPT OF MEDICINE

701 N LOGAN ST

MICH STATE UNI V

ANTHONY V SMITH MD

LANSING MI

48915

COLLEGE OF HUMAN MED

116 W SYCAMORE

EAST LANSING MI

48823

MASON MICH

48854

FREDK C TRAGER MO
1322 E MICHIGAN AVE

RALPH H RUHMKORFF MD

R

BERNARD H SMOOKLER

MD

LANSING MI

48912

1060 GLENHAVEN

2909 E GRAND RIVER

EAST LANSING MICH

48823

LANSING MICHIGAN

48912

ROBT F TRESCOTT MD
1322 E MICHIGAN AVE

SAML H RUTLEDGE JR MD

LE MOYNE SNYDER MD

R

LANSING MICHIGAN

48912

1322 E MICHIGAN AVE

P 0 BOX 5

LANSING MI

48912

PARADISE CA

95969

ROBT H TRIM8Y MO
1322 E MICHIGAN AVE

LANSING MICHIGAN 48912

FRANKLIN L TROOST MD L

4378 W DELHI RO

HOLT MICH 48842

PAUL C TURNER MD

2909 E GRAND RIVER 203

LANSING MI 48912

EVA URBAN MD
540 GLENMOOR

EAST LANSING MICH 48823

T P VANDERZALM MD L

1452 CAMBRIDGE RD
LANSING MI 48910

CAROL VARNER MD
OKEMOS MEDICAL BLDG
OKEMOS MICHIGAN 48864

HUBERT P VELTEN MD
SPARROW HOSP EEG LAB
LANSING MI 48902

JOS H VENIER MD

1628 HITCHING POST RD

EAST LANSING MI 48823

DOUGLAS F HACKER MD

1323 E MICHIGAN

LANSING MI 48912

RALPH WADLEY MD

HARBOR SPRINGS MI 49740

LEO W WALKER MD
4225 APPLE TREE LANE
LANSING MICHIGAN 48917

WM 8 WEIL JR MD

DEPT OF HUMAN DEV MSU

EAST LANSING MI 48823

JOHN M WELLMAN MD

1236 WOODCREST LANE

EAST LANSING MI 48823

ARNOLD WERNER MD

DEPT OF PSYCHIATRY MSU

EAST LANSING MI 48823

CHAS CARL WEST MD
2909 E GRAND RIVER
LANSING MICH 48912

W DONALD WESTON JR MD
DEPT OF PSYCHIATRY-MSU
EAST LANSING MI 48823

HENRY 0 WICK JR DO 0

VA HOSPITAL
PHYSICAL MED £ REHAB

WOOD WISCONSIN 53193

JOHN G WIEGENSTEIN MD

ST LAWRENCE HOSP

LANSING MI 48914

K R WILCOX JR MD
MICH DEPT OF HEALTH
LANSING MICHIGAN 48906

STEPHEN P WILENSKY MD

ST LAWRENCE HOSP

LANSING MI 48914

THOS WILENSKY MD

701 N LOGAN ST

LANSING MICHIGAN 48915

D BRUCE WILEY MD L

921 COOLIDGE APT 3
LANSING Ml 48912

HOWARD S WILLSON MD L

1052 MICH NAT L TOWER
LANSING MI 48933

JANUARY, 1972/Michigan Medicine 21

Ingham County

LISTED BY COMPONENT MEDICAL SOCIETIES

RALPH WORTHINGTON MO

JOS KOPCHICK MD

SAUL APPEL MD

810 W SAGINAW

112 W MICHIGAN AVE

LANSING MI

48915

MUIR MI

48860

JACKSON MICH

49201

CHAS K WORTLEY MD

MARTIN J KOZACHIK MD

TURAN ARGUN MD

1200 E MICHIGAN AVE

123 BRIOGE ST

762 W MICHIGAN AVE

EAST LANSING MI

48823

PORTLAND MICH

48875

JACKSON MI

49201

JOHN H WYLIE JR MD

JOHN L LONDON MD

JAMES C ASKINS MO

2243 W GRAND RIVER AVE

LAKEVIEW MEDICAL CTR

214 N WEST AVE

OKEMOS MI

48864

LAKEVIEW MI

48850

JACKSON MI

49201

KARL F YOSHONIS MD

LEO L MARSTON MD

BURHAN C BABACAN MD

1322 E MICHIGAN AVE

BOX 235

569 WILDWOOD AVE

LANSING MI

48912

LAKEVIEW MICH

48850

JACKSON MI

49201

WRALD A 2 ICK MD

FRANK A MERCHUN MD

GEO M BAKER MD

1322 E MICHIGAN AVE

11804 W CARSON CITY RD

350 S UNION

LANSING MI

48912

GREENVILLE MICHIGAN

48838

PARMA MICH

49269

LUTHER H ZICK MO

JEKABS NAGLINS MD

R

SIDNEY A BECKWITH MD

1023 E MICHIGAN

3475 S OCEAN BLVD #105

100 E MAIN ST

LANSING MI

48912

PALM BEACH FL

33480

STOCKBRIDGE MICH

49285

HERMANN A ZIEL JR MD

BRUCE C OLSEN MD

JACK P BENTLEY MD

MICH DEPT OF HEALTH

917 W OAK ST

2532 SPRING ARBOR RD

LANSING MICHIGAN

48906

GREENVILLE MICHIGAN

48838

JACKSON MICH

49203

R J 0 MALLEY MD

MARY E N BENTLEY MD

IONIA

910 E LINCOLN

2532 SPRING ARBOR RD

IONIA MICHIGAN

48846

JACKSON MICH

49203

D HESS ANDERSON MD

ROBT E RICE MD

JERRY B BOOTH DDS

A

207 BRIDGE ST

420 S BOWER ST

123 N WEST AVE

PORTLAND MICH

48875

GREENVILLE MI

48838

JACKSON MI

49201

LEANORE I BAUTISTA MD

PERRY C ROBERTSON MO

L

ZANE A BRASHARES MD

910 E LINCOLN AVE

327 CENTER ST

IONIA MI

48846

IONIA MI

48846

BROOKLYN MI

49230

W BRUCE BENNETT MD

G JAY ROTTMAN MD

RAFAEL C BRILLANTES MD

LAKEVIEW HOSPITAL

6413 N LAFAYETTE

1514 FOURTH ST

LAKEVIEW MICHIGAN

48850

GREENVILLE MICHIGAN

48838

JACKSON MI

49203

WM L BIRD MD

LOUIS E SANFORD MD

G R BULLEN MD

L

917 W OAK ST

302 S BRIDGE ST

418 THIRD ST

GREENVILLE MICHIGAN

48838

BELDING MI

48809

JACKSON MI

49201

ALFREDS A BIRZGALIS

MD

MILTON E SLAGH MD

ROBERT C BUSLEPP MD

IONIA STATE HOSP

901 REYNOLDS BLDG

IONIA MICH

48846

SARANAC MI

48881

JACKSON MICHIGAN

49201

JACK H BUCK MO

ROBT 0 SMITH MD

F T CEL I S MD

517 DIVISION

910 E LINCOLN AVE

766 W MICHIGAN AVE

IONIA MICHIGAN

48846

IONIA MI

48846

JACKSON MI

49201

LEO W BUNCE MD

EDMUND S SOCHA MD

L

RAY H CLARK MD

1612 N E 56TH

500 LANSING AVE

TRUFANT MI

49347

FORT LAUOERDALE FL

33308

JACKSON MI

49201

SANTIAGO C CA8ERT0 MD

ROBERT SOSA MD

CORWIN S CLARKE MD

L

685 W RIVERSIDE DR

P 0 BOX 32

HACINDA CARMEL

IONIA MI

48846

BELDING MI

48809

CARMEL CA

93921

RICHARD E CAMPBELL MD

CHARLES E STEVENS MO

JAMES 0 CLIFFORD MD

104 S KIDD

513 N LAFAYETTE ST

500 LANSING AVE

IONIA MICH

48846

GREENVILLE MICH

48838

JACKSON MI

49201

CESAR H COLON SONET

MD

JOHN F TANNHEIMER MD

CHAS W COOLEY MD

LAKEVIEW MDCL C TR

525 LAFAYETTE ST

MERCY HOSP

LAKEVIEW MI

48850

IONIA MICH

48846

JACKSON MICH

49201

LLOYD S DUNKIN MD

L

AHMAD YOUNIS MD

CECIL CORLEY MD

L

410 S CLAY ST

1205 W OAK ST

800 CRESCENT RD

GREENVILLE MICH

48838

GREENVILLE MICHIGAN

48838

JACKSON MI

49203

JOHN HALICK MD

ENNIS H CORLEY MD

L

200 S FRANKLIN

JACKSON

3923 KATHMAR DR

GREENVILLE MI

48838

JACKSON MICH

49203

CARL M HANSEN MD

A 0 ABRAHAM MD

STEPHEN F CROWLEY MD

1930 HERKIMER OR

W A FOOTE MEM HOSP

STANTON MI

48888

JACKSON MI

49203

JACKSON MI

49202

ROBT H HASKELL MD

L

ELLIS W AOAMS MD

BYRNE M DALY M D

ZETLANDS ESTATE TWR

720 W FRANKLIN

569 WILDWOOD AVE

NEVIS LEEWRD I SL BWI

JACKSON MICHIGAN

49201

JACKSON MICHIGAN

49201

GLENN W HOUSE JR MD

J H AHRONHE I M MD

BRUCE DAVENPORT MD

1200 W OAK ST

569 WILDWOOD AVE

2424 SPRING ARBOR RD

GREENVILLE MICH

48838

JACKSON MICH

49201

JACKSON MI

49203

NIKOLAS KAZMERS MD

DUANE M ALLEN MD

CUTHBERT E DE MAY MD

L

HANOVER MEDICAL CTR

901 ALBRIGHT DR

LAKEVIEW MI

48850

HANOVER MICHIGAN

49241

JACKSON MI

49203

JOHN D DE MAY MD
403 E MICHIGAN AVE
JACKSON MI 49201

RICHARD C OEMING MO

724 W FRANKLIN

JACKSON MICH 49201

H K FILIP MO
502 LANSING AVE
JACKSON MI

49201

R08T E FINTON MD
608 W MICHIGAN AVE
JACKSON MICH 49201

HUGH B FOLEY MO
MERCY HOSP PATHOLOGY
524 LANSING AVE

JACKSON Ml

49201

HARRY GREENBAUM MO
1203 GREENWOOD AVE
JACKSON MI 49201

BOWERS H GROWT MO L

ADOI SON MI 49220

HILDA A HABENICHT MO

545 LANSING AVE

JACKSON MICH 49201

THOS L HACKETT MD

519 N EAST AVE

JACKSON MI 49202

GEO C HAROIE MD
724 W MICHIGAN
JACKSON MICH

49201

HOWARO C HOFFMAN MO
2424 SPRING ARBOR RO
JACKSON Ml 49203

JOHN B HOLST MD
606 CITY BANK BLDG
JACKSON MICH 49204

ROLAND IMPERIAL MD
843 HAZEL WOOD

JACKSON MI 49203

LARRY E JENNINGS MD
766 W MICHIGAN AVE
JACKSON MI 49201

WM A JOERIN MD
1322 PARK RD

JACKSON MI 49203

HENRY A KALLET MD
FOOTE MEMORIAL HOSP
JACKSON MI 49201

JEAN P KARR MD

1615 CARLTON BLVD

JACKSON MI 49203

ALBERT H KEEFER MD

CONCORD MI 49237

CLIFFORD E KEELER MD
2424 SPRING ARBOR RD
JACKSON MI 49203

BRUCE F KNOLL MD

766 W MICHIGAN

JACKSON MI 49201

ROBT J KOBS MD

720 W FRANKLIN ST

JACKSON MICHIGAN 49201

RONALD W KORNAK MD
123 N WEST

JACKSON MI 49201

FRANK S KOROTNEY MO

720 W FRANKLIN

JACKSON MI 49201

22 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Kalamazoo County

EDWARD C LAKE MD
720 W FRANKLIN ST
JACKSON MICH

49201

LLOYD L OLSEN MD
1410 W WASHINGTON
JACKSON MICHIGAN

R

49205

ALFRED M SIRHAL MD
BROOKLYN MI

49230

WILLIAM R LATCHAW MD
628 WEBB ST
JACKSON MICHIGAN

R

49202

J GIL 0 ROURKE MD
517 WILDWOOD
JACKSON MI

49201

DEAN W SMITH MD
569 WILDWOOD
JACKSON MI

49201

CHAS R LENZ JR MD
405 1ST ST
JACKSON MICH

49201

HAROLD L OSTER MD
1514 FOURTH ST
JACKSON MI

49203

WM R STACKABLE MD
2307 SOUTHBROOK
MT VERNON ILL

62804

ELMORE F LEWIS MD
1112 CARLTON BLVD
JACKSON MI

L

49203

GRANT L OTIS MD
525 WILDWOOD AVE
JACKSON MICH

49201

JOHN F STAGEMAN MD
123 N WEST ST
JACKSON MI

49201

FREDDY G LIM MD
1310 GREENWOOD
JACKSON MI

49203

MUSTAFA C OZ MD
1700 WOODBRIDGE
JACKSON MI

49201

LEWIS L STEWART JR MD
1919 KIBBY RD

JACKSON MICHIGAN 49203

VICTOR E LINDEN MD
2025 FOURTH ST
JACKSON MICHIGAN

49203

EARL E PARKER MD
207 E BELLEVUE
LESLIE MICH

49251

CARL A STOLBERG MD
724 W FRANKLIN

JACKSON MICH

49201

JOHN P LUDWICK MD
237 W WASHINGTON
JACKSON MI

49201

JOHN C PARKER MD
517 WILDWOOD
JACKSON MICHIGAN

49201

ETHON L STONE MD
721 SEVENTEENTH ST
JACKSON MICH

49203

JOHN E LUDWICK MO
1112 BERMUDA AVE
KISSIMMEE FL

L

32741

ANDREW K PAYNE MD
FOOTE MEMORIAL HOSP
JACKSON MICH

49201

SAMUEL SUGAR MD
762 W MICHIGAN
JACKSON MI

49201

GERALD I MAAS MD
1310 GREENWOOD AVE
JACKSON MICHIGAN

49203

GEO H PHILLIPS MD
MERCY HOSPITAL
JACKSON MICH

49201

CECIL E TATE MD
2400 W MICHIGAN AVE
JACKSON MICH

49202

WM E MC GARVEY MO

L

FRANK F PRAY MD

L

ROSS V TAYLOR MO

161 W MICHIGAN AVE
JACKSON MI

49201

6533 WOODARD LAKE RO
FENWICK MI

48834

517 WILDWOOD AVE
JACKSON MI

49201

JOHN M MC LAUGHLIN MD

BERNARD Z REIZNER MD

LEONARD F THALNER MD

L

710 S BROWN ST
JACKSON MICH

49203

815 W MICHIGAN AVE
JACKSON MI

49201

609 W MICHIGAN AVE
JACKSON MI

49201

MI AR J MC LAUGHLIN MD L

710 S BROWN ST

JACKSON MI 49203

JOHN W RICE MD
421 MC NEAL ST
JACKSON MICH

49203

T 8 THOMPSON MD
1310 GREENWOOD
JACKSON MI

49203

H B MC LAUTHLIN HD

PHILLIP 0 RICHARDS MD

JAMES W TOWNSEND MD

L

1123 S BROWN ST
JACKSON MICH

49203

214 N WEST AVE
JACKSON MI

49201

108 HAGUE AVE
VANDERCOOK LAKE

F P MC OUILLAN MD

A

RICHARD G RIES MD

JACKSON MI

49203

405 S HIGBY
JACKSON MICHIGAN

49203

720 W FRANKLIN ST
JACKSON MICH

49201

FRANK VAN SCHOICK MD

JASON B MEADS MD

L

PHILIP A RILEY MD

L

2100 4TH ST
JACKSON MI

49203

915 S HIGBY
JACKSON MI

49203

500 S JACKSON ST
JACKSON MI

49203

R M VANSCHOICK MD

ROBT E MEDLAR MD

PHILIP A RILEY JR M

D

2100 FOURTH ST
JACKSON MICHIGAN

49203

719 SEVENTEENTH ST
JACKSON MICH

49203

500 S JACKSON ST
JACKSON MICH

49203

F I VAN WAGNEN JR MD

A J MICHAUD MD
1310 GREENWOOD
JACKSON MI

49203

IGNACIO RUA MD
1810 W HIGH
JACKSON MICHIGAN

49203

434 WILDWOOD AVE
JACKSON MICH

EDWARD E VIVIRSKI MD

49201

LORENZO MORELLI MD
401 W PROSPECT ST
JACKSON MICH

49203

PARVIZ SAM I I MD
508 HARRIS BLDG
JACKSON MI

49201

603 S ELM AVE
JACKSON MICH

EDWARD R WEDDON MD

49203

RALPH A MUHICH MD
2532 SPRING ARBOR RD
JACKSON MICH

49203

WM A SAUTTER MD
HORTON MI

49246

R F D 2

STOCKBRIDGE MICH
JOHN W WHOL I HAN MD

49285

R

NATHAN D MUNRO MD

THEOPHILE E SCHMIDT

MD L

604 W MICHIGAN AVE
JACKSON MICH

49201

740 W MICHIGAN AVE
JACKSON MICH

49201

180 W MICHIGAN AVE
JACKSON MI

49201

WOODWARD A WICKHAM MD

BERNARD M MURPHY MO
770 BLOOMFIELD BLVD
JACKSON MICH

49201

R H SCHNEIDER MD
724 W FRANKLIN
JACKSON MICH

49201

2029 FOURTH
JACKSON MICHIGAN

WARREN S WILLE MD

49203

RAY E NEWTON MD

L

FRANK J SCHRADER MD

5325 BROWN LAKE RD
JACKSON MICHIGAN

49203

180 W MICHIGAN AVE
JACKSON MI

49201

502 LANSING AVE
JACKSON MI

49201

THOMAS S WITTMAN DOS

A

HAROLD NIEKAMP MD
762 W MICHIGAN AVE
JACKSON MI

49201

LELAND D SHAEFFER MD
1615 CARLTON BLVD
JACKSON MICH

49203

761 W MICHIGAN AVE
JACKSON MI

ANDRE Y ZARZOUR MD

49201

STANLEY P OLEKSY MD
744 W MICHIGAN
JACKSON MICH

49201

HENRY W SILL MD
724 W MICHIGAN AVE
JACKSON MICHIGAN

49201

707 N WISNER
JACKSON MI

49202

KALAMAZOO

HUGO A AACH MO R

425 SORRENTO CT

PUNTA GORDA FL 33950

EDWARD P A JEM I AN MD
208 BRONSON MED CTR
KALAMAZOO MICH 49006

C A ALEXANDER MD

118 W NORTH ST

KALAMAZOO MICH 49007

H DALE ALKEMA MD
1631 GULL RD

KALAMAZOO MI 49001

JAMES A AMLICKE MD

1219 SO PARK ST

KALAMAZOO MI 49001

SHERMAN E ANDREWS MD
935 JOHN ST

KALAMAZOO MI 49001

THOMAS E ANOREWS MD
1634 GULL RD #207
KALAMAZOO MI 49001

WALTER M ANGLIN MD A

7211 L ANTOLLARV RD
KALAMAZOO MI 49004

BEN A APPEL MD

252 E LOVELL ST

KALAMAZOO MICH 49006

WILLIAM APPEL MD

252 E LOVELL ST

KALAMAZOO MI 49006

LLOYD E APPELL MO
126 N KALAMAZOO AVE
VICKSBURG MICH 49097

ROBT J ARMSTRONG MD R

3336 LAKESHORE DR

SAULT STE MARIE MI 49783

ENVER AYDOGAN MD

1141 S ROSE ST

KALAMAZOO MICHIGAN 49001

FREDK W BALD 111 MD
BRONSON MEDICAL CTR
KALAMAZOO MI 49006

ROBERT P BARCALA MD
1631 GULL RD #210
KALAMAZOO MI 49001

WINONA M BARROWS MD
1500 BLAKESLEE ST
SW MICH TB CONTROL CTR

KALAMAZOO MI 49007

MANLEY L BARRY MD
10292 DOUGLAS AVE
PLAINWELL MICH 49080

WILLIAM T BATEMAN MD
914 S BURDICK

KALAMAZOO MI 49001

KEITH F BENNETT MD

252 E LOVELL ST

KALAMAZOO MICH 49006

H CURTIS BENSON MD
217 BRONSON MED CTR
KALAMAZOO MI 49006

THOMAS R BERGLUND MD

325 E CENTRE ST

PORTAGE MI 49081

V A BERGLUND MD
325 E CENTRE ST
PORTAGE Ml 49081

JANUARY, 1972/Michigan Medicine 23

Kalamazoo County

LISTED BY COMPONENT MEDICAL SOCIETIES

IVOR BERRY JR MO
516 WHITES RO

KALAMAZOO MICHIGAN 49001

KENNETH J BETTEN MD
216 BRONSON MED C TR
KALAMAZOO MI 49006

F L CLEMENT MD

502 BRONSON MEO CEN

KALAMAZOO MICHIGAN 49006

MAYNARD M CONRAO MD

252 E LOVELL ST

KALAMAZOO MICH 49006

DAVID G DVORAK MD
212 BRONSON MED CTR
KALAMAZOO MI 49006

DAVID S DYKE MD
HEALTH CENTER
WESTERN MICH UN I V

WALTER GRABOWSKI MD
315 BRONSON MED CTR
KALAMAZOO MI 49006

MICHAEL GRAF MD

1634 GULL ROAD

KALAMAZOO MI 49001

ELOEAN G BETZ MD
202 BRONSON MED CTR
KALAMAZOO MI 49006

WM G BIRCH MO

252 E LOVELL ST

KALAMAZOO MI 49006

WILBUR R BIRK MD
216 BRONSON MED CTR
KALAMAZOO MI 49006

HARVEY C BODMER MD
403 W KALAMAZOO AVE
KALAMAZOO MICH

DAVID E BOSWELL MD
325 E CENTRE ST
PORTAGE MI

RICHARD J BOWER MO
325 E CENTRE ST
PORTAGE MI

JAMES C BRENEMAN MD

9880 E MICHIGAN

GALESBURG MI 49053

WILLIAM P BRISTOL MD
2019 RAMBLING RD
KALAMAZOO MI 49001

CARTER D BROOKS MD A

UPJOHN COMPANY

KALAMAZOO MI 49001

ARTHUR L BROWN 11 MD
101 BRONSON MED CTR
KALAMAZOO MI 49006

PETER P BRUE MD R

1009 CAMBRIDGE DR
KALAMAZOO MICH 49001

HARRY W BURDICK MD

1219 S PARK ST

KALAMAZOO MICHIGAN 49001

ROBT B BURRELL MD

IT l 1 MERRILL ST

KALAMAZOO MICH 49001

WM J BUTLER MD
1631 GULL RD

KALAMAZOO MICHIGAN 49001

C GLEN CALLANOER MD

252 E LOVELL ST

KALAMAZOO MICH 49006

49006

49081

49081

PAUL F COOPER MD

252 E LOVELL ST

KALAMAZOO MICHIGAN 49006

F L CORNISH III MD
1634 GULL RD

KALAMAZOO MICHIGAN 49001

N WARN COURTNEY MD

458 W SOUTH ST

KALAMAZOO MI 49006

FRANKLIN COX MD
BORGESS HOSPITAL
KALAMAZOO MI 49001

KENNETH R CRAWLEY MD A

UPJOHN COMPANY

KALAMAZOO MI 49006

RAY 0 CREAGER MD
1218 BRONSON CIRCLE
KALAMAZOO MICH 49001

FRANCIS C CRETSINGER
2012 CHEVY CHASE BLVD
KALAMAZOO MI 49001

R E CROASDALE MD

252 E LOVELL ST

KALAMAZOO MICHIGAN 49006

JAMES P CURRAN MD
KALAMAZOO STATE HOSP
KALAMAZOO MI 49001

CYRIL J CURRAN MD
BORGESS HOSPITAL
KALAMAZOO MI 49001

RICHARD K CURRIER MD

325 E CENTRE ST

PORTAGE MI 49081

DORIS E DAHLSTROM MD
ROUTE 1

HICKORY CORNERS MI 49060

WM A DECKER MD
1207 OAKLAND

KALAMAZOO MICH 49001

RAYMOND M DEHAAN MD A

UPJOHN COMPANY

KALAMAZOO MI 49006

HAROLD E DE PREE MD

252 E LOVELL ST

KALAMAZOO MICH 49006

KALAMAZOO MI 49001

ROBERT FABI MD
1631 GULL RD

KALAMAZOO MI 49001

AUGUST F FATH MD

1631 GULL ROAD

KALAMAZOO MICHIGAN 49001

ROBT K FERGUSON MD

1141 S ROSE ST

KALAMAZOO MICH 49001

F J FITZSIMMONS MD
GMC DIV 5200 E CORK ST
KALAMAZOO MICHIGAN 49002

ROMAN FLUNT M 0

BOX A KALAMAZOO ST HOS

KALAMAZOO MI 49003

JOHN V FOPEANO MO
2121 SHEFFIELD DR
KALAMAZOO MICH 49001

ROBERT J FOSMOE MD

458 W SOUTH ST

KALAMAZOO MICHIGAN 49006

J WILLIAM FRY MD

1821 WHITES RD

KALAMAZOO MICHIGAN 49001

PAUL M FULLER MD R

1700 GULL RO

KALAMAZOO MICH 49001

ALMARIO M GARAZA MD
COPPER CO MENTAL HLTH
HOUGHTON MI 49931

CARL A GARONER MD

1141 S ROSE ST

KALAMAZOO MICH 49001

JAMES A GARDNER MD

458 W SOUTH ST

KALAMAZOO MI 49006

ARTHUR F GEIS MD

424 JENNISON ST

KALAMAZOO MI 49007

RICHARD M GERSTNER MO
212 BRONSON MED CTR
KALAMAZOO MICHIGAN 49006

RICHARD E GIBSON MD

ROBT H GREKIN MD
417 FOREST ST

KALAMAZOO MI 49001

NORMAN GREMEL MD

458 W SOUTH ST

KALAMAZOO MICH 49006

KARE GUNOERSEN MD A

UPJOHN COMPANY
KALAMAZOO MI 49001

D A HADDOCK JR MD

1711 MERRILL ST

KALAMAZOO MICH 49001

JAMES A HAGANS MD

MERCK SHARP 6 DOHME

WEST POINT PA 19486

HAROLD F HAILMAN MD
PO BOX 430

YONKERS NY 10702

JOHN M HAMMER MD
100 MAPLE ST

PARCHMENT MICH 49004

CURTIS M HANSON MD
1324 S PARK ST *1
KALAMAZOO MI 49001

J DONALD HARE MD

516 WHITES ROAD

KALAMAZOO MI 49001

FRANK G HARRELL MD
1602 GULL RD

KALAMAZOO MICHIGAN 49001

WM D HARRELSON MD
1324 S PARK

KALAMAZOO MICHIGAN 49001

RUSSELL A HAYNER MD R

4015 PORTAGE

KALAMAZOO MICH 49001

H SIDNEY HEERSMA MD

517 PLEASANT

KALAMAZOO MICH 49001

ROBT W HEINLE MD
MED DIV UPJOHN CO
KALAMAZOO MICH 49006

J W HENDRIX MD
515 FINEVIEW

KALAMAZOO MI 49007

E R CARTER MD

1324 S PARK ST

KALAMAZOO MICHIGAN 49001

GEO F CARTLAND PHD A

1704 DOVER RO

KALAMAZOO MI 49001

RUSSELL M CASHEN MD

252 E LOVELL ST

KALAMAZOO MICH 49006

JOHN M DE VRIES MD
516 WHITES RD

KALAMAZOO MI 49001

NORMAN L DE WITT MD R

5131 M43 BOX 77A

HICKORY CORNERS MI 49060

LEO A DICK MD
1700 GULL RD

KALAMAZOO MICHIGAN 49001

RONALD S CHIPPS MD
1017 ELDRIDGE DR
KALAMAZOO MI 49007

DALE 0 J CHOOOS MD A

UPJOHN COMPANY
KALAMAZOO MI 49001

KENNETH R DORNER MD
220 BRONSON MED CENTER
KALAMAZOO MI 49006

GLEN H DOUGLASS MD
1324 S PARK

KALAMAZOO MI 49001

CLARENCE P CHREST MD

458 W SOUTH ST

KALAMAZOO MICH 49006

BENNARO J DOWD MO
1700 GULL RD

KALAMAZOO MICHIGAN 49001

DANIEL K CHRISTIAN MD FREDK M DOYLE MD R

252 E LOVELL ST 3320 BRONSON BLVD

KALAMAZOO MICHIGAN 49006 KALAMAZOO MI 49001

SCHOOLCRAFT MI 49087

WM S GLADSTONE MD

458 W SOUTH ST

KALAMAZOO MICH 49006

DANL F GLASER MD

463 ACAOEMY ST

KALAMAZOO MICH 49006

GLENN E GOOD MD
2901 S WESTNEDGE
KALAMAZOO MI 49001

LOLITA G GOODHUE MD L

905 A MENLO AVE

MENLO PARK CALIF 94025

SADANANOA C M GOUD MD
325 E CENTRE AVE
PORTAGE MI

ROBERT S GOVE MD
1631 GULL RO
KALAMAZOO MICH

49081

49001

DONALD E HERENDEEN MD
1219 S PARK

KALAMAZOO MI 49001

DAVID K HICKOK MD
517 PLEASANT AVE
KALAMAZOO MI 49001

ROSCOE C HILDRETH MO
458 W SOUTH ST
KALAMAZOO MI

ROBERT V HILL
WESTERN MICH UN I V
HEALTH CENTER

KALAMAZOO MI

RALPH M HODGES MD
6565 W MAIN
KALAMAZOO MI

ALBERT B HOOGMAN MD

612 OOUGLAS AVE

KALAMAZOO MICHIGAN 49007

49006

49001

49001

24 JANUARY, 1972/Michigan Medicine

49006

49004

49001

49006

49001

49001

49001

49001

L

49006

49001

L

49001

49001

49001

49007

49001

) A

49006

)

49006

49001

A

49001

49001

49001

49007

49001

MEMBERS

Kalamazoo County

ROBERT C KETTUNEN MD

252 E LOVELL ST

KALAMAZOO MICHIGAN 49006

ANIS A KHAN MO A

KALAMAZOO STATE HOSP
KALAMAZOO MI 49003

JOHN L KIHM MD
1219 S PARK ST
KALAMAZOO MICHIGAN 49001

JAMES B KILWAY MO
BRONSON MEDICAL CTR
KALAMAZOO MI 49006

JAMES G MALONE MD
420 JOHN ST

KALAMAZOO MICH 49006

FREDK J MARGOLI S MD
2901 S WESTNEDGE
KALAMAZOO MICH 49001

DON MARSHALL MD
301 BRONSON MED CTR
KALAMAZOO MICH 49006

WM P MARSHALL MD
211 BRONSON MDCL CTR
KALAMAZOO MI 49006

ROBT M NICHOLSON MD
517 PLEASANT AVE

KALAMAZOO MICH 49001

ANNA NOVAK MD
1706 HELEN ST

KALAMAZOO MI 49002

ERVIN NOVAK MD A

UPJOHN COMPANY
KALAMAZOO MI 49001

GEORGE H ONG MD
1631 GULL RD

KALAMAZOO MI 49001

JOSEPH E KINCAID MD
1634 GULL RD

KALAMAZOO MI 49001

WM B MARTIN MD
UPJOHN CO BLDG 24-2
KALAMAZOO MI 49001

CHAS B OVERBEY JR MD
BOX A KAZOO ST HOSP
KALAMAZOO MI 49003

WM J KLERK MO
2421 WAITE
KALAMAZOO MICH

R

49001

DONALD G MAY MD
1634 GULL RD
KALAMAZOO MI

49001

SOO H PA I MD
BORGESS HOSPITAL
1521 GULL RD

PAUL A KOESTNER MD

1303 PORTAGE ST

KALAMAZOO MICH 49001

EVAN P KOKALES MD
WESTERN MICH UN I V
KALAMAZOO MI 49003

JOHN S KOSTIN MD
9880 E MICHIGAN AVE
GALESBURG MI 49053

WILLIAM J KUBE MD

1219 S PARK ST

KALAMAZOO MI 49001

JAMES 0 LAWRENCE MD A

924 SUNSET LANE
KALAMAZOO MI 49001

JAMES B LAWSON MD A

709 REGENCY SQ APT 301
KALAMAZOO MI 49001

RICHARD A LEMMER MD

252 E LOVELL ST

KALAMAZOO MICH 49006

JOHN D LITTIG MD
7171 PORTAGE AVE
KALAMAZOO MICH 49002

P M LITTLEJOHN MD
5111 WOODMONT DR
KALAMAZOO MICHIGAN 49001

W KAYE LOCKLIN MD
1141 S ROSE

KALAMAZOO MICH 49001

GEORGE J LODE MD
100 MAPLE ST

PARCHMENT MI 49004

JAMES M LOUI SELL MD

611 WHITCOMB ST

KALAMAZOO MICHIGAN 49001

W CARTER LOWE MD

252 E LOVELL ST

KALAMAZOO MI 49006

JAMES W LOYND II MD

1141 S ROSE ST

KALAMAZOO MICH 49001

KONRADS V LUBAVS MD
420 JOHN ST

KALAMAZOO MICHIGAN 49006

M A MAC DONALD MD

252 E LOVELL ST

KALAMAZOO MICH 49006

HAROLD A MACHIN MD
420 JOHN ST

KALAMAZOO MICHIGAN 49006

JAMES E MAC VICAR MD

252 E LOVELL ST

KALAMAZOO MICHIGAN 49006

GARY D MAYNARD MD
216 BRONSON MED CTR
KALAMAZOO MI 49006

JAMES H MCCARTHY MD
100 MAPLE ST

PARCHMENT MICHIGAN 49004

JOS S MC CARTHY MD L

2236 TIPPERARY RD
KALAMAZOO MI 49001

JOHN A MCCOLL MD
1634 GULL RD

KALAMAZOO MICHIGAN 49001

RICHARD R MCCONNELL MD

458 W SOUTH ST

KALAMAZOO MICHIGAN 49006

WM E MCNALLY MD
325 E CENTRE ST
PORTAGE MI 49081

RICHARD MELLIS MD

611 WHITCOMB ST

KALAMAZOO Ml 49001

JAMES W MELLUISH MD
350 S BURDICK

KALAMAZOO MI 49006

RICHARD C MERRIMAN MD
516 WHITES RD

KALAMAZOO MICHIGAN 49001

BRUCE W MESARA MD
239 WESTVIEW

KALAMAZOO MI 49007

CARL R MOE MD

1324 S PARK ST

KALAMAZOO MICH 49001

RUSSELL E MOHNEY JR MD
1631 GULL RD

KALAMAZOO MI 49001

BASIL A MOLONY MD M

C/0 ST CHARLES CLINIC
ST CHARLES MO 63301

ROGER M MORRELL MD A

4016 NICHOLS RD
KALAMAZOO MI 49001

JOHN B MORRILL MO
1634 GULL RD

KALAMAZOO MI 49001

ROY A MORTER MD L

2421 SHEFFIELD

KALAMAZOO MI 49001

ADRIAN J NEERKEN MD

404 BRONSON MED CTR

KALAMAZOO MICH 49001

FRANK J NEWMAN MD

405 BRONSON MED CTR

KALAMAZOO MI 49006

KALAMAZOO MI 49001

JAMES D PANZER MD A

UPJOHN CO

KALAMAZOO MI 49006

CHAS 0 PEAKE I I I MD

252 E LOVELL ST

KALAMAZOO MICH 49006

EDWIN 0 PEARSON MD

458 W SOUTH ST

KALAMAZOO MI 49006

J W PEELEN MD

516 WHITES RD

KALAMAZOO MI 49001

MATTHEW PEELEN MD

252 E LOVELL ST

KALAMAZOO MI 49006

CLIFTON W PERRY MO R

1425 BALBOA

KALAMAZOO MI 49002

RAYMOND A PINKHAM MD

611 WHITCOMB ST

KALAMAZOO MICHIGAN 49001

GERALD W POWLEY MD

517 PLEASANT

KALAMAZOO MICHIGAN 49001

HAROLD M PRITCHARD MD
HEALTH CENTER WMU
KALAMAZOO MI

RICHARD A PROOS MD
WESTERN MICH UNIV
KALAMAZOO MICHIGAN

ALTON E PULLON MD
1223 S PARK ST
KALAMAZOO MICH

LEO B RASMUSSEN MD
152 N MAIN ST
VICKSBURG MICHIGAN

HAROLD R REAMES MD
2901 S WESTNEDGE
KALAMAZOO MICHIGAN

THOMAS J REIGEL JR MD
2019 RAMBLING RD
KALAMAZOO MICHIGAN 49001

GERALD H RIGTERINK MD
433 SOUTH ROSE ST
KALAMAZOO MICH 49006

MILLARD S ROBERTS MD
1631 GULL RD

KALAMAZOO MICHIGAN 49001

WALTER A ROBISON MD

1631 GULL ROAD

KALAMAZOO MI 49001

49003

49003

L

49001

49097

49001

JANUARY, 1972/Michigan Medicine 25

Kalamazoo County

LISTED BY COMPONENT MEDICAL SOCIETIES

OONALD C ROCKWELL MO
1227 JEFFERSON
KALAMAZOO MI

L

99007

MORRIS B SOFEN MD
503 KALAMAZOO BLDG
KALAMAZOO MICH

99006

ROBT D WARNKE MD
1639 GULL ROAD
KALAMAZOO MI

99001

HUGO K RQESLER MD
1191 S ROSE ST
KALAMAZOO MICHIGAN

99001

R R SPRINGGATE MD
1639 GULL RD
KALAMAZOO MICHIGAN

99001

PRESTON S WEADON MD
252 E LOVELL ST
KALAMAZOO MICH

99006

RODNEY J ROGERS M D
126 N KALAMAZOO
VICKSBURG MICH

99097

FRANK M STEELE MD
1711 MERRILL
KALAMAZOO MI

99001

FRED L WEDEKING MD
HLTH CENTER WMU
KALAMAZOO MI

99001

AUGUST R ROTY JR MD
252 E LOVELL
KALAMAZOO MI

99006

R 8 STEWART MO

216 BRONSON MDCL CTR

KALAMAZOO MI

99006

IRVING R WEISS MD
9880 E MICHIGAN
GALESBURG MI

99053

GARY RUOFF MD
6565 W MAIN
KALAMAZOO MI

99001

WM C STEWART JR MD
2019 RAMBLING RD
KALAMAZOO MICH

A

99001

HOWARD S WHARTON MD
WMU HEALTH CTR
KALAMAZOO MI

99001

ALLAN H RUSSCHER MD
252 E LOVELL
KALAMAZOO MICHIGAN

99006

L D STIEGLITZ MD
218 W INKSTER
KALAMAZOO MI

99001

EDWIN M WILLIAMSON MD
252 E LOVELL ST
KALAMAZOO MICH 99006

FREDK C RYAN MD
KALAMAZOO STATE HOSP
KALAMAZOO MI

99003

ANTHONY F STILLER MD
1235 N HILLANDALE DR
KALAMAZOO MI

R

99001

DOYLE E WILSON MD
252 E LOVALL ST
KALAMAZOO MICHIGAN

99006

WM A RYE MD
UPJOHN COMPANY
KALAMAZOO MICHIGAN

99006

PHILLIP B STOTT MD
102 BORGESS MED CTR
KALAMAZOO MI

99001

WILLIAM H WOODHAMS MD
6565 W MAIN

KALAMAZOO MI 99001

EDWARD 0 SAGE MD
1028 PORTAGE ST
KALAMAZOO MICH

L

99001

HOMER H STRYKER MD
920 ALCOTT
KALAMAZOO MI

L

99001

JACK F WU M D
810 E CENTER AVE
KALAMAZOO MICH

99001

SOLOMON K SAMUELS MD
1631 GULL RD #205
KALAMAZOO MI

99001

SAMUEL S STUBBS MD
5071 FOXCROFT DR
KALAMAZOO MI

A

99002

WILL I AM G YANG MD
3125 W MAIN ST
KALAMAZOO MICHIGAN

99007

F W SASSAMAN MD
301 BRONSON MED CTR
KALAMAZOO MI

99006

RAYMOND 0 SWANN MD
611 WHITCOMB ST
KALAMAZOO MICH

99001

EDWARD L YAPLE MD
1191 S ROSE ST
KALAMAZOO MICHIGAN

99001

DONALD S SCHAEFER MD
1329 S PARK
KALAMAZOO MI

99001

EDMUND TALANDA MD
3125 W MAIN
KALAMAZOO MICH

99007

CYRIL A YOUNGS MD
916 SO BURDICK ST
KALAMAZOO MI

L

99006

FLORA E SCHERER MD
3628 BRONSON BLVO
KALAMAZOO MI

A

99001

WILL l AM G TUCKER MD
1631 GULL ROAD
KALAMAZOO MI

99001

JOHN L ZETTELMAIER
6565 W MAIN
KALAMAZOO MI

MO

99001

JAMES W SCHOLL MD
1639 GULL RD
KALAMAZOO MICHIGAN

99001

E GIFFORD UPJOHN MD
2230 GLENWOOD DR
KALAMAZOO MICH

R

99001

MARGARET H ZOLEN MD
628 S PARK ST
KALAMAZOO MICH

99007

ROGER A SCHOLTEN MD
252 E LOVELL
KALAMAZOO MICH

99006

GERALD VAN ARENDONK
203 UPJOHN DR
KALAMAZOO MICH

MD

99001

KENT

R S SCHRIEBER PHD
UPJOHN COMPANY
KALAMAZOO MI

A

99006

PAUL VAN DEN BRINK MD
208 BRONSON MED CENTER
KALAMAZOO MI 99006

ARSEN 1 0 B ABLAO MD
1330 BRADFORD ST NE
GRAND RAPIDS MI

99503

CLARENCE T M SCHRIER
KALAMAZOO STATE HOSP
KALAMAZOO MICH

99001

K M VANOER VELDE MD
252 E LOVELL ST
KALAMAZOO MI

99006

RAM ADVANI MD
1890 WEALTHY ST SE
GRAND RAPIDS MI

99506

ALMON L SCHUT MD

901 BRONSON MED CENTER

KALAMAZOO MICHIGAN 99006

JAMES J VAN HARE MD
3506 LOVERS LANE
KALAMAZOO MI

99001

GEO T AITKEN MO
50 COLLEGE AVE SE
GRAND RAPIDS MI

99503

PAUL C SCHWALL I E MD
983 SUNRISE CIRCLE
KALAMAZOO MI

A

99001

ALAN B VARLEY MD
2196 TREEHAVEN DR
KALAMAZOO MICHIGAN

99001

G DONALD ALBERS MD
203 PARIS AVE SE
GRAND RAPIOS MI

99503

GARTH SHULTZ MD
217 BRONSON MED CTR
KALAMAZOO MI

99006

THOMAS J VECCHIO MD
UPJOHN CO
KALAMAZOO MI

A

99001

CHAS W ALDRIDGE JR
1925 MICHIGAN ST NE
GRAND RAPIDS MI

MD

99503

WM S SKELLENGER MD
2019 RAMBLING RD
KALAMAZOO MICHIGAN

99001

WILLIAM J VENEMA MD
517 PLEASANT AVE
KALAMAZOO MI

99001

FELIX S ALFENITO JR
515 LAKESIDE DR SE
GRANO RAPIOS MICH

MD

99506

KAREL R SLATMYER JR
211 BRONSON MDCL CTR
KALAMAZOO MI

MD

99006

MARTIN D VERHAGE MD
1798 GREENLAWN
KALAMAZOO MI

R

99007

GEORGE D ALGER M D
2910 GAYNOR AVE NW
GRANO RAPIDS MI

99509

ROGER J SMITH MD
3010 BROOK DRIVE
PARCHMENT MI

99009

JOHN C VOLOERAUER MD
905 EDGEMOOR AVE
KALAMAZOO MICH

R

99001

JERRY W ANDERSON MD
295 STATE ST SE
GRANO RAPIDS MICH

99502

JOSEPH T SOBOTA MD
UPJOHN CO
KALAMAZOO MI

99006

PAUL WANG MD
917 FOREST ST
KALAMAZOO MI

99001

HARVEY M ANDRE MO
21 MICHIGAN ST NE
GRAND RAPIDS MI

99502

V W ARMBRUSTMACHER MAJ A
USAF-MC-USAF HOSP
BOX 219

APO NEW YORK N Y 09220

ROBERT N ASHBY MO
201 LAFAYETTE AVE SE
GRANO RAPIOS MI

NOYES L AVERY JR MD
515 LAKESIDE DR SE
GRAND RAPIDS MICH

ROBT J BAKER MD
6850 DIVISION AVE S
GRAND RAPIDS MI

OURWARD J BARKER MD
1033 FULTON ST W
GRAND RAPIDS MI

GORDON W BALYEAT MD
1810 WEALTHY ST S E
GRAND RAPIDS MI

GERALD F BAROFSKY MD

808 ALGER ST S E

GRAND RAPIDS MI 99507

GORDON L BARTER M D

833 LAKE DR SE

GRAND RAPIDS MI 99502

FRED A BAUGHMAN JR MO

1810 WEALTHY ST SE

GRAND RAPIDS MICH 99506

JERIAL A BEARD MD

295 STATE ST SE

GRAND RAPIDS MI 99502

JAMES H BEATON MD

1925 MICHIGAN ST NE

GRAND RAPIDS MI 99503

DAVID S BEEBE MO
153 LAFAYETTE AVE SE
GRAND RAPIDS MI

CARL B BEEMAN MD
515 LAKESIDE DR SE
GRAND RAPIDS MI

W CLARENCE BEETS MD
129 FULTON ST E
GRANO RAPIDS MI

CHAS M BELL MO
50 COLLEGE AVE SE
GRAND RAPIDS MI

GEORGE J BENISEK MD
365 DOGWOOO NE
ADA MICHIGAN

HOWARD G BENJAMIN MD

72 SHELDON AVE S E

GRAND RAPIDS MI 99502

ROLAND R BENSON MD

201 LAFAYETTE SE

GRANO RAPIDS MI 99503

STUART BERGSMA MD

6850 DIVISION S

GRAND RAPIDS MI 99508

MARENUS J BEUKEMA MD
6850 S DIVISION AVE
GRAND RAPIDS MI 99508

C REXFORD 8 IGNALL MD

21 MICHIGAN ST NE

GRAND RAPIDS MI 99502

BEN J H BIRKBECK MD
26 SHELDON AVE S E
GRANO RAPIDS MI 99502

RALPH BLOCKSMA MD
21 MICHIGAN ST NE
GRANO RAPIOS MI 99502

99503

99506

L

99502

99503
99301

99503

99506

99508

99509

99506

26 JANUARY, 1972/Michigan Medicine

49503

49504

49502

49503

49506

49507

49506

49418

49315

49503

49503

49506

49506

49506

49504

49503

49506

L

49345

49503

A

49418

49502

49506

A

85710

49505

MEMBERS

Kent County

CHARLES L CALLAWAY MD

2505 ARDMORE ST SE

GRAND RAPIDS MI 49506

MANUEL M CAMPOS MD

72 SHELDON AVE SE

GRAND RAPIOS MI 49502

SAMUEL C CAPPS M D

100 MICHIGAN ST N E

GRAND RAPIDS MICH 49503

L C CARPENTER MD

50 COLLEGE AVE SE

GRAND RAPIDS MI 49503

HOWARD S C4UKIN MD

21 MICHIGAN ST NE

GRAND RAPIOS MI 49502

WM CAYCE MD

245 STATE STREET SE

GRAND RAPIDS MI 49502

JOHN P CHAMPION MD

2060 ROBINSON RO SE

GRAND RAPIOS MI 49506

DONALD CHANDLER MD

60 MONROE AVE NW

GRAND RAPIDS MI 49502

ROBERT J CHASE M 0

833 LAKE DRIVE SE

GRAND RAPIDS MICH 49506

ALFRED DEAN MD L

SAGOLA MI 49881

ARTHUR F DE BOER MD
2435 EASTERN AVE SE
GRAND RAPIOS MICH 49507

CLARENCE J DE BOER MD
3181 PRAIRIE S W
GRANDVILLE MICH 49418

GUY W DE BOER MD L

26 SHELDON AVE S E

GRAND RAPIDS MI 49502

BUD R DEJONGE MD

909 FULTON ST E

GRAND RAPIDS MI 49503

JAMES W DELAVAN MD
1810 WEALTHY ST SE
GRAND RAPIOS MI 49506

RICHARD M DELNAY MD
1908 MENOMINEE OR SE
GRANO RAPIDS MI 49506

HARVEY J DEMAAGD MD
3239 LAKEVIEW LN NE
GRANO RAPIOS MI 49505

J G DEN HARTOG MD A

AM EVANGELICAL MISSION
GHINDA ERITREA

WALLACE B DORAIN MD

1810 WEALTHY ST SE

GRAND RAPIDS MI 49506

JOHN L DOYLE MD
2435 EASTERN SE
GRAND RAPIDS MI 49507

WALLACE B DUFFIN MD
3431 TRICKLEWOOD SE
GRAND RAPIOS MI 49506

ROBERT A DYE MD
124 FULTON ST E
GRANO RAPIDS MI 49502

MERLE L DYKEMA MD A

2301 RIVERSIDE DR N E
GRAND RAPIOS MI 49505

CALVIN J DYKMAN MD
515 LAKESIDE DR SE
GRAND RAPIOS MI 49506

CALVIN J DYKSTRA MD A

19981 STRATFORO RD
DETROIT MI 48221

L EDMOND EARY JR MD

222 HARPER DRIVE

SPARTA MICH 49345

CURTIS D EDHOLM MD

50 COLLEGE AVE SE

GRAND RAPIDS MI 49503

J ROGER CHATTERTON MD A
2/14 ARTY APO

NEW YORK N Y 09093

ETHIOPIA

ISLA G DE PREE MD R

ROBERT L EGGLESTON MO

1514 -WEALTHY SE

GRANO RAPIDS MI 49506

MEY EN CHEN MD A

518 BELVEDERE DR SE
GRAND RAPIDS MI 49506

ERWIN G CLAHASSEY MD
1425 MICHIGAN ST NE
GRANO RAPIDS MI 49503

JAMES F CLARK MD
201 LAFAYETTE AVE SE
GRAND RAPIDS MI 49503

CARROLL K CLAWSON MD

445 CHERRY ST S E

GRAND RAPIDS MICH 49503

ROBT W CLAYTOR MD L

1424 MADISON AVE S E
GRAND RAPIDS MI 49507

R PAUL CLODFELDER MD

937 W FULTON ST

GRAND RAPIOS MI 49504

FREDERICK W CLOSE MD

833 LAKE DR SE

GRAND RAPIOS MI 49506

HAROLD D CRANE MD L

26 SHELDON AVE S E
GRAND RAPIDS MI 49502

JOHN A CREMER MD A

JEAN ORR MEM HOSP
DEMBI DOLLO ETHIOPIA

RICHARD K CRISSMAN MD
2747 CLYDE PARK SW

GRAND RAPIDS MICH 49509

PAUL M DASSEL MD

833 LAKE DR SE

GRAND RAPIDS MI 49506

DAVID B DAVIS MO R

266 PETTIS AVE NE

ADA MI 49301

THOMAS B DAVIS MD

1810 WEALTHY ST SE

GRAND RAPIDS MI 49506

WALTER D DAWSON MD

26 SHELDON AVE SE

GRAND RAPIDS MI 49502

ORUMMONO ISLAND MI 49726

THEODORE R DEUR MD
DEUR CLINIC

GRANT MI 49327

LEON DE VEL MD R

739 PLYMOUTH BLVD S E
GRANO RAPIDS MI 49506

DANIEL A DE VRIES MO
1414 EASTERN AVE S E
GRAND RAPIDS MI 49507

KENT A DEWEY MO

456 CHERRY ST SE

GRAND RAPIDS Ml 49503

NANETTE DICE MD

535 GREENWOOD AVE SE

GRAND RAPIDS MI 49506

MARK W DICK MD

146 MONROE AVE N W

GRAND RAPIDS MI 49502

MAJ W L DICKASON MC A

MEDDAC BOX 464

FT ORD CALIFORNIA 93941

DONALD G DISKEY MD

2015 BRIDGE NW

GRAND RAPIDS MI 49504

WILLIS L DIXON MD

26 SHELDON AVE S E

GRANO RAPIDS MI 49502

LUEBERT DOCTER MD

26 SHELDON AVE S E

GRAND RAPIDS MI 49502

PHILLIP J DOMMISSE MD A

REYNOLDS ARMY HOSP

FORT SILL OK 73503

HENRY A DOORN MD
2450 LEE S W

GRANO RAPIDS MI 49509

FRED A DOORNBOS MD

21 MICHIGAN ST NE

GRAND RAPIDS MI 49502

HERMAN C ELDERSVELD MD

815 ALGER ST SE

GRANO RAPIDS MICH 49507

MICHAEL E ELLIS M D

2030 LEONARD ST NW

GRAND RAPIDS MICH 49504

JOHN P ENGELS MD

8375 BAILEY DR N E

ADA MICHIGAN 49301

GEO T R FAHLUND MD

920 CHERRY ST SE

GRAND RAPIDS MI 49506

CHAS E FARBER MD

50 COLLEGE AVE SE

GRAND RAPIDS MI 49503

PAUL J FATUM MO

2054 CAMBRIDGE SE

GRAND RAPIDS MICH 49506

L H FEENSTRA MD
833 LAKE DR S E
GRAND RAPIDS MI 49506

KENNETH E FELLOWS MD
515 LAKESIDE SE
GRAND RAPIDS MI

JAMES A FERGUSON MO
72 SHELDON AVE SE
GRAND RAPIDS MI

LOUIS G FERRAND MO
8149 NORTHLAND DR
ROCKFORO MICH

E E FIERENS MD
21 MICHIGAN ST NE
GRANO RAPIDS MI

RALPH L FITTS MD
50 COLLEGE AVE SE
GRAND RAPIDS MI

49506

49502

49341

49502

49503

ERWIN L FITZGERALD MD

50 COLLEGE AVE SE

GRAND RAPIDS MI 49503

WM M FLINTOFF M D

1632 DIAMOND AVE NE

GRAND RAPIDS MI 49505

JANUARY, 1972/Michigan Medicine 27

Kent County

LISTED BY COMPONEI

J DONALD FLYNN MD

A

ROBT E LEE GUNNING

MD

ALBERTUS J HOFFS MD

1761 DXFORO OR SE

369 GREENWICH RD NE

2607 FREDERICKS DR SE

GRAND RAPIOS MICH

49506

GRAND RAPIOS MI

49506

GRAND RAPIOS MI

49506

THOMAS W FOCHTMAN MD

FAROUK A HABRA MD

A

HENRY D HOLKEBOER MD

A

72 E DIVISION

987 CALVARY NW

251 CURLEW ST

SPARTA MICH

49345

GRAND RAPIDS MI

49504

FT MYERS FL

33931

J CLINTON FOSHEE MD

L

WILLIAM HAECK MD

STEPHEN HOLLANDER MD

8400 BAILY DR BOX 131

21 MICHIGAN ST NE

1451 GRANDVILLE AVE

ADA MICH

49301

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49509

JOHN P FOXWORTHY MO

DAVID L HAMMER MD

ROBERT S HOLM MD

50 COLLEGE AVE SE

50 COLLEGE AVE SE

515 LAKESIDE DR SE

GRAND RAPIOS Ml

49503

GRANO RAPIOS MI

49503

GRAND RAPIOS MI

49506

CHARLES H FRANTZ MO

R

ARTHUR K HAMP MD

JACK HOOGERHYDE MD

2430 VILLAGE DR SE

515 LAKESIDE DR SE

26 SHELDON AVE SE

GRAND RAPIDS MICH

49506

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49502

EDSON H FULLER JR MD

LAIRD E HAMSTRA MD

DAVID J HORNING MD

514 MEDICAL ARTS BLDG

515 LAKESIDE DR S

E

26 SHELDON AVE SE

GRAND RAPIDS MI

49502

GRAND RAPIOS MI

49506

GRAND RAPIOS MI

49502

RAYMOND E FULLER MD

MARK P HARMELING MD

BRIAN L HOTCHKISS MD

515 LAKESIDE DR SE

124 FULTON ST EAST

515 LAKESIDE DR SE

GRAND RAPIDS MI

49506

GRANO RAPIDS MI

49502

GRAND RAPIDS MI

49506

WM J FULLER MO

ROBERT W HARRISON

MD

CHARLES R HOWIE MD

515 LAKESIDE DR SE

1810 WEALTHY ST SE

255 WASHINGTON ST SE

GRAND RAPIDS MI

49506

GRAND RAPIOS MI

49506

GRAND RAPIDS MI

49502

KENNETH E GAMM MD

ROBERT E HAYES MD

ROBERT L HOYT MO

153 LAFAYETTE SE

456 CHERRY ST SE

1810 WEALTHY ST SE

GRANO RAPIDS MI

49503

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49506

LEONARD S GELL MD

THOMAS A HAYES MD

A

HARRY C HUDSON MD

1425 MICHIGAN ST NE

2604 FABER CT

50 COLLEGE AVE SE

GRAND RAPIDS MI

49503

FALLS CHURCH V A

22046

GRAND RAPIDS MI

49503

HARVEY M GENDLER MD

THOS P HAYES MD

A RAY HUFFORO MO

L

112 N MONROE

1840 WEALTHY ST S

E

455 CHERRY SE

ROCKFORD Ml

49341

GRAND RAPIOS MI

49506

GRAND RAPIDS MI

49502

DONALD G GERARD MD

JOHN R HEATON MO

A

JAMES C HUMPHREY MO

1150 N HUDSON ST

2984 FOUNTAINHEAD

RD

26 SHELDON AVE S E

LOWELL MI

49331

LARGO FLA

33540

GRANO RAPIOS Ml

49502

RALPH H GILBERT MD

DEWEY R HEETDERKS

MD

L

MARILYN R HUNTER MD

A

26 SHELDON AVE SE

3413 BURTON RIDGE

BOX 628

GRANO RAPIDS MICH

49502

GRAND RAPIDS MI

49506

PORT AU PRINCE HAITI

FREDK S GILLETT MD

0 R HEETDERKS JR MD

F A HUTCHINSON MD

50 COLLEGE AVE SE

21 MICHIGAN ST NE

21 MICHIGAN ST NE #635

GRAND RAPIDS MICH

49503

GRANO RAPIDS MI

49502

GRAND RAPIDS MICH

49502

ROBERT W GILLIES MO

LOUIS HELOER MO

ROBT H HYDRICK MD

100 MICHIGAN ST NE

1947 HUTCHINSON SE

1039 W FULTON

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49506

GRANO RAPIDS MICH

49504

JAMES R GLESSNER JR

MD

CHRISTIAN HELMUS MD

JAMES R IRWIN MD

825 LEONARD ST NE

203 PARIS AVE SE

21 MICHIGAN NE

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49503

GRANO RAPIDS MI

49502

SALOMEA J GOLDBERG MD

RUTH HERRICK MD

L

JERRY L IRWIN MD

515 LAKESIDE DR SE

903 E MAIN ST

26 SHELDON AVENUE SE

GRAND RAPIDS MI

49506

LOWELL MICHIGAN

49331

GRANO RAPIDS MI

49502

C ROBERT GOOD M 0

D W HESSELSCHWERDT

MD

WM W JACK MO

2743 DE HOOP ST SW

928 PRINCETON SE

1810 WEALTHY ST S E

GRAND RAPIOS MICH

49509

GRAND RAPIDS MICH

49506

GRAND RAPIDS MI

49506

RUSSELL G GRAFF MD

A MORGAN HILL MD

FRED M JAMESON MD

515 LAKESIDE DR SE

50 COLLEGE AVE SE

833 LAKE DR SE

GRAND RAPIOS MI

49506

GRANO RAPIDS MI

49503

GRANO RAPIDS MI

49506

EDWARD J GRASS MO

L

JACK W HILL MD

WALTER J JARACZ MD

L

3010 LAKE DR S E

6850 DIVISION AVE

S

634 BRIDGE ST N W

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49508

GRAND RAPIDS MI

49504

FRED B GRAY M 0

C P HODGKINSON II

MD

WALTER J JARACZ JR MD

456 CHERRY ST SE

26 SHELDON AVE SE

2410 GAYNOR AVE NW

GRANO RAPIDS MI

49503

GRAND RAPIDS MI

49502

GRANC RAPIDS MI

49504

PERRY W GREENE JR MD

RONALD A HOEKMAN MD

A

ROBT W JARKA MD

515 LAKESIDE SE

960 LAKESIDE DR SE

50 COLLEGE AVE SE

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49506

GRANO RAPIDS MI

49503

CLARE H GROSENBAUGH

MD

ANDREW L HOEKSTRA

MD

CHAS JARVIS JR MD

A

1810 WEALTHY ST SE

111 N KIDD

218 SLIGH BLVO NE

GRAND RAPIOS MICH

49506

IONIA MI

48846

GRAND RAPIDS MI

49505

JAMES A GUNN MD

PHILIP J HOEKSTRA

MD

JANE J JAWAHIR MD

1840 WEALTHY ST S E

909 FULTON ST E

190 ROBINWOOD SE

GRAND RAPIDS MI

49506

GRANO RAPIOS MI

49503

GRANO RAPIDS MI

49506

VIVIAN P JAWAHIR MD
3181 PRAIRIE ST SW
GRANDVILLE MI 49418

WILLIAM B JENSEN JR MD
425 CHERRY SE

GRAND RAPIDS MICH 49502

DONALD C JOHNS MD
655 BROADVIEW ST S E
GRAND RAPIDS MI 49507

LARRY S JOHNSGARD MD
5726 RIDGEBROOK OR SE
GRAND RAPIDS MI 49506

TOM JOHNSON MD

201 LAFAYETTE AVE SE

GRAND RAPIDS MI 49503

DAN W JOHNSTON MD
2440 BEECHWOOD SE
GRAND RAPIDS MI 49506

WM L JOHNSTON MD

245 STATE ST SE

GRAND RAPIDS MI 49502

HAVEN E JONES MD

833 LAKE DR S E

GRAND RAPIDS MICH 49506

JOHN 0 L JUI MD
4234 LAKE MICH DR NW
GRAND RAPIDS MI 49504

ALEKSANDRS KALNINS MD A
1052 EASTERN AVE NE
GRANO RAPIDS MI 49503

L A KAMMERAAD MD

1810 WEALTHY ST SE

GRAND RAPIDS MICH 49506

PAUL E KASCHEL MD

1330 BRADFORD ST NE

GRANO RAP I OS MI 49503

DONALD E KELLEY MD
515 LAKESIDE DR SE
GRAND RAPIDS MI 49506

DAVID W KEMPERS MD
50 COLLEGE AVENUE SE
GRAND RAPIDS MICH 49503

ALBERT H KEMPTER MD

750 FULLER AVE SE

GRANO RAPIDS MI 49503

DALE L KESSLER MD

540 BELVEDERE DR SE

GRANC RAPIDS MI 49506

DONN W KETCHAM MD A

MEM CHRISTIAN HOSP
P 0 MALUMGHAT
0 T CHITTAGONG
EAST PAKISTAN

YOUN S KIM MD

1810 WEALTHY ST SE

GRAND RAP I OS MI 49506

WILLIAM E K INCA 10 MD

100 MICHIGAN ST NE

GRANO RAPIDS MI 49503

JACOB E KLEIN MD
RR 2 BOX 30
BANGUR MI

49013

THOMAS E KLEIN MD
21 MICHIGAN ST NE
GRAND RAPIDS MICH 49502

JAMES T KLOMPARENS MO

7050 ADA DR S E

GRAND RAPIDS MI 49506

PAUL W KNISKERN MD
26 SHELDON AVE S E
GRAND RAPIDS MI 49502

28 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Kent County

BERNARD P KOOL MD
445 CHERRY ST S E
GRAND RAPIDS Ml 49503

BERT J KORHONEN MD

21 MICHIGAN ST NE

GRAND RAPIDS MI 49502

SYLVIA M KOSCIOLEK MD
201 LAFAYETTE AVE SE
GRAND RAPIDS MI 49503

HARM KRAAI MD A

1466 DERBYSHIRE S E
GRAND RAPIDS Ml 49508

CHARLES F KRECKE MD
201 LAFAYETTE AVE SE
GRAND RAPIDS MICH 49503

HENRY J KREULEN MD

2135 ONEKEMA DR S E

GRAND RAPIDS MI 49506

RICHARD L KREUZER MD A

470 TUTTLE N E

GRAND RAPIDS MI 49503

FRANK J KRHQVSKY MD
153 LAFAYETTE AVE SE
GRAND RAPIDS MI 49503

WM T KRUSE JR MD A

3044 HALL ST S E

GRAND RAPIDS MI 49506

K V KUIPER MD

2208 MADISON AVE SE

GRAND RAPIDS MI 49507

HALTER W LA I DL AW MD

1840 WEALTHY ST SE

GRAND RAPIDS MI 49506

ROBT G LAIRD MD L

940 BELLCLAIR SE

GRAND RAPIDS MICH 49506

RUTH E LALIME MD

52 BURTON ST W

GRAND RAPIDS MI 49507

AUSTIN E LAMBERTS MD A

4300 WAIALAE AVE B-503
HONOLULU HAWAI I 96816

RAMON B LANG MD

21 MICHIGAN ST NE

GRAND RAPIDS MI 49502

JOS H LEEP MD

1545 DIAMOND AVE NE

GRAND RAPIDS MI 49505

JOS R LENT I N l MD

303 FULTON ST E

GRAND RAPIDS MI 49502

C A LEUZ 111 MD A

331 HOLMDENE 8LVD N E
GRAND RAPIDS MI 49503

ROBERT S LEVINE MD

50 COLLEGE AVE SE

GRAND RAP I OS MI 49503

GEO H LEWIS MD
3181 PRAIRIE S W
GRANDVILLE MI 49418

HARRY LIEFFERS MD L

26 SHELDON AVE S E

GRAND RAPIOS MI 49502

WILLIAM T LINCER MD

833 LAKE DR S E

GRAND RAPIDS MI 49506

KENNETH E LOBBES MD

425 CHERRY ST S E

GRAND RAPIDS MI 49502

JAMES W LOGIE MD
RAMONA MEDICAL CENTER
GRAND RAPIOS MICH 49506

F RAYMER LOVELL JR MD

515 LAKESIDE DR SE

GRAND RAPIDS MI 49506

R J LOVETT JR MD A

1320 PLYMOUTH RD S E
GRAND RAPIDS MI 49506

JACK G LUKENS MD

245 STATE ST SE

GRAND RAPIDS MI 49502

DUGALD S MAC INTYRE MD

515 LAKESIDE DR SE

GRAND RAPIDS MI 49506

JAMES T MAHER MD

320 MEDICAL ARTS BLDG

GRAND RAPIDS MI 49502

JEROME F MANCEWICZ MD

1156 LEONARD ST NW

GRAND RAPIDS MICH 49504

JOS D MANN MD

100 MICHIGAN ST NE

GRAND RAPIDS MI 49503

JOSEPH B MAROGIL MD

21 MICHIGAN ST NE

GRAND RAPIDS MI 49502

JOHN P MARSH MD L

35 BEL AIR DR NE

GRAND RAPIDS MI 49503

STEPHEN K MARSH MD

6143 28TH ST SE

GRAND RAPIOS MI 49506

ROBERT B MARSHALL MD

100 MICHIGAN ST NE

GRAND RAPIDS MI 49503

MARTIN MARTINUS MD
750 FULLER AVENUE NE
GRAND RAPIDS MI 49503

JOHN A MARVIN MD

1425 MICHIGAN ST NE

GRAND RAPIDS MI 49503

WARREN B MASON MD
50 COLLEGE AVE SE
GRAND RAPIDS MI 49503

C J MATERNOWSKI MD

1425 MICHIGAN ST NE

GRAND RAPIDS Ml 49503

RALPH E MATHIS MD

245 STATE ST SE

GRAND RAPIDS MI 49502

LELAND R MATTHEWS MD A

1509 ARDMORE S E

GRAND RAPIDS MI 49507

T C MAYCROFT MD

238 BRISTOL AVE NW

GRAND RAPIDS MI 49504

MASON S MAYNARD MD

445 CHERRY ST SE

GRAND RAPIDS MI 49503

W PATRICK MAZIER MD

72 SHELDON AVE SE

GRAND RAPIDS8 MI 49502

JOHN K MC CORMICK MD

122 CALEDONIA NE

GRAND RAPIDS MI 49505

WM J MC DOUGAL MD

1011 E FULTON ST

GRAND RAPIDS MI 49503

ORVAL I MC KAY MD

1150 N HUDSON ST

LOWELL MICH 49331

LELAND M MC KINLAY MD R

403 DIXIE DR SOUTH

HOWEY IN HILLS FL 32737

MYRTLE S MCLAIN MD

645 OAKLEIGH N W

GRAND RAPIDS MI 49504

RICHARD H MEADE JR MD A

750 SAN JOSE DRIVE

GRAND RAPIDS MI 49506

WALTER D MEESTER MD

1840 WEALTHY ST SE

GRAND RAPIDS MI 49506

GAYLE H MEHNEY M 0

245 STATE ST SE

GRAND RAPIDS MI 49502

JUDITH L MEYER MD

1756 NEWARK AVE SE

GRAND RAPIDS MI 49507

JAMES A MILLARD MD

1553 BOSTON ST SE

GRAND RAPIDS MI 49507

J D MILLER MD

50 COLLEGE AVE SE

GRAND RAPIDS MI 49503

THEO P MILLER MD

833 LAKE DRIVE SE

GRAND RAPIDS MI 49506

CARL H MOBERG MD

21 MICHIGAN ST NE

GRAND RAPIDS MI 49502

CORNETTA G MOEN MD L

844 LEFFINGWELL RD NE
GRAND RAPIDS MI 49506

JOSEPH V MOLESKI M 0

26 SHELDON AVE S E

GRAND RAPIDS MICH 49502

LEO T MOLESKI MD

26 SHELDON AVE S E

GRAND RAPIDS MICH 49502

STANLEY L MOLESKI MD A

1701 PONTIAC RD SE

GRAND RAPIDS MI 49506

ARTHUR M MOLL MD L

146 156 MONROE AVE NW
GRAND RAPIDS MI 49502

ARTHUR H MOLLMANN MD L

506 MULFORO DR SE

GRAND RAPIDS MI 49507

JOHN C MONTGOMERY MD
1810 WEALTHY ST S E
GRANO RAPIDS MI 49506

DOUGLAS P MOORE MD
515 LAKESIDE DR SE
GRAND RAPIDS MI 4.9506

JOSEPH S MOORE MD
21 MICHIGAN ST NE
GRAND RAPIDS MI 49502

E L MOORHEAD I I MD

833 LAKE DR SE

GRAND RAPIDS MI 49506

DIRK R MOUW MD

1854 S DIVISION AVE

GRAND RAPIDS MI 49507

G ARTHUR MULDER MD

1414 EASTERN AVE SE

GRAND RAPIOS MI 49507

JAMES P MULDOON MD

72 SHELDON AVE SE

GRAND RAPIDS MICH 49502

MILES J MURPHY MD

1425 MICHIGAN ST NE

GRAND RAPIDS MI 49503

ROBT M N AL B AND I AN MD
2812 OAKWOOD DR
E GRAND RAPIDS MI 49506

RE IN ARD P NANZIG MD
1425 MICHIGAN ST NE
GRAND RAPIDS MI 49503

JOHN P NEWTON MD

1632 DIAMOND AVE NE

GRAND RAPIDS MI 49505

KENNETH C NICKEL MD

833 LAKE DRIVE SE

GRAND RAPIDS MICH 49506

MELVIN L NOAH MD

MIDOLEVILLE MI 49333

M SAMUEL NOORDHOFF MD A

92 N CHUNG SHAM SEC 2
TAIPEI TAIWAN

PETER B NORTHOUSE MD

26 SHELDON AVE S E

GRAND RAPIDS MI 49502

VICTOR A NOTIER MD

50 COLLEGE AVE SE

GRAND RAPIDS MI 49503

S AML M OATES MD
245 STATE ST SE
GRAND RAPIDS MI 49502

JAMES D 0 BRIEN MD
1156 LEONARD ST NW
GRAND RAPIDS Ml 49504

WM G 0 DRISCOLL MD
515 LAKESIDE DR SE

GRAND RAPIDS MI 49502

RICHARD L ORDERS MD

255 WASHINGTON SE

GRAND RAPIDS MI 49502

RALPH W ORTWIG MD

1425 MICHIGAN ST NE

GRAND RAPIDS MI 49503

ERNEST L OVERBEEK M D

26 SHELDON AVE S E

GRANO RAPIDS MICH 49502

A VN I D OZKAN MD

1444 MICHIGAN NE

GRAND RAPIDS MI 49503

RUSSELL J PAALMAN MO

21 MICHIGAN ST NE

GRANO RAPIDS MI 49502

ROBERT H PAINTER MD
DEUR CLINIC

GRANT MI 49327

THERESA A PAL ASZEK MD

833 LAKE DR S E

GRAND RAPIDS MICH 49506

STEVEN S PALMER MD
515 LAKESIDE DR SE
GRAND RAPIDS MI 49506

JOHN P PAPP MO

515 LAKESIDE OR SE

GRAND RAPIDS MI 49506

WM J PASSINAULT MD

26 SHELDON AVE SE

GRANO RAPIDS MI 49502

MARSHALL PATTULLO MD

515 LAKESIDE DR SE

GRAND RAPIDS MI 49506

C ALLEN PAYNE MD L

1840 WEALTHY ST

GRAND RAPIDS MICH 49506

JOHN R PEDOEN MD

445 CHERRY ST S E

GRAND RAPIDS MI 49503

JOHN C PEIRCE MD
201 LAFAYETTE AVE SE
GRAND RAPIDS MI 49503

JANUARY, 1972/Michigan Medicine 29

LISTED BY COMPONENT MEDICAL SOCIETIES

Kent County

WARREN C PILLING MD

J C RINGENBERG MD

LOUISE F SCHNUTE MD

833 LAKE DR SE

1425 MICHIGAN ST NE

146 MONROE N W

GRANO RAPIDS MI

49506

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49502

M S PISKIN MD

CHAS S ROBB MD

PAUL G SCHUTT MD

1077 LEONARD ST NE

445 CHERRY ST SE

21 MICHIGAN ST NE

GRAND RAPIOS MI

49503

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49502

JOHANNES D PLEKKER MD

JOHN H ROBBERT MO

THOS G SCHWADERER MO

833 LAKE DR SE

2911 TIMBER LANE

21 MICHIGAN ST NE

GRAND RAPIDS MI

49506

GRANDVILLE MI

49418

GRAND RAPIDS MI

49502

LEE R POOL MD

WM G ROBINSON MD

WM B SCOTT MD

245 STATE ST SE

6850 DIVISION AVE SO

26 SHELDON AVE SE

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49508

GRAND RAPIDS MI

49502

HOWARD P PORTER JR MD

LARRY J ROBSON MD

ALISON W SCR l MGEOUR

A

2743 DE HOOP ST SW

1810 WEALTHY ST SE

2260 NELSON SE APT C

GRAND RAPIDS MI

49509

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49507

ALBERT E POSTHUMA MD

WM L RODGERS MD

RAYMOND E SCULLEY MD

153 LAFAYETTE SE

2865 LAKE DR SE

20 BURTON ST S E

GRAND RAPIDS MI

49503

GRAND RAPIOS MICH

49506

GRAND RAPIDS MICH

49507

EDWARD Y POSTMA MD

LUIS R RODRIGUEZ MD

J A SENTKERESTY MD

21 MICHIGAN ST NE

50 COLLEGE AVE SE

515 LAKESIDE DR SE

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49506

HOWARD F POSTMA MD

LELAND E ROGGE MD

A

C A SETTERSTROM MD

3860 CHICAGO DR SW

2326 BURCHARD SE

734 ALGER ST S E

GRANDVILLE MICH

49418

GRAND RAPIDS MI

49506

GRANO RAPIDS MI

49507

E JAMES POTCHEN MD

A

JACK L ROMENCE MD

EUGENE S SEVENSMA MD

E MALL I NCKRODT

21 MICHIGAN ST NE

124 FULTON ST EAST

INST OF RADIOLOGY

GRANO RAPIOS MI

49502

GRAND RAPIDS MI

49502

510 KINGSHIGHWAY
ST LOUIS MO

63110

WENDELL H ROOKS MD

MARTIN SHARDA M D

1339 PLAINFIELD NE

300 36TH ST SW

ABRAHAM L POTT MD
1011 FULTON ST E

L

GRAND RAPIOS MICH

49505

GMC PLANT #1

GRAND RAPIDS MI

49503

WILLIAM ROOSENBERG MD

GRAND RAPIOS MICH

49508

550 CHERRY ST SE

WINSTON B PROTHRO MD

GRAND RAPIDS MICH

49502

ROBERT B SHARP MD

1619 WALKER ST NW

833 LAKE DR SE

GRANO RAPIDS MI

49504

LEONARD ROSENZWEIG MD

GRAND RAPIOS MI

49506

515 LAKESIDE DR SE

ROBERT H PUITE MD

GRAND RAPIDS MI

49506

RICHARD H SIDELL MD

515 LAKESIDE DR SE

515 LAKESIDE DR S E

GRAND RAPIOS Ml

49506

EMIL M ROTH MD
202 S W 63RD AVE

A

GRAND RAPIDS MI

49506

LEONARD L RADECKI MD

A

PLANTATION FL

33314

BERNARD H SIEBERS MD

TAC HOSPITAL

P 0 BOX 6189

FORBES AFB KS

66620

0 W ROTTSCHAFER MD
50 COLLEGE AVE SE

GRANO RAPIDS MI

49506

ROBERT J R A I MAN MD

GRAND RAPIDS MI

49503

ALAN E SIEGEL MD

50 COLLEGE AVE SE

1810 WEALTHY ST S E

GRANO RAPIDS MICH

49503

JOHN A RUPKE MD

GRAND RAPIDS MI

49506

324 FOREST HILL DR SE

L PAUL RALPH MO

GRAND RAPIDS MICH

49506

WILLIAM D SIMPSON MD

5075 EGYPT VALLEY N

E

2777 NIPAWIN CT NE

BELMONT MI

49306

THEO J RUPP MD
20441 DANBURY LN

GRAND RAPIDS MI

49505

RICHARD A RASMUSSEN

MD

HARPER WOODS MI

48225

JOHN S SLUYTER MD

BLODGETT MED BLDG

750 FULLER AVE N E

GRAND RAPIDS MI

49501

JOHN A RYAN MO
153 LAFAYETTE SE

GRANO RAPIDS MI

49503

D F REARDON MD

GRAND RAPIDS MI

49503

DEAN B SMITH MD

1168 NIXON NW

4236 KALAMAZOO SE

GRANO RAPIDS MI

49504

JAMES SCHARPHORN MO
P 0 BOX 174

GRAND RAPIDS MI

49508

WM F REUS JR MD

GRANDVILLE MI

49418

DEAN T SMITH MD

A

153 LAFAYETTE AVE SE

2111 EASTERN AVE NE

GRANO RAPIOS MI

49503

HOWARD J SCHAUBEL MD
124 FULTON ST E

GRAND RAPIOS MI

49505

MOHAMMAD RIAHI MD

GRANO RAPIDS MI

49502

JOHN H SMITH MD

456 CHERRY ST SE

1840 WEALTHY ST SE

GRAND RAPIDS MI

49506

DONALO C SCHEK MD
2749 CLYDE PARK SW

GRAND RAPIDS MI

49506

ROBERT E RIBBE MO

GRAND RAPIDS MI

49508

ROBT B SMITH MD

124 FULTON ST E

26 SHELDON AVE SE

GRAND RAPIOS MI

49502

L J SCHERMERHORN MD
2317 VINE HILL RD

R

GRAND RAPIDS MI

49502

ROBERT K RICHMOND MD

SANTA CRUZ CA

95062

ROLAND G SNEARLY MD

A

24 BURTON ST SE

BP 1 3 BAPTIST MISSION

GRAND RAPIDS MI

49507

RALPH J SCHLOSSER M C
456 CHERRY ST SE

KOUMRA REPUBLIQUE

JAMES M RIEKSE MD

GRAND RAPIDS MI

49503

DU TCHAD AFRICA

21 MICHIGAN ST NE
GRAND RAPIDS MI

49502

GEO R SCHNEIOER MD

JOHN D SNIDER MD

1810 WEALTHY ST SE

1827 ARGENTINA DR SE

JOHN C RIENSTRA MD

GRAND RAPIDS MI

49506

GRAND RAPIDS MICH

49506

833 LAKE DR SE
GRAND RAPIDS MI

49506

ELMER W SCHNOOR MD

L

844 IROQUOIS DRIVE S

E

GRAND RAPIDS MI

49506

CLARENCE A SNYDER MD A

KIBAGORA MISSION HOSP
B P 31

CYANGUGU RWANDA
AFRICA

T H SOUTHWELL MD

21 MICHIGAN ST NE

GRAND RAPIDS MI 49502

C H SOUTHWICK MD

515 LAKESIDE DR SE

GRAND RAPIDS MI 49506

G HOWARD SOUTHWICK MD L

515 LAKESIDE SE

GRAND RAPIDS MI 49506

WM E SPRAGUE MD

2150 LK MICHIGAN DR NW

GRAND RAP I OS MI 49504

MAJ WILLARD S STAWSKl A
LUKE AFB HOSPITAL
SURGEON TAC

LUKE AFB ARIZONA 85301

W H STEFFENSEN MD
1061 SANTA BARBARA SE
GRAND RAPIDS MICH 49506

GARNET G STONEHOUSE MD R
408 MEDICAL ARTS BLOG
GRAND RAP I OS MI

FERNLEY STONEMAN MD
3181 PRAIRIE ST SW
GRANDVILLE MI

VIRGIL E STOVER MD
545 LAKESIDE DR SE
GRAND RAPIDS MI

LEROY E STRONG MD
515 LAKESIDE OR SE
GRANO RAPIDS Ml

CULLEN E SUGG MD
3175 CASCADE RO SE
GRAND RAPIDS MI

TETSUO SUGIYAMA MD
26 SHELDON AVENUE SE

GRANO RAPIDS MI 49502

KEH MING SUN MD

ST MARYS HOSP LAB

GRAND RAPIDS MI 49503

JEROME W SWAN MD

21 MICHIGAN ST NE

GRANO RAPIDS MI 49502

ALFRED B SWANSON MD
1810 WEALTHY ST S E

GRAND RAPIDS MI 49506

HAROLD C SWENSON MD

124 FULTON ST E

GRAND RAPIDS MI 49502

T M TALBOTT MD

1407 TREMONT NW

GRANO RAPIDS MI 49504

JOSEPH L TAYLOR MD

1033 FULTON ST W

GRAND RAPIDS MI 49504

DONALD H TER KEURST MD
2740 EASTERN AVE SE

GRAND RAPIDS MI 49507

49502

49418

49506

49506

L

49506

ARTHUR J TESSEINE MD

3000 MONROE AVE NW

GRAND RAPIOS MI 49505

PAUL G THEODORE MD

21 MICHIGAN ST NE

GRAND RAPIOS MI 49502

ATHOL B THOMPSON MO L

1857 GOLDEN RAIN RO #2
WALNUT CREEK CA 94595

30 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Lapeer County

EDWARD C THOMPSON MD

HENRY J VAN OUINE MD

JAY D VYN MD

L

1401 BRETON RD SE

153 LAFAYETTE SE

7119 DRIFTWOOD S E

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49506

FRANK 0 THOMPSON MD

HAROLD E VAN DYKE MD

T G WADSWORTH FRCS

2008 EL DORADO DR SE

1425 MICHIGAN ST NE

1810 WEALTHY ST S E

EAST GRAND RAPIDS MI

49506

GRAND RAPIDS MICH

49503

GRAND RAPIOS MI

49506

JOS C TIFFANY MD

KORNELIUS VAN GOOR MD

ELMER F WAHBY MD

502 MEDICAL ARTS BLDG

26 SHELDON AVE S E

100 MICHIGAN ST NE

GRAND RAPIDS MI

49501

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49503

LUIS A TOMATIS MD

CORNEL I S VAN NUIS MD

TED J WALLER HD

A

456 CHERRY ST SE

245 STATE ST SE

3025 PORTALES DR

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49502

FORT WORTH TEXAS

76116

WM R TORGERSON MD

L

G F VAN OTTEREN MD

DANIEL WALMA MD

515 LAKESIDE DR S E

21 MICHIGAN ST NE

745 TOWERS MED BLDG

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49503

JACK H TOWNSEND MD

PAUL VAN PORTFLIET MD

LLOYD A WALWYN MO

A

515 LAKESIDE DR SE

245 STATE ST SE

1147 COOPER ST S E

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49502

GRANO RAPIDS MI

49507

ROBT L TROSKE MD

ALBERT VAN T HOF MD

MARY GRACE W-DUNLOP

MD A

534 DOGWOOD DR NE

50 COLLEGE AVE SE

1840 WEALTHY ST SE

ADA MI

49301

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49506

CLARENCE P TRUOG MD

L

PETER D VAN VLIET MD

ROGER N WASSINK MD

833 LAKE DR S E

100 MICHIGAN ST N E

21 MICHIGAN ST NE

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49502

V J TURCOTTE JR MD

B R VAN ZWALENBURG MD

DONALD F WATERMAN MD

515 LAKESIDE DR SE

2116 CORONAOO DR SE

515 LAKESIDE DR SE

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49506

GRAND RAPIDS MICH

49506

VERNON D VAANDRAGER

MD

C MARK VASU MD

JAMES K WATKINS MD

21 MICHIGAN ST NE

1425 MICHIGAN AVE

26 SHELDON AVE SE

GRAND RAPIDS MI

49502

GRANO RAPIDS MI

49503

GRAND RAPIDS MI

49502

F VALDMANIS MD

HAROLD E VELDMAN MD

L

P L WATTERSON MD

A

2120 LAKE DR SE

21 MICHIGAN ST NE

2110 EDGEWOOD S E

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49506

RAYMOND S VAN BREE MD

JAY H VELTMAN MO

CLARENCE F WEBB MD

812 ROSALIE NW

3946 G 30TH ST

833 LAKE DR S E

GRAND RAPIDS MI

49504

GRANDVILLE MICHIGAN

49418

GRAND RAPIDS MI

49503

FORREST R VAN DAM MD

JAY R VENEMA MD

JEROME E WEBBER MD

1810 WEALTHY ST SE

540 OVERBROOK LANE S

E

50 COLLEGE AVE SE

GRAND RAPIDS MICH

49506

GRAND RAPIDS MI

49507

GRAND RAPIDS MI

49503

A R VANDEN BERG MD

GLENN P VERBRUGGE MD

A

THOMAS A WEEBER MD

833 LAKE DR SE

468 TUTTLE AVE N E

3181 PRAIRIE S W

GRANO RAPIOS MI

49506

GRAND RAPIDS MI

49503

GRANDVILLE MICH

49416

WM VANDENBERG MD

PETER VER MEULEN MD

A

R A WEHRENBERG MD

124 FULTON ST E

105 BAYNTON N E

833 LAKE DR SE

GRAND RAPIDS MICH

49502

GRAND RAPIDS MI

49503

GRAND RAPIDS MI

49506

WM 0 VANDEN BERG MD

A L HUBERT VERWYS MD

JACK E WEIGLE MD

50 COLLEGE AVE SE

815 ALGER ST S E

3860 CHICAGO DR SW

GRANO RAPIDS MI

49503

GRAND RAPIOS MI

49507

GRANDVILLE MI

49418

H L VANDER KOLK MD

KEATS K VINING JR MD

KEITH E WELLER MD

611 ROSEWOOD AVE SE

515 LAKESIDE DR SE

1200 LAKE DRIVE S E

GRAND RAPIDS MI

49506

GRAND RAPIDS MICH

49506

GRAND RAPIDS MI

49506

K J VANDER KOLK HO

H C VISSCHER MD

VERNON E WENDT MD

21 MICHIGAN ST NE

515 LAKESIDE OR SE

937 FULTON ST W

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49504

RAYMOND VANDER MEER

MD

ROBERT D VISSCHER MD

ROBERT J WESTERHOFF

MD

26 SHELDON AVE S E

515 LAKESIDE DRIVE SE

808 ALGER ST SE

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49506

GRAND RAPIDS MICH

49507

JOHN VANDERMOLEN MD

EARL R VISSER MD

JOS F WHINERY MD

124 FULTON ST E

530 OVERBROOK LANE SE

50 COLLEGE AVE SE

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49507

GRAND RAPIDS MI

49503

R A VANDER PLOEG MD

ANTON VOGEL MD

JOHN D WHITEHOUSE MD

26 SHELDON AVE SE

1204 MADISON AVE S E

1201 COLORADO AVE S

E

GRANO RAPIDS MICH

49502

GRANO RAPIOS MICH

49507

GRANO RAPIDS MI

49506

WM H VANDER PLOEG MD

JAMES S VOLKEL MD

R N WH I TTENBERGER M

D

833 LAKE DR SE

833 LAKE DRIVE SE

21 MICHIGAN ST NE

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49506

GRAND RAPIDS MI

49502

C G VANDERVEER MD

JOHN A VOSS MD

JOHN L WIESE MD

21 MICHIGAN ST NE

2410 GAYNOR AVE NW

50 COLLEGE AVE SE

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49504

GRAND RAPIDS MI

49503

G M VAN DOMMELEN MD

JOHN VROON MD

REX G WILCOX MD

A

21 MICHIGAN ST NE

50 COLLEGE AVE SE

726 CASS ST

GRAND RAPIDS MI

49502

GRAND RAPIDS MI

49503

MONTEREY CA

93940

MORRIS WILDEROM MD
6495 TWO MILE RD
AOA MI

JOHN B WILKES MD
833 LAKE DR SE
GRAND RAPIDS MI

C A WILKINSON MD
1745 VESTA LANE SE
GRAND RAPIDS MICH

HARVEY S WILKS MO
109 BEE ST-VA HOSP
CHARLESTON S C

JOHN R WILLIAMS MD
833 LAKE DR SE
GRAND RAPIDS MICH

JOHN R WILSON MD
1085 E LEONARD ST
GRAND RAPIDS MI

ROBERT J WILSON MD
1085 LEONARO ST N E
GRAND RAPIDS MI

GARRETT E WINTER MD

1967 GODFREY AVE S W
GRAND RAPIDS MI 49509

JEROME J WISNESKI MD
26 SHELDON AVE S E
GRAND RAPIDS MI 49502

DONALD D WORCESTER MD

50 COLLEGE AVE SE

GRAND RAPIDS MI 49503

THOS B WRIGHT MD A

2614 PLAINFIELD AVE NE
GRANO RAPIDS MI 49505

JOHN F WUR Z MD

201 NORWOOD AVE S E

GRAND RAPIDS MI 49506

MARTIN K WYNGAARDEN MD

245 STATE ST SE

GRANO RAPIDS MI 49503

JEROME A YARED MD

651 CHERRY ST SE

GRAND RAPIDS MI 49506

WILL I AM G YOST JR MD

50 COLLEGE AVE SE

GRAND RAPIDS Ml 49503

DONALD G YOUNG MD

100 MICHIGAN ST N E

GRAND RAPIDS MICH 49503

Z ZADVINSKIS MD

833 LAKE DR SE

GRAND RAPIDS MI 49506

WM G ZIMMERMAN MD
435 CHERRY SE

GRAND RAPIDS MI 49502

R

49301

49506

49506

A

29403

49506

49503

49503

GLENN A ZIMMERMANN MD

100 MICHIGAN ST NE

GRAND RAPIDS MI 49503

LAPEER

ANTHONY M ABRUZZO MD

1568 RULANE DR

LAPEER MICHIGAN 48446

ISAK 0 BERKER MD

912 N STATE ST

DAVISON MICHIGAN 48423

G CLARE BISHOP MD L

ALMONT MICH 48003

LEON R BORUCH MD

834 LIBERTY ST

LAPEER MICH 48446

JANUARY, 1972/Michigan Medicine 31

Lapeer County

LISTED BY COMPONENT MEDICAL SOCIETIES

CHAS E CONAWAY MD
1257 N MAIN ST
LAPEER MICHIGAN

48446

CARL A BENZ MD
308 N BROAD ST
ADRIAN MICH

49221

ROBT E HARRISON MD
410 BRENOT COURT
BLISSFIELD MICH

49228

JAMES R DOTY MD
315 CLAY ST
LAPEER MICH

48446

JOHN BERGHUIS M D
225 RIVERSIDE AVE
ADRIAN MICHIGAN

49221

CHAS H HEFFRON MD
231 N MAIN ST
ADRIAN MICH

49221

CORNELL GREAVU JR MD
NORTH BRANCH MICH

48461

LOWELL E BLANCHARD
HUDSON MI

MD

49247

HOWARD H HEFFRON MD
231 N MAIN ST
ADRIAN MICH

49221

M BENNET HANEY MO
145 N MAIN ST
ALMONT MICHIGAN

48003

MERWIN R BLANDEN MO
TECUMSEH MI

49286

C HAROLD HEFFRON MD
231 N MAIN ST
ADRIAN MI

L

49221

WM C HE I T SCH MD
3257 DAVISON RD
LAPEER MI

48446

B G BUENAFLORE MD
10 CAIRNS
TECUMSEH MI

49286

RALPH F HELZERMAN MD
112 S OTTAWA ST
TECUMSEH MICH

49286

CLIFFORD HOUSE MD
1750 GREY RD
LAPEER MICH

48446

F F BUENAFLORE MD
10 CAIRNS
TECUMSEH MI

49286

WM H HEWES MD
YPSILANTI STATE HOSP
YPSILANTI MI

A

48197

E G KIEHLER I I MD
3257 OAVISON RD
LAPEER MI

48446

LARRY T BURCH MD
610 W POTTAWATAMIE
TECUMSEH MI

A

ST

49286

ROY A HIGHSMITH MD
113 W FRONT ST
AORIAN MI

49221

LUBOMIRA KOCUR MD
DRAWER A
LAPEER MICH

48446

RICHARD D COAK MD
308 W CHICAGO BLVO
TECUMSEH MICH

49286

PHILIP HUNT MD
MILL ST
ADRIAN MI

49221

EMIL LEBEDOVYCH MD
6457 LOTUS COURT
WATERFORD MI

L

48095

EDWARD D CONNER MD
3 SCOTT COURT
ADRIAN MI

49221

WILLIAM T KELLY MD
755 HIGH ST
ADRIAN MI

49221

KSENIA LEBEDOVYCH MD
6457 LOTUS COURT
WATERFORD MI

R

48095

CARLTON L COOK MD
603 E POTTAWATAMIE
TECUMSEH MICH

49286

FRANCIS A LOCKE MD
755 HIGH ST
ADRIAN MICHIGAN

49221

DOROTHY L LEITH MD
240 MAIN ST
I ML AY CITY MICH

48444

R A DICC ION MD
W MAIN ST
MORENCI MI

49256

A 0 LUZ-PINEDA MD
MILL STREET
ADRIAN MI

49221

STANLEY M LYNK MD
4589 LIPPINCOTT
LAPEER MICHIGAN

48446

HARRY M DICKMAN MD
104 OAK ST
HUDSON MICHIGAN

49247

P LYNFORD MILLER MD
BOX 38
ADRIAN MI

R

49221

ELLEN SMITH MD
400 WHITE RD R 1
COLUMB I A V I LLE MI

A

48421

E J DRANGINIS MO
HERRICK MEM HOSP
TECUMSEH MI

49286

ELL I MOELLER-FABOK MD
602 E POTTAWATAMIE ST
TECUMSEH MI 49286

GLENN L SMITH MD
6552 IMLAY CITY RD
IMLAY CITY MICH

48444

RICHARD E DUSTIN MD
103 W BROWN ST
TECUMSEH MICH

49286

HAROLD 0 OCAMB MD
600 E POTTAWATAMIE
TECUMSEH MICH

49286

VINCENTE UY MD
1218 OREGON ST
LAPEER MI

A

48446

HOWARD R C EDDY MD
MILL RD
ADRIAN MICH

49221

EDUARDO ORTIZ MO
227 RIVERSIDE DR
ADRIAN MI

49221

H R ZEMMER MD
N MAIN ST
LAPEER MI

48446

FERENC FABOK MD
602 E POTTAWATAMIE
TECUMSEH MI

ST

49286

DONALD A PARKER MD
BIXBY HOSPITAL
AORIAN MICH

49221

CARL R ZOLLIKER MD
2255 BETHEL BLVD
BOCA RATON FL

R

33432

JAMES L FEENEY MD
MILL ST

ADRIAN MICHIGAN

49221

BERNARD PATMOS MO
127 E MAUMEE ST
ADRIAN MICH

49221

LENAWEE

M GALL IAN I MD
4410 EVERGREEN DR
ADRIAN MICHIGAN

49221

CONRAD L PICKETT MD
220 E BUTLER
ADRIAN MI

49221

RUSSELL A ALLEN MD
689 STOCKFORD DR
ADRIAN MICHIGAN

49221

RICHARD H GASCUIGNE
225 RIVERSIDE AVE
ADRIAN MI

MD

49221

WM P PURFIELD MO
MANCHESTER MI

48158

HERMINIO ARMOVIT MD
236 S FOURTH ST
ONSTED MICHIGAN

49265

WILLIAM C GILKEY MD
227 RIVERSIDE DR
ADRIAN MICH

4922i

BERT R RICHEY MD
765 MANITOU RD
MANITOU BEACH MICH

49253

JOSEPH F BACHMAN MD
SCOTT £ WHITE CLINIC
TEMPLE TEXAS

78210

RICHARD GILMARTIN MD
MILL ST

ADRIAN MICH 49221

J Y SAMSON MD
310 E MAUMEE
ADRIAN MI

49221

F W BAL ICE MD
128 E BUTLER ST
ADRIAN MICHIGAN

49221

ROBERT A GREINER MD
PROFESSIONAL BLDG
ADRIAN MICHIGAN

49221

SERAFIN L SAMSON MD
160 PARK ST
ADRIAN MI

49221

LEONAROO BAYLON MD
693 STOCKFORD
ADRIAN MI

49221

JOHN HAMILTON MD
MILL ST

ADRIAN MICHIGAN

49221

DONATO F SARAPO MD
MILL ST

ADRIAN MICHIGAN

49221

WILFRIDO L BAYLON MD
693 STOCKFORD
ADRIAN MI

49221

GORDON HAMMERSLEY MD

1361 OREGON RD

AORIAN MICHIGAN 49221

ELEANOR P SKUFIS MD
201 ORCHARD RD
ADRIAN MICHIGAN

49221

XENOPHON SKUFIS MO

123 E CHESTNUT

ADRIAN MICH 49221

LANDIS C STEWART MD
750 HIGH ST

ADRIAN MICH 49221

RICHARD L TAYLOR MD

2550 N ADRIAN RD

ADRIAN MI 49221

CHAD A VAN DUSEN MD L

ROUTE 42

BLISSFIELD MI 49228

PATRICIA WENTZ MD
760 RIVERSIDE

ADRIAN MICHIGAN 49221

KEITH H WHITEHOUSE MD
MORENCI MI 49256

GEO C WILSON MD
BOX 224

CLINTON MICH 49236

MARVIN B WOLF MO
225 RIVERSIDE AVE
ADRIAN MICH

GEO H WYNN MD
1115 W MAUMEE
ADRIAN MICH

LIVINGSTON

THOS A BARTON MD
116 N MICHIGAN
HOWELL MICH

JOHN H BETHEA MD
12851 E GR RIVER AVE
BRIGHTON MI 48116

49221

49221

48843

FRANK J DETTERBECK MD
HOWELL STATE HOSPITAL

HOWELL MI 48843

RAY M DUFFY MD L

600 ILLINOIS

HOWELL MI 48843

KAROL GRANOWSKI MO
MCPHERSON COMM HL T CTR
HOWELL MICHIGAN 48843

R FRED HAUER MD

FOWLERVILLE MI 48836

THOMAS F HIGBY MO

FOWLERVILLE MICHIGAN 48836

HAROLD C HILL MD

116 N MICHIGAN AVE

HOWELL MICH 48843

STANLEY L HOFFMAN MD

1200 BYRON ROAD

HOWELL MICHIGAN 48843

PETER A LANGE MD
HOWELL STATE HOSPITAL
HOWELL MI 48843

LOUIS E MAY MD
CITY ROUTE 4

HOWELL MICH 48843

FLORENCE J C PERRY MD

1161 FOX HILLS DR

HOWELL MI 48843

R W PHILLIPS MD

HAMBURG MICHIGAN 48139

PHILLIP E SCHMI TT MO

515 SO TOMPKINS

HOWELL MI 48843

32 JANUARY, 1972/Michigan Medicine

48116

48843

L

48143

48116

48843

49827

49868

49868

49868

49868

49868

93010

L

49684

48093

48081

48093

48066

48091

48230

48093

48077

48043

Macomb County

JOHN G BARKER MO
8050 WARREN BLVD
CENTER LINE MICH 48015

ALVIN J BEECHER M 0
21501 KELLY

EAST OETROIT MICH 48021

BERNARD BIGLEY MO
35992 GRATIOT

MT CLEMENS MICHIGAN 48043

FRANK J BILUK MD
GM TECH CENTER
12 MILE £ MOUND RD

WARREN MICH 48090

YOUSEF B BISMAI MD
28043 HOOVER

WARREN MICHIGAN 48093

DONALD G BLAIN MD
198 S GRATIOT

MT CLEMENS MI 48043

LELAND C BROWN MD
21536 PARKWAY

ST CLAIR SHORES MICH 48082

G C BRUECKNER MD
ST JOSEPH HOSPITAL
MT CLEMENS MI 48043

JAMES W BRYCE MO

24735 VAN DYKE

CENTERLINE MI 48015

CARLOS J BULCOURF MD

31170 HOOVER RD

WARREN MI 48093

W B CARRUTHERS MD
198 S GRATIOT

MT CLEMENS MI 48043

JOSE L CHALELA MD
122 W WASHINGTON AVE
ROMEO MI 48065

HAROLD P CHARBENEAU MO
229 S GRATIOT

MT CLEMENS MICH 48043

LUIS M CHARBON I ER MD

28532 SCHOENHERR

WARREN MICHIGAN 48093

JOEL W CLAY MD

263 S GRATIOT AVE

MT CLEMENS MICHIGAN 48043

ALBERTO COHEN MD
25705 STONEYCROFT DR
SOUTHFIELD MICHIGAN 48075

ALAN COHEN MD

12500 TWELVE MILE RD

WARREN MICHIGAN 48093

CELAL COLAKOGLU MD
46056 CASS

UTICA MI 48087

SORAB A COLAH MD

708 MONITOR LEADER BL

MT CLEMENS MICHIGAN 48043

DAVID COLLON DOS A

MACOMB DAILY BLDG
MT CLEMENS MI 48043

JOHN CORBETT MD
225 S GRATIOT

MT CLEMENS MICHIGAN 48043

JOSE COSIO MD

ST JOSEPH HOSPITAL

MT CLEMENS MICH 48043

JOS M CROMAN JR MD R

131 MARKET ST

MT CLEMENS MI 48043

VICTOR CURATOLO MD
67 CASS AVE

MOUNT CLEMENS MICH 48043

BERNARDO M DANAN MD

28043 HOOVER RD

WARREN MI 48093

H B DARIAN MD

2151 LIVERNOIS

TROY MI 48084

E DEOCAMPO MD
20720 MAXINE

ST CLAIR SHORES MI 48080

NESTOR D DEOCAMPO MD
28043 HOOVER

WARREN MI 48093

DARIO C DEPAULIS MD
22770 KELLY

EAST DETROIT MICH 48021

POL 1810 A D I LONE MD

493 W GRAND BLVD

DETROIT MI 48216

PAUL DIONNE MD

8216 E 12 MILE RD

WARREN MI 48093

EDMUND J DUDZINSKI MD
43533 ELIZABETH RD
MT CLEMENS MI 48043

CHARLES M EBNER MD
12296 TWELVE MILE RD
WARREN MI 48093

SEYMOUR B EKELMAN MD
14 BELLEVIEW

MT CLEMENS MICHIGAN 48043

ELMER P ELL I A S MD
23700 VAN DYKE

WARREN MICH 48089

JOHN A ENGELS MD
69311 N MAIN

RICHMOND MICH 48062

THOMAS B EYL MO
815 BROWN ST

ST CLAIR MI 48079

JERRY S FAGELMAN MD

1514 HOUNDS CHASE

TROY MI 48084

JOHN M FEILLA MD

21811 KELLY RD

EAST DETROIT MI 48021

JAMES WM FINN MD
46056 CASS

UTICA MICHIGAN 48087

LAWRENCE W FRENCH MD
25815 HARPER

ST CLAIR SHORES MI 48081

HERBERT F FRIEDMAN MD
11885 E 12 MILE RDK203
WARREN MI 48093

ANOREW A FULGENZI MD
17301 E EIGHT MILE RD
EAST DETROIT MI 48021

FRANCIS S GERBASI MD

81 LOCHMOOR BLVD

GROSSE PTE SHORES MI 48236

CARLOS B GAYLES MD

122 WASHINGTON

ROMEO MI 48065

MORRIS I GOLDIN MD

6902 CHICAGO RD

WARREN MICH 48092

BERNARD J GOLDMAN MD

243 S GRATIOT AVE

MT CLEMENS MICH 48043

C G GONZALEZ MD
20 PARKVIEW
ST JOSEPH HOSP

MT CLEMENS MI 48043

SEYMOUR V GORDON MD
13500 E 12 MILE RD
WARREN MI 48093

WALTER GUEVARA MD
67 CASS AVE

MT CLEMENS MI 48043

MICHAEL HAAS MD

20867 MACK AVE

GROSSE PTE WDS MI 48236

OTTO H HAHNE MD

8425 E TWELVE MILE RD

WARREN MICHIGAN 48093

WALDEMAR B HARTMANN MD

1416 S GRATIOT

MOUNT CLEMENS MICH 48043

HERBERT M HILLER MD
13500 E TWELVE MILE RD
WARREN MICHIGAN 48093

LEON S HIRZEL MD

33080 GARFIELD

FRASER MICHIGAN 48026

JAMES M HOLBROOK MD
23700 VAN DYKE AVE
WARREN MI 48089

JULIUS HORVATH MD
18947 ROSETTA

EAST DETROIT MICH 48021

A JOSEPH HOSKI MO
8425 E TWELVE MILE RD
WARREN MI 48093

MICHAEL HRANCHOOK MD

30001 VAN DYKE

WARREN MICHIGAN 48093

FRANK J HULL MD

MACOMB DAILY BLDG

MT CLEMENS MI 48043

CLAUDIO M I ACOBELL I MD

21811 KELLY RD

EAST DETROIT MI 48021

DAN I LO H IGLESIAS MD

229 S GRATIOT AVE

MT CLEMENS MI 48043

ERNESTO R IGLESIAS MD
P 0 BOX 665

MT CLEMENS MI 48043

ELI M ISAACS MO
17210 CEDARCROFT PL
SOUTHFIELD MI 48075

EDWARD K ISBEY HD
28495 HOOVER

WARREN MI 48093

ROBERT 0 ISGUT MD

28477 HOOVER RD

WARREN MI 48093

MANUEL JACOBS MD

23700 VAN DYKE AVE

WARREN MI 48089

JAMES H JEWELL MD
ROSEVILLE THEATRE BLDG
ROSEVILLE MICH 48066

JOHN P KANE MD
67 CASS AVE

MOUNT CLEMENS MICH 48043

PETER V KANE MD

230 NORTH AVE

MOUNT CLEMENS MICH 48043

JANUARY, 1972/Michigan Medicine 33

Macomb County

LISTED BY COMPONENT MEDICAL SOCIETIES

WM J KANE MD
171 NORTH AVENUE
MT CLEMENS MI

L

48043

RODOLFO V LOO MD
2597 TOWN HILL DR
TROY MI

48084

HELEN M NUTTING MD
22631 GREATER MACK
ST CLAIR SHORES MI

48080

HAROLD L KATZMAN MD
13500 E 12 MILE RD

GERALD L LOPEZ MD
37159 CHARTER OAKS BLD

VINCENT R 0 SHEE MD
8216 E TWELVE MILE RD

WARREN MI

48093

MT CLEMENS MI

48043

WARREN MI

48093

ROBIN S KEY MO
28495 HOOVER RD

WARREN MI

48093

RICHARO J LUBERA MD
12296 TWELVE MILE RD
WARREN MI

48093

ORVILLE OUGHTREO MD
26401 HARPER
ST CLAIR SHORES MI

48081

JOYCE W KINGSLEY JR
18801 TEN MILE RD
ROSEVILLE MICH

MD

48066

ANOREW J MAGUIRE MD
45569 VAN DYKE
UTICA MICH

48087

MARC PACHO MD
32397 DESMOND DR
WARREN MI

48093

PAUL R KIPP MD
14 BELLEVIEW
MT CLEMENS MICHIGAN

48043

EDO V MARCUZ MD
45420 VAN DYKE
UTICA MI

48087

DELMO A PARIS MD
18801 E TEN MILE RD
ROSEVILLE MICH

48066

WM B KIRTLANO JR MO
18801 E TEN MILE RD
ROSEVILLE MICHIGAN

48066

MAX W MATTES MD
20280 FOREST WOOD DR
SOUTHFIELD MI

48075

N H PARMELEE MO
50551 VAN DYKE AVE
UTICA MICHIGAN

48087

ALFRED A KLEIN MD
23700 VAN DYKE
WARREN MICH

48089

C MATTHEWS JR MO
230 NORTH AVE
MT CLEMENS MICHIGAN

48043

LEO PARNAGIAN MD
230 NORTH AVE
MT CLEMENS MI

48043

K H KNOBLAUCH MD
8425 TWELVE MILE RD
WARREN MICHIGAN

E

48093

EDWARD S MAXIM M D
225 S GRATIOT
MT CLEMENS MI

48043

GILBERT PENA MD
4573 RANCH LANE
BLOOMFIELD HILLS MI

48013

WM J KOKENY MD
23700 VAN DYKE AVE
WARREN MI

48093

MARY L MAYER MD
715 S ROGERS APT 19
MASON MI

48854

FLORENCE PEREZ MD
32397 DESMOND DR
WARREN MI

48093

RICHARD M KOMMEL MD
26510 DUNDEE
HUNTINGTON WDS MICH

48070

JOHN D MC GINTY MD
243 S GRATIOT
MT CLEMENS MICHIGAN

48043

ANTHONY C PORRETTA MD
423 NORTH SHORE OR
ST CLAIR SHORES MI 48080

JOEL M KRIEGEL MD
35992 GRATIOT AVE
MT CLEMENS MI

48043

KATHRYN MC MORROW MD
22900 E REMICK
MT CLEMENS MI

48043

ANGELO PUGLIESI MD
21811 KELLY
EAST DETROIT MI

48021

BRUCE KRIEGER MD
23365 COUNTRY WOODS
SOUTHFIELD MI

LN

48075

G MEDINA MD

8425 E 12 MILE RD

WARREN MI

48093

FRANK J PUGLIESI MD
21811 KELLY RD
EAST DETROIT MI

48021

HARVEY A KRIEGER MD
13500 12 MILE RD E
WARREN MI

48093

KRIKOR MERAME TD J I AN MD
22841 VANDYKE

WARREN MI 48089

MOUFID RAGHEB MD
37976 GRATIOT
MT CLEMENS MI

48043

MORTON J KRIPKE MD
45420 VAN DYKE
UTICA MICHIGAN

48087

JULE J MERRITT MD
35992 S GRATIOT AVE
MT CLEMENS MI

48043

GERALD RAKOTZ MD
13087 ELEVEN MILE RD
WARREN MICHIGAN

48093

JOSEPH D KROON MD
14 BELLEVIEW
MT CLEMENS MICHIGAN

48043

HAROLD 0 MESSMER MD
7817 MCCLELLAN
UTICA MICHIGAN

48087

ANTONIO E RAMOS MD
29846 SCHOENHERR
WARREN MICHIGAN

48093

HYMAN KURTZ MD
16712 T IMBERVI E W
FRASER MI

48026

SIDNEY S MEYERS MD
28477 HOOVER
WARREN MICHIGAN

48093

RUFUS H REITZEL MD
199 S GRATIOT AVE
MOUNT CLEMENS MICH

48043

GEORGE P KYPROS MD
25520 LITTLE MACK
ST CLAIR SHORES MI

48081

GEORGE W MILLER MO
18815 E TEN MILE RD
ROSEVILLE MI

48066

LEWIS D RICKMAN MD
14 HOWARD ST
MT CLEMENS MI

48043

JOSEPH J LAHOOD MD
319 N GRATIOT
MT CLEMENS MI

48043

SIDNEY S MILLER MD
28477 HOOVER RD
WARREN MICHIGAN

48093

CHARLES B RIDDLE MD
620 EASTLAND PROF BLD
HARPER WOODS MI 48236

CHARLES LAPP MO
7817 MC CLELLAN
UTICA MICHIGAN

48087

EARL G MOEHN MD

309 MACOMB DAILY BLDG

MT CLEMENS MI 48093

E A RINKENBERGER MD
243 S GRATIOT AVE
MT CLEMENS MICH

48043

LAWRENCE E LEE MD
11885 E 12 MILE RD
WARREN MICHIGAN

48093

GEO F MOORE MD
69434 N FOREST
RICHMOND MI

L

48062

JOS RIVKIN MD
14 BELLEVIEW
MOUNT CLEMENS MICH

48043

THOMAS E LEE MD
13403*kE 13 MILE RD
WARREN MI

48093

GERALD W MORRIS MD
14 BELLEVIEW
MT CLEMENS MICHIGAN

48043

GEO E ROTH MD
19136 MENDOTA AVE
DETROIT MI

48221

CHARLES LEVI MD

8262 E TWELVE MILE RD

WARREN MICHIGAN 48093

PHILIP T MULLIGAN MD
612 MONITOR LEADER BL
MOUNT CLEMENS MICH

48043

ARTHUR M ROTHMAN MD
22422 GRATIOT AVE
EAST DETROIT MICH

48021

SAMUEL A LICATA MD
21349 KELLY RD
EAST DETROIT MI

48021

ATALAY M MURGUZ MO
26451 RYAN RD
WARREN MI

48091

RONALD E ROURKE MD
14628 E 7 MILE RD
DETROIT MI

48205

ONOFRE 8 LLANEZA MO
38544 FOXCROFT BLVD
MT CLEMENS MI

48043

P F NOWOSIELSKI MD
31271 HARPER AVE
ST CLAIR SHORES MI

48082

DANIEL L ROUSSEAU MD
MONITOR LEADER BLDG
MT CLEMENS MICHIGAN

48043

WM E RUSH MO
ST JOHNS HOSP

DETROIT MI 48236

PAUL RUSSELL MD A

207 CIRCLE OR

TRAVERSE CITY MI 49684

JACK RYAN MO

23700 VAN DYKE AVE

WARREN MICH 48089

THOMAS E RYAN MD

39310 GARY AVE

MT CLEMENS MICHIGAN 48043

RONALD J SABLES MD

225 S GRATIOT AVE

MT CLEMENS MI 48043

RUSSELL F SALOT MD
230 NORTH AVE

MOUNT CLEMENS MICH 48043

A C SANDOVAL JR MD
ST JOSEPHS HOSPITAL
MT CLEMENS MI 48043

CARL J SARNACKI MD
8425 TWELVE MILE RD E
WARREN MICHIGAN 48093

HOWARD J SAWYER MD

11177 E 8 MILE RD

WARREN MI 48089

JOS N SCHER MD
130 CASS AVE

MOUNT CLEMENS MICH 48043

SYDNEY SCHER MD
132 CASS AVE

MOUNT CLEMENS MICH 48043

ROBERT F SCHMUNK MD

136 CASS AVENUE

MT CLEMENS MICHIGAN 48043

MAHMOUD M SELIM MD

8425 E 12 MILE RD

WARREN MI 48093

THOMAS J SETTER MD

319 N GRATIOT AVE

MT CLEMENS MI 48043

JACK M SHARTSIS MD
11885 E 12 MILE RD
WARREN MI 48093

YEHYA A SHAWKY MD
8425 E TWELVE MILE RD
WARREN MICHIGAN 48093

EZRA S SHAYA MD
31170 HOOVER

WARREN MICHIGAN 48093

LAWRENCE F SHEPPARD MD
23700 VAN DYKE AVE
WARREN MI 48089

HERBERT D SHERBIN MO
12500 TWELVE MILE RD
WARREN MICHIGAN 48093

GERALD SHERMAN MD

12500 12 MILE RD

WARREN MI 48093

EDWARD G SIEGFRIED MD
229 S GRATIOT AVE
MT CLEMENS MICH 48043

MICHAEL P SILVESTER MD
350 WESTVIEW TERRACE
ARLINGTON TEXAS 76013

MILTON F SIMMONS MD
12500 E TWELVE MILE RD
WARREN MICHIGAN 48093

WM N SIMS MD
229 S GRATIOT

MOUNT CLEMENS MICH 48043

34 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Marquette County

NELSON SINGER MD
22100 GRATIOT AVE
EAST DETROIT MICH

48021

LACEY WALKE MD

214 DAV WHITNEY BLDG

DETROIT MI

48226

KARL K KELLAWAN MD
490 FOURTH ST
MANISTEE MI

49660

JAMES 8 STANTON MD
319 N GRATIOT AVE
MT CLEMENS MICH

48043

ALBERT A J WALLAERT
23700 GRATIOT
EAST DETROIT MI

MD

48021

ROMAN R KNOBLICH MD
WEST SHORE HOSPITAL
MANISTEE MI

49660

WM A STARBIRD MO
8216 E 12 MILE RD
WARREN MICH

48093

FREDRIC WATTS MD
27440 HOOVER RD
WARREN MI

48093

JOHN F KONOPA MD
57 POPLAR ST
MANISTEE MICH

49660

MORRIS STARKMAN MD
28477 HOOVER
WARREN MICHIGAN

48093

K A WEINBERGER MD
27643 SCHOENHERR RD
WARREN MI

48093

ERNEST B MILLER MD
8454 CANDLEWOOD
LARGO FLORIDA

R

33540

GEORGE H STEELE MD
229 S GRATIOT
MT CLEMENS MICHIGAN

48043

CHAS J WEINGARTEN MD
12500 E 12 MILE RD
WARREN MI

48093

RICHARD L NOVACK MD
324 FIRST ST
MANISTEE MI

49660

EUGENE STEINBERGER MD

23700 VAN DYKE

WARREN MI 48089

JACK I WEISS MD
23700 VAN DYKE AVE
WARREN MICH

48089

ROGER PATERSON MD
310 9TH ST
MANISTEE MI

49660

CARMELA M STELLA MO
69311 MAIN ST
RICHMOND MI

48062

ALEC WHITLEY MO
21707 ERBEN DR
ST CLAIR SHORES MI

48081

HOMER A RAMSDELL MD
398 RIVER ST
MANISTEE MI

L

49660

JOSEPH E STEPKA M D
50551 VAN DYKE
UTICA MI

48087

MAURICE M WILDE MD
5930 CHICAGO
WARREN MICH

L

48092

K G ROSENOW MD
FOREST CLINIC BLDG
MANISTEE MICH

49660

KIRWIN STIEF MD

218 N CHRISTINE CIRCLE

MT CLEMENS MI 48043

NORMAN R WILSON MD
225 S GRATIOT AVE
MT CLEMENS MICHIGAN

48043

DONALD N SCHWING MD
FOREST CLINIC BLDG
MANISTEE MICH

49660

JULIUS STONE MD
198 S GRATIOT
MT CLEMENS MI

48043

HENRY J WINKLER MD
32865 NORTH RIVER RD
MT CLEMENS MI

48043

DAVID A WILD MD
84 CYPRESS ST
MANISTEE MI

49660

CHARLES STOYKA MD
21420 HARPER
ST CLAIR SHORES MI

48080

CARL WITUS MD
21349 KELLY RD
EAST DETROIT MICH

48021

MARQUETTE

DONALD E STROUD DDS
8425 TWELVE MILE RD
WARREN MI

A

48093

ERVIN WOLF MD
ROSEVILLE THEATRE BLDG
ROSEVILLE MI 48066

JAMES R ACOCKS MD
MORGAN HEIGHTS
MARQUETTE MICH

49855

OSCAR D STRYKER MD
38422 HIDDEN LANE
MT CLEMENS MI

L

48043

WM C WYTE MD

263 S GRATIOT AVE

MT CLEMENS MICHIGAN

48043

BUSHARAT AHMAD MD
1414 W FAIR AVE
MARQUETTE MI

49855

FREDK A STURM MD
76 LOCHMOOR
GROSSE PTE MI

48236

KEN YAMASAKI MD
23700 VAN DYKE
WARREN MICH

48089

ARTHUR L AMOLSCH MD
1008 BLUFF ST
MARQUETTE MICHIGAN

L

49855

ADOLPH W SUKSTA MD
23350 GRATIOT
EAST DETROIT MICH

48021

DAN ZAVELA MD
679 N RENAUD
GROSSE PTE WOS MICH

48236

HENRY J BARSCH MD
1414 W FAIR AVE
MARQUETTE MI

49855

M SUZUKI M D
23700 VAN DYKE
WARREN MICH

48089

R08ERT A ZINK MD
25815 HARPER AVE
ST CLAIR SHORES MI

48081

MATTHEW C BENNETT MD
1414 W FAIR AVENUE
MARQUETTE MICH

49855

AKEMI TAKEKOSHI MD
22900 E REMICK
MT CLEMENS MI

48043

MR GILBERT E ZOOK
253 S GRATIOT
MT CLEMENS MI

A

48043

ROBT F BERRY MD
1414 W FAIR AVENUE
MARQUETTE MI

49855

FRANK E TAORMINA MD
P 0 BOX 83
MT CLEMENS MI

48043

ALEX ZOTOVAS MD
23700 VAN DYKE AVE
WARREN MI

48089

JOS P 8ERTUCC I MD
114 S FIRST ST
ISHPEMING MICH

49849

ALFRED A THOMPSON MD
126 CASS AVE
MOUNT CLEMENS MICH

48043

NORMAN ZUCKER MD
11885 E 12 MILE RD
WARREN MI

48093

THOS B BOLITHO MD
1414 W FAIR AVENUE
MARQUETTE MICHIGAN

49855

BERNARD L TOFT MD
29256 RYAN RD
WARREN MI

48092

MANISTEE

ADAM BRISH MD
1414 W FAIR AVE
MARQUETTE MI

49855

DAVID TRANSUE MD
13403 E 13 MILE RD
WARREN MI

48093

LE ROY A FUTTERER MD
FOREST CLINIC BLDG
MANISTEE MICH

49660

RANKIN L CAREFOOT MD
1414 W FAIR AVENUE
MARQUETTE MICHIGAN

49855

KENNETH F TUCKER MD
23700 VAN DYKE
WARREN MI

48089

ROBT R GARNEAU MD
FOREST CLINIC BLDG
MANISTEE MICH

49660

WILBUR L CASLER MD
131 E RIDGE ST
MARQUETTE MI

L

49855

WILLIAM URBANCIC MD
22048 GRATIOT
EAST DETROIT MI

48021

ERNEST C HANSEN MD
326 FIRST ST
MANISTEE MICH

49660

LUCIANO CELORI MD
427 W COLLEGE
MARQUETTE MI

49855

RAMON A URENA MO
38028 ROCK HILL RD
MT CLEMENS MI

48043

VICKERS HANSEN MD
310 NINTH ST
MANISTEE MI

49660

DONAL T CONLEY MD
4400 N RIVER BAY RD
WATERFORD WISC

53185

MOSES COOPERSTOCK MO L

1414 W FAIR AVE
MARQUETTE MICH 49855

WM A CORCORAN MD L

168 DAVIS ST

ISHPEMING MI 49849

MICHAEL COYNE MD

1414 W FAIR AVE

MARQUETTE MI 49855

DONALD R ELZINGA MD

1414 W FAIR AVE

MARQUETTE MI 49855

EUGENE R ELZINGA MO L

1414 W FAIR AVENUE
MARQUETTE MICH 49855

JOHN W ENGLISH MD
1414 W FAIR AVENUE
MARQUETTE MICHIGAN 49855

D C FAHRBACH MD
SAND POINT RD

MUNISING MI 49862

R E FLORES MD
613 LAKE ST

MARQUETTE MI 49855

SOUTHGATE J GREEN MD

GWINN MICHIGAN 49843

CARL F HAMMERSTROM MD
1414 M FAIR AVE
MARQUETTE MI 49855

EUGENE W HILDEBRAND MD

MEDICAL CENTER

MUNISING MI 49862

WILLIAM F HOPKINS MD
1414 W FAIR AVENUE
MARQUETTE MICHIGAN 49855

DANL P HORNBOGEN MD
1414 W FAIR AVENUE
MARQUETTE MICHIGAN 49855

ELSTUN R HUFFMAN MD
1414 W FAIR AVENUE
MARQUETTE MICHIGAN 49855

WILL I AM C HUMPHREY MD
829 CROIX STREET
NEGAUNEE MICHIGAN 49866

ROBT G JAEDECKE MD
829 CROIX

NEGAUNEE MICH 49866

ELIZABETH 0 KANE MD R

JAMES B KEPLINGER MD

1414 W FAIR AVE
MARQUETTE MI 49855

HARRY KOENIG MD
540 E DIVISION ST
ISHPEMING MI 49849

E F KRONSCHNABEL MD

1414 W FAIR AVE

MARQUETTE MI 49855

JOHN C KUBLIN MD

1414 W FAIR AVE

MARQUETTE MI 49855

WARREN C LAMBERT MD

347 E RIDGE ST

MARQUETTE MI 49855

M J LEXMOND MD
524 MATHER AVE
ISHPEMING MICHIGAN 49849

E T LINCKE MD
1414 W FAIR AVENUE
MARQUETTE MICHIGAN 49855

JANUARY, 1972/Michigan Medicine 35

Marquette County

JAMES W LYONS MD

1919 w FAIR AVE

MARQUETTE MICH 49855

NORMAN L MATTHEWS MD
N MICH CHILD CLINIC
MARQUETTE MICH 49855

THOMAS J MUDGE MO
W FAIR AVENUE

MARQUETTE MI 49855

ARCHIE S NAROTZKY MD

MIRACLE CIRCLE

ISHPEMING MICH 49899

R WILLIAM NEUMANN MD
1919 W FAIR AVE
MARQUETTE MI 49855

WILSON G NEWELL MD
101 S FOURTH
ISHPEMING MI

LISTED BY COMPONENT MEDICAL SOCIETIES

REGINALD G WILLIAMS MD
529 MATHER ST iQai.Q

ISHPEMING MICH 49899

GEORGE M WILSON JR MD
1919 W FAIR AVENUE
MARQUETTE MICHIGAN 99855

KENNETH C WRIGHT M D
1919 W FAIR AVENUE
MARQUETTE MICH 49855

MECOSTA

CHARLES M ASPLUND MD
213 ELM ST

BIG RAPDIS MI 49307

FREO F BIRKAM MD
FERRIS STATE COLLEGE
HEALTH CENTER

BIG RAPIDS MI

99307

MASON

99899

99893

OSMO NIEMl MD
BOX 151
GWINN MI

EARLE S OLDHAM MD
927 W COLLEGE AVE
MARQUETTE MI 49855

HUSCHANG M PAYAN MD
BELL MEMORIAL HOSP
ISHPEMING MI 99899

WALLACE G PEARSON MD
1919 w FAIR AVENUE
MARQUETTE MICHIGAN 99855

PHILLIP E PERKINS MD
37089 HARRISON CT #707
FARMINGTON MI 98029

FLORENCE A PILLOTE MD

26 LAKEVIEW DR

MARQUETTE MICHIGAN 99855

JOHN F PILLOTE MD
1919 W FAIR AVENUE
MARQUETTE MICHIGAN 99855

RICHARD POTTER MD

ROUTE 1 BOX 63A

NEGAUNEE MI 99866

LOUIS ROSENBAUM MD
529 MATHER ST

ISHPEMING MICH 99899

COL ROBERT ROUSE MC A

US AF HOSPITAL K I

SAWYER AFB MICH 99893

FREDK C SABIN MO
1919 w FAIR AVENUE
MARQUETTE MICH 99855

W GENE SCHROEDER MD
529 MATHER ST

ISHPEMING Mt 99899

SARA K D SCHWE 1 NSBERG A
COUNTY RD 992

MARQUETTE MI 99855

MILTON SODERBERG MD

1919 w FAIR AVE

MARQUETTE MI 99855

FREDERICK A STONE MD
829 CROIX ST

NEGAUNEE MI 99866

JAMES F TOBIN JR MD

729 ELLIOTT AVE

ISHPEMING MICHIGAN 99899

DAVID R WALL MD
A IT AMONT C FISHER
MARQUETTE MICHIGAN 99855

ROBERT B WHITE MD

1503 CENTER ST

MARQUETTE MI 99855

HERBERT G BACON JR MO
101 N MAIN

SCOTTVILLE MICH 99959

A FLOYD BOON MD
203 N FERRY

LUDINGTON MICH 49931

JOHN R CARNEY MD
202 N PARK ST

LUDINGTON MICH 99931

RUTH V C CARNEY MD

202 N PARK AVE

LUDINGTON MICH 49931

R J CASTELLANl MD
PO BOX 399
LUDINGTON MICH

JACOB BRUGGEMA MD
101 N MAIN ST

EVART MICH 99631

JEROME A CONRAD MD
905 WINTER AVE

BIG RAPIDS MI 99307

ROY A DAVIS MD
FERRIS STATE COLLEGE
BIG RAPIDS MI 99307

JACK HALOEMAN MD
1019 S STATE ST
BIG RAPIDS MICH 99307

LELAND A HICKOX MD
1019 S STATE ST
BIG RAPIDS MICH

RICHARD D CHALTRY DO

STEPHENSON MI 99887

FRANCIS J DEWANE MD
913 10TH AVE

MENOMINEE MICH 99858

LEON GARBOWICZ MD

1713 SEVENTH ST

MENOMINEE MI 99858

L GRANT GLICKMAN MD L

958 FIRST ST

MENOMINEE MICH 99858

JOHN R HE I OENRE ICH MD

DAGGETT Ml 99821

WM S JONES MD L

1196 TENTH AVE

MENOMINEE MI 99858

99931

99307

L

HARRY L CLARK MD L

619 N LAKESHORE DR
LUDINGTON MI 99931

F E ERLANDSON MD
121 E LUDINGTON AVE
LUDINGTON Ml 99931

WM S JONES JR MO
1196 10TH AVE
MENOMINEE MICH

99858

L

R L EWING MD
600 TINKHAM AVE
LUOINGTON MICHIGAN

99931

ROBERT IRICK MD
MEMORIAL hospital
LUDINGTON MI 99931

GLADYS J KL E I NSCHM IDT

100 W BUTTERFIELD RD

OAK BROOK ILLINOIS 60521

MM S MARTIN MO
107 LUDINGTON
LUDINGTON MICH

GERRY MAYER MD
806 RUSSELL
LUDINGTON MI

PAUL B KILMER MD
350 W UPTON AVE
REED CITY mi 99677

EDWARD H KOWALESKI MD

REMUS MI 99390

NORMAN V LINCOLN MD
108 E UPTON

REED CITY MI 49677

FRANK A MERLO MD

206 S MICHIGAN ST

BIG RAPIOS MICH 49307

HARRY MOHAMMED MD
809 IVES AVE

BIG RAPIDS MI 99307

KARM C KERWELL MD
P 0 BOX 17
STEPHENSON MI 99887

BENEDICT M POLCYN MD
205 FIRST ST

MENOMINEE MI 99858

MIDLAND

WM W MOON MD
BOX 175
BALDWIN MI

99309

99931

99931

ROBT A OSTRANDER MD R

5000 E GRANT RD #5
TUCSON A Z 85716

CHAS A P AUK ST l S MD

111 E COURT ST

LUDINGTON MICH 99931

JOHN RAMSEY MD

902 E LUDINGTON AVE

LUDINGTON MI 99931

WM F SUTTER MD
220 S JAMES ST
LUDINGTON MICH

99931

GIRARD VEENSCHOTEN MD
380 SOUTH ST

BALDWIN MI 99309

LORENZO R NELSON MD
R F D 1

BALDWIN MICH 49309

LELAND B PHELPS MD
598 BENJAMIN SE
GRAND RAPIDS MI 99506

GEORGE B PUSCZAK MD
213 ELM ST

BIG RAPIDS MI 99307

JAMES L TYSON MD
1019 SOUTH STATE ST

BIG RAPIDS MICH 99307

EDWARD W VAN AUKEN MD
229 S WARREN

BIG RAPIDS MICH 99307

JAMES E WALTERS MD
1019 S STATE ST
BIG RAPIDS MICH

ADELTO ADAN MD

3103 WASHINGTON

MIDLAND MI 98690

ARTHUR R BASEL MD
901 CRESCENT

MIDLAND MI 98690

MAC B BENJAMIN MD

521 MADISON ST

SAGINAW MI 98603

DONALD R BENNETT MD

3902 APPLEWOOO

MIDLAND MI 98690

JOSEPH A BERNIER MD
218 E RAILWAY

SANFORD MI 98651

J F BLACKHURST M D
2715 ASHMAN STREET
MIDLAND MICH 98690

ROBT T BLACKHURST MD
233 E LARKIN

MIDLAND MICH 98690

ROBT E BOWSHER MO

9005 ORCHARD DR

MIDLAND MICHIGAN 98690

99307

JAMES E WAUN MD
1011 N SHERMAN
LUOINGTON MI

99931

MENOMINEE

NILS 0 AGNEBERG MD
531 1ST ST

MENOMINEE MICH 99858

HERMAN R BRUKARDT MD
539 FIRST ST

MENOMINEE MICH 99858

ROBT G BRIDGE MD
2715 ASHMAN
MIDLAND MICH

98690

DAN J BULMER MD

2707 ASHMAN ST

MIDLAND MICH 98690

RAYMOND C BUSH MD
808 W SUGNET

MIDLANO MICHIGAN 98690

J DANIEL CLINE MD
920 W SUGNET

MIDLAND MI 98690

JAMES A DEVLIN MD
115 JEROME

MIDLAND MICH 98690

DALE J DUCOMMUN MD
P 0 BOX 1693 MED DEPT
MIDLAND MI 98690

36 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Monroe County

DENNIS G EGNATZ MD

LINFERD G LINABERY

MD

WILBUR 0 TOWSLEY MD

R

312 E MAIN ST

3808 NOTTINGHAM TERR

515 W MAIN ST

MIDLAND MI

48640

MIDLAND MI

48640

MIDLAND MICH

48640

RUTH ELLIS M D

KARL W LINSENMANN MD

GEORGE ULMER M D

2510 ASHMAN

2604 MANOR DR

4005 ORCHARD

MIDLAND MICHIGAN

48640

MIDLAND MICHIGAN

48640

MIDLAND MICH

48640

DOZIER N FIELDS JR

MD

V A MARKS MO

ROBERT L VANSICKLE MD

515 W MAIN ST

2706 LOUANNA

222 N SAGINAW RD

MIDLAND MICH

48640

MIDLAND MICHIGAN

48640

MIDLAND MI

48640

PETER C GAY MD

WM A MAYNARD MD

R

RICHARD W WELK MD

P 0 BOX 1693 MEO DEPT

3862 N W RIVER RD

1705 DILLOWAY

MIDLAND MI

48640

SANFORD MICHIGAN

48657

MIDLAND MI

48640

HAROLD H GAY MD

R

E M MC GOWAN MD

HARRY 0 WESTPHAL MD

4689 RUHLE RD

910 EASTLAWN DR

910 EASTLAWN

COLEMAN MI

48618

MIDLAND MI

48640

MIDLAND MI

48640

ROY M GOETHE MD

EDWARD H MEISEL JR

MD

CHAS H WILLI SON MD

222 N SAGINAW RD

MASONIC BLDG

122 TOWNSEND ST

MIDLAND MI

48640

MIDLAND MICH

48640

MIDLAND MICH

48640

HAROLD L GORDON MD

MICHAEL P MESAROS MD

G JAMES YOBST MD

DOW CHEMICAL CO

222 N SAGINAW RD

2719 ASHMAN

MIDLAND MICH

48640

MIDLAND MICHIGAN

48640

MIDLAND MICHIGAN

48640

ROBERT GRANT MD

G FREDK MOENCH MD

R

2931 MANOR DR

147 CENTER ST

MIDLAND MICHIGAN

48640

SANFORD MICHIGAN

48657

MONROE

NORMAN C GREWE MD

RICHARD MOULTON MD

FLORENCE D AMES MD

L

501 E PINE ST

115 JEROME ST

2 W NOBLE AVE

MIDLAND MICHIGAN

48640

MIDLAND MI

48640

MONROE MI

48161

EDW P GUNDERSON JR

MD

GURDON R PATTON MD

SHAPOOR ANSARI MD

2000 DILLOWAY DR

2707 ASHMAN

750 STEWARD RD

MIDLAND MI

48640

MIDLAND MI

48640

MONROE MI

48161

COLLEEN HABERSTROH

MD

MELVIN H PIKE MD

C D BARRETT SR MD

L

3710 APPLEWOOD

224 E LARKIN

2133 HOLLYWOOD DR

MIDLAND MICHIGAN

48640

MIDLAND MICH

48640

MONROE MI

48161

WILLIAM E HARRIGAN

MD

ROBERT W POLLOCK MD

ANTHONY H BARTOLO MD

110 W SUGNET

2707 ASHMAN ST

757 N MONROE

MIDLAND MICHIGAN

48640

MIDLAND MICH

48640

MONROE MI

48161

D D HEFFERNAN MD

LEONARD A POZNAK MD

CHARLES E BLACK MD

ROUTE #8

4005 ORCHARD DR

721 N MACOMB ST

MIDLAND MICH

48640

MIDLAND MICH

48640

MONROE MICHIGAN

48161

WM A HIMMELSBACH MD

STEPHEN H RANDOLPH

MD

LEONARO C BLAKEY MD

L

5411 STURGEON CRK PKWY

201 E ELLSWORTH ST

745 N MONROE ST

MIDLAND MI

48640

MIDLAND MICHIGAN

48640

MONRUE MICHIGAN

48161

BEN J B HOLDER MD

WILLIAM B REDMON MD

WM W BONO MD

L

P 0 BOX 1693 MED DEPT

115 JEROME

222 N MONROE

MIDLAND MICH

48640

MIDLAND MICHIGAN

48640

MONROE MICH

48161

FREDERICK R HOLLAND

MD

JAMES REIF MD

J J BURROUGHS MO

1801 RAPANOS

222 N SAGINAW RD

745 N MONROE ST

MIDLAND MI

48640

MIDLAND MI

48640

MONRUE MICHIGAN

48161

IRVIN M HOWE MD

THOMAS E RUSH MD

ZOLTAN B CIGANY MD

110 W SUGNET

115 JEROME ST

MIDLAND MICH

48640

MIDLAND MI

48640

CARLETON MI

48117

RICHARD H HOWELL MD

CHARLES A SANISLOW

MO

BRUCE CLARK MD

2707 ASHMAN ST

2707 ASHMAN ST

8308 LEWIS AVE

MIDLAND MI

48640

MIDLAND MICHIGAN

48640

TEMPERANCE MICHIGAN

48182

MARTIN J ITTNER MD

H C SCHARNWEBER MD

S G COCOREL I S MD

217 N SAGINAW RD

P 0 BOX 1693 MEO DEPT

750 STEWARD RD

MIDLAND MICH

48640

MIDLAND MICHIGAN

48640

MONROE MI

48161

DAVID B JOHNS MD

CHARLES A SCHOFF MD

FRANK COSTA MD

P 0 BOX 1693 MED DEPT

5209 SUNSET DRIVE

21941 WOOORUFF

MIDLAND MI

48640

MIDLAND MI

48640

ROCKWOOD MI

48173

YAHYA K I YAK MD

ANTON SCHWARZ MD

JOSE DEL-ROSAR I 0 MD

206 GRAHAM

12437 WINDSOR

750 STEWART

MIDLAND MI

48640

CARMEL INDIANA

46032

MONROE MI

48161

CHAS G KRAMER MD

JOHN W SHRINER MD

JOY 0 S DIEHL MD

P 0 BOX 1693

222 N SAGINAW RD

15463 S MONROE

MIDLAND MICHIGAN

48640

MIOLAND MICH

48640

MONROE MICHIGAN

48161

HAROLD A KWAST MD

DONALD S SMITH JR MD

GEORGE Z DIEHL MD

2715 ASHMAN

2715 ASHMAN

721 N MACOMB

MIDLAND MICHIGAN

48640

MIDLAND MI

48640

MONROE MICHIGAN

48161

MICHAEL S LEAHY MD

SIDNEY N SMOCK MD

DALE W DOUGLAS MD

MIDLAND HOSPITAL

3410 VALLEY DR

124 COLE RO

MIDLAND MI

48640

MIDLAND MI

48640

MONROE MICH

48161

EMILIO A ESPINOSA MO
9042 LEWIS AVE
TEMPERANCE MI 48182

ROBT T EWING MO
201 N MACOMB
MONROE MI

L

48161

R

JOHN P FLANDERS MO
5347 QUESTA TIERRA OR
PHOENIX ARIZ 85012

REGINALD A FRARY MO L

CTRY CLUB MOBILE MAN
HWY 19 TROUT LK

EUSTIS FLORIDA 32726

JOHN W FREUO MO

1262 N MACOMB ST

MONROE MICH 48161

HILDA M HENSEL MD
12 E 4TH ST

MONROE MICH 48161

NIKOLAS HNATCZUK MO
8078 SUMMERF IELO
LAMBERTVILLE MICH 48144

FRANCIS IVAN1CHEK MD

29 WASHINGTON ST

MONROE MI 48161

A ESTHER JOHNSON MD

751 N MONROE ST

MONROE MICHIGAN 48161

S NEWTON KELSO JR MD
116 COLE RO

MONROE MICHIGAN 48161

JOHN R KING MO
12 EAST 4TH ST
MONROE MICHIGAN 48161

EDWARD W LABOE MD R

424 HOLLYWOOO

MONROE MI 48161

GERALD P LAMMERS MD

IDA MI 48140

JOSEPH LIBRES MD

721 N MACOMB ST

MONROE MI 48161

WARREN J LIEDEL MD
136 COLE RD

MONROE MICHIGAN 48161

EDGAR C LONG MD R

P 0 BOX 1120

SEOONA ARIZONA 86336

WILLIAM F LUSHER MD
8308 LEWIS AVENUE
TEMPERANCE MICHIGAN 48182

REGINALD W MC GEOCH MD L

718 N MACOMB ST

MONROE MI 48161

AMIR H MEHREGAN MO

12 E FOURTH ST

MONROE MI 48161

WALTER A MEIER MD
134 COLE RD

MONROE MICHIGAN 48161

W S MIDDLETON MD

219 W FRONT STREET

MONROE MICH 48161

JIMMY MISTRY MD

MERCY HOSPITAL

MONROE MI 48161

WALTER L MOLESKI MD
134 COLE RD

MONROE MI 48161

JANUARY, 1972/Michigan Medicine 37

Monroe County

LISTED BY COMPONENT MEDICAL SOCIETIES

MEHMET N OZDAGLAR MD

HELEN S BARNARD MD

R

KSHITISH C DAS MD

721 N MACOMB

1381 CREEK RD APT D4

NORTON MEDICAL CTR

MONROE MICHIGAN

48161

MUSKEGON MI

49441

MUSKEGON MI

49444

EMILIO PENA MD

JAMES W BARNES MD

ADOLPH F DASLER MD

424 MONROE ST

102 PROFESSIONAL BLDG

2208 GLENDALE

DUNDEE MICHIGAN

48131

MONTAGUE MICH

49437

AUGUSTA GA

30904

HERMANN K B PINKUS MO

JAMES M BARNETT MD

HENRY DE LEEUW MD

415 S MONROE

2416 PECK ST

4090 HIGHGATE RD

MONROE MICH

48161

MUSKEGON MI

49444

MUSKEGON MI

49441

JULIO C POSTIGO MD

ARTHUR L BENEDICT JR

ROLAND W DEYOUNG MD

721 N MACOMB

22 W SOUTHERN AVE

3800 MONTEVIEW

MONROE MI

48161

MUSKEGON MICH

49441

MUSKEGON MICHIGAN

49441

J LAURENCE PROCTOR MO

ROBT E BLOOM MD

FRANK DISKIN MD

750 STEWART

MEOICAL ARTS CENTER

1324 MARQUETTE AVE

MONROE MI

48161

MUSKEGON MICH

49440

MUSKEGON MICHIGAN

49442

ALBERT H REISIG MD

ROBT E BOLTHOUSE MD

NICHOLAS J ELLIS MD

1 S MONROE ST

2101 PECK ST

1891 LAKE SHORE DR

MONROE MICH

48161

MUSKEGON HTS MICH

49444

MUSKEGON MI

49444

DONALD L SALVA MD

WM H BOND MD

PAUL R ENGLE MO DIR

753 N MONROE

3535 PARK ST

MUSKEGON CO HL TH DEPT

MONROE MI

48161

MUSKEGON MICH

49444

MUSKEGON MI

49440

BERNARD SISMAN MD

DE VERE R BOYD MD

ALBERT D ENGSTROM MD

130 COLE RD

1735 PECK ST

117 W COLBY

MONROE MICHIGAN

48161

MUSKEGON MICH

49441

WHITEHALL MICH

49461

THOMAS H SNIDER MD

JACK L BOYD MD

A

JOHN C FARMER MD

204 W ELM AVE

BOX C

MEDICAL ARTS CENTER

MONROE MI

48161

TRAVERSE CITY MI

49684

MUSKEGON MICH

49440

ROBT G STREICHER MO

PARK S BRADSHAW MD

ENID FILLINGHAM MD

R

729 N MONROE ST

MEDICAL ARTS CENTER

1034 GILES RD

MONROE MICH

48161

MUSKEGON MICH

49440

MUSKEGON MI

49445

SPENCER H WAGAR MD

JAMES H BULTEMA MD

ROBT J FLES MD

1310 N MACOMB

1470 PECK ST

1715 PECK ST

MONROE MICHIGAN

48161

MUSKEGON MI

49441

MUSKEGON MICH

49441

VERNON L WEEKS MD

J MAX BUSARD MD

JOHN D FOLSOM MO

749 N MONROE ST

1200 RANSOM

1706 PECK ST

MONROE MI

48161

MUSKEGON MICHIGAN

49442

MUSKEGON MICH

49441

ROLLAND W WILKINS MD

THOS R BUSARD MO

PHIL IP H FRANDSEN MO

118 COLE RD

MEOICAL ARTS CENTER

1470 PECK ST

MONROE MICHIGAN

48161

MUSKEGON MICHIGAN

49440

MUSKEGON MICHIGAN

49441

ROBT J WILLIAMS MD

L

MR JAMES C CARLSON

A

PHILLIP E FRY MD

A

158 MACOMB CT

2060 BELMONT

680 ASH

MONROE MICHIGAN

48161

MUSKEGON MI

49441

DENVER CO

80220

JAMES S CETON MD

A

E M FUGATE MD

MUSKEGON

SUDAN INTERIOR MISSION

206 WESTGATE MED TWR

GALMI PAR MADAOUA
REPUBLIC OF NIGER

MUSKEGON MICH

49441

AUSTIN A AARDEMA MD

WEST AFRICA

EVERETT W GAIKEMA MD

R

1470 PECK ST

605 FIRST ST

MUSKEGON MICHIGAN

49441

ANTONIO CHIASSON MD
4056 NOB HILL DR

NORTH MUSKEGON MI

49445

ARDEN G ALEXANDER MD

MUSKEGON MICHIGAN

A9AA1

FRANK W GARBER JR MD

1725 PECK ST

601 RUDDIMAN

MUSKEGON MI

49441

J W CHR I STOPHER SEN MO

NO MUSKEGON MI

49445

1276 LAKE SHORE DR

RICHARD T ALLEN MO

MUSKEGON MI

49444

FRANK W GARBER MO

L

768 W BROADWAY

235 MONROE AVENUE

MUSKEGON HTS MI

49444

HENRY W CLAPP MO
202 WESTGATE MED TWR

MUSKEGON MI

49441

WILLIAM J ALT MD

MUSKEGON MI

49441

ROBT E GARRISON JR MD

MEDICAL ARTS CENTER

210 MED ARTS BLDG

MUSKEGON MICHIGAN

49440

H EUGENE CORNELL MD

MUSKEGON MI

49440

104 NORTON MEDICAL CTR

DAVID A AMOS MD

MUSKEGON MI

49442

DOUGLAS H GIESE MD

307 MEDICAL ARTS BLDG

2218 SOUTHWOOD DR

MUSKEGON MI

49440

DONALD K CRANDALL MD
4155 NOB HILL DR

MUSKEGON MICH

49441

G W ANNESSA MD

NORTON SHORES MI

49441

JAMES L GILLARD MD

MEDICAL ARTS CENTER

1642 PECK ST

MUSKEGON MICHIGAN

49440

JOHN W CRAWFORD JR MD

MUSKEGON MICHIGAN

49441

1470 PECK ST

RALPH F ASKAM MD
MEDICAL ARTS CENTER

MUSKEGON MICHIGAN

A9441

MARTHA H GOLTZ MD

L

MUSKEGON MICHIGAN

49440

ANNE B CRONICK MD
435 WHITEHALL RD

MONTAGUE MI

49437

ANNIE L ATKINSON MO

A

MUSKEGON MI

A9445

RONALD GRANT DOS

A

P 0 BOX 233

P 0 BOX 724

MONTAGUE MICHIGAN

49437

DOROTHY 0 DART MD
4110 MAPLE LANE

A

MUSKEGON MI

49443

RALPH V AUGUST MD

RIVES JUNCTION MI

49277

ERWIN GRASMAN MD

72 E BROAOWAY

NORTON MEDICAL CTR

MUSKEGON HEIGHTS MI

49444

MUSKEGON MI

49441

CHAS J GRAYSON MO
910 W HILE RD

MUSKEGON MI 494A1

LAWRENCE E GRENNAN MD
1200 RANSOM

MUSKEGON MI A9440

ROBT M GRIFFITH MD

868 W BROAOWAY

MUSKEGON HGTS MI A9A41

HERNAN L GUIANG MD
1725 PECK ST

MUSKEGON MI 49A41

DONALD W HACK MD
MEDICAL ARTS CENTER
MUSKEGON MICHIGAN 49440

WM J HANLEY MD
315 W CLAY AVE
MUSKEGON MICHIGAN 49440

W RICHARD HARRI S MD
852 WINSLOW

MUSKEGON MI 49441

JAMES E HARRYMAN MD

1200 RANSOM ST

MUSKEGON MICH 49442

SHATTUCK W HARTWELL MD L

NORTHSHORE HOSP

NORTH MUSKEGON MI 49445

JOHN G KLEMM HARVEY MD R

MERCY HOSPITAL

MUSKEGON MI 49443

DALE W HEERES MD
657 SEMINOLE RD
MUSKEGON MI

JOHN HENEVELD MD
10902 PEORIA AVE
SUN CITY ARIZONA

49441

R

85351

ROBT G HENEVELD MD
1470 PECK ST

MUSKEGON MICHIGAN 49441

MARY E HENNESSY MD A

1200 RANSOM ST

MUSKEGON MI 49442

OSBIE J HERALD MD
208 WESTGATE MDCL TWR
MUSKEGON MI 49441

LELAND E HOLLY MD L

889 N SECOND ST

MUSKEGON MI 49440

LELAND E HOLLY 11 MD

889 N SECOND ST

MUSKEGON MICH 49440

WM J HORNBECK MD
3535 PARK ST

MUSKEGON MICH 49444

W LEONARD HOWARD MD
635 FRANKLIN ST
N MUSKEGON MI 49445

RICHARD A HUNTLEY MD
1704 W SHERMAN BLVD
MUSKEGON MICHIGAN 49441

ROBT M JESSON MD

1200 RANSOM ST

MUSKEGON MICH 49442

E H JOHNSTON MD
889 N SECOND ST
MUSKEGON MI

49440

ARTHUR H JOISTAD JR MD

889 N SECOND ST

MUSKEGON MICH 49440

STEPHEN P KAHN DOS A

1810 RUDDIMAN DR
NO MUSKEGON MI 49445

38 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

North Central

THOS J KANE MD
2086 LEIMERT BLVD
OAKLAND CA

M

94602

PAUL E MEDEMA MD
1661 CLINTON ST
MUSKEGON MICH

L

49442

H CLAY TELLMAN MD
315 W CLAY
MUSKEGON MI

49440

CECELIA S KAY MD
1533 PECK ST
MUSKEGON MICHIGAN

49441

MARVIN B MEENGS MD
10910 CAMEO DR
SUN CITY ARIZ

A

85351

R K TORREY MO
WESTGATE MEDICAL BLDG
MUSKEGON MI 49441

MARIE KEILIN MD L

1077 JEFFERSON APT 607
MUSKEGON MI 49440

LAMBERTUS MULDER MD
MEDICAL ARTS CENTER
MUSKEGON MICH

49440

CHAS M TOY MD
1067 PINE ST
MUSKEGON MICH

49442

JAY E KELLAWAY MD
1915 LOTUS SE
GRAND RAPIDS MI

49506

C L A ODEN MD
MEDICAL ARTS CENTER
MUSKEGON MI

L

49440

WM H TYLER MD
1435 PECK ST
MUSKEGON MICH

49441

CHARLES T KELSO MD
15575 OAK DRIVE .
SPRING LAKE MI

49456

RICHARD R OSLUND MD
889 N SECOND ST
MUSKEGON MI

49440

C A VANDERVELDE MD
1470 PECK ST
MUSKEGON MICHIGAN

49441

HOWARD J KERR MD
3054 HENRY ST
MUSKEGON MICHIGAN

49444

ROBERT C PACKER MD
4216 HARBOR POINT DR
MUSKEGON MI

49441

WM C VANGELDER MD
NORTON MEDICAL CTR
MUSKEGON MICH

49441

RICHARD KISLOV MD
1810 RUDDIMAN AVE
NORTH MUSKEGON MI

49445

FRANK W PARSONS MD
206 WESTGATE MED TWR
MUSKEGON MICHIGAN

49441

VIRGIL 10 VASQUEZ MO
932 FENWOOD CIRCLE
NO MUSKEGON MI

49445

INGRAM J KLEAVELAND
1670 PECK STREET
MUSKEGON MICHIGAN

MD

49441

LESTER C PATERSON MD
1643 PECK ST
MUSKEGON MICH

49441

TED VELLENGA
3789 WICKHAM DR
MUSKEGON MI

A

49441

MARLIN P KRENZ MD
HACKLEY UNION BK BLDG
MUSKEGON MI 49443

FRANK L PETTINGA MD
1470 PECK ST
MUSKEGON MICH

49441

GEO A VOIKOS MD
1470 PECK
MUSKEGON MICHIGAN

49441

EUGENE W LANGE MD R

680 WAUWATOSA RD RTE2
CEDAR8URG WI 53012

ROBT D RISK MD
1160 RANSOM ST
MUSKEGON MICH

49442

EDWARD H WAGENAAR MD
3054 HENRY ST
MUSKEGON MICHIGAN

49444

EMIL J LAURETTI MD
MEDICAL ARTS CENTER
MUSKEGON MICH

49440

HOWARD V SANDEN MD
1643 PECK ST
MUSKEGON MICH

49441

NORMAN L WELCH MD
MERCY HOSP
MUSKEGON MI

49443

L A LAURETTI MD
936 SECOND ST
MUSKEGON MICHIGAN

49440

NORBERT W SCHOLLE MD
204 WESTGATE MED TWR
MUSKEGON MICHIGAN

49441

WARREN G WHITE JR MD
307 WESTGATE MED TWR
MUSKEGON MICHIGAN

49441

VILDA S LAURIN MD
MEDICAL ARTS CENTER
MUSKEGON MI

L

49440

EMIL M SHEBESTA MD
MEDICAL ARTS CENTER
MUSKEGON MICH

49440

SILAS C WIERSMA MD
1115 SUMMIT AVE
ST ALBANS W V A

A

25177

GEO L LE FEVRE JR MD
726 LAKE DR
NORTH MUSKEGON MI

R

49445

FREDRIC E SIMPSON MD
1903 MARQUETTE AVE
MUSKEGON MI

49442

RICHARD T WILCOX MD
1700 CLINTON ST
MUSKEGON MI

49442

WM M LE FEVRE MD
1011 RUDDIMAN
NO MUSKEGON MI

L

49445

ROBERT E SMITH MD
MEDICAL ARTS CENTER
MUSKEGON MICHIGAN

49440

BERNARD C WILDGEN MD
MEDICAL ARTS CENTER
MUSKEGON MICHIGAN

49440

LLOYD J LEMMEN MD
1724 PECK ST
MUSKEGON MICHIGAN

49441

WILLIAM P STEFFEE MD
442 VALHALLA CT
ROCHESTER MINN

A

55901

CARL A WILKE MD
QRTS 2 WARREN AFB
CHEYENNE WY

R

82001

MR A T LEONARD
435 WHITEHALL RD
MUSKEGON MI

A

49445

THOMAS E STONE MD
2110 MARYLANO
MUSKEGON MI

49441

DALE L WILLIAMS MD
3535 PARK ST
MUSKEGON HEIGHTS Ml

49444

LEONEL L LODER MD
406 HACKLEY BANK BLDG
MUSKEGON MICH 49440

DOLORES B STOREY PH D A

207 LIBERTY LIFE BLDG
MUSKEGON MI 49440

EDWA-RD V WILLIAMS MD
2501 BAKER ST
MUSKEGON HEIGHTS MI

49444

ROBT A LOWRY MO
300 HOP I PLACE
BOWLDER CO

A

80302

DONALD P STRATTON MD
3535 PARK ST
MUSKEGON MI

49444

B DAVID WILSON MD
1724 TIMSON LANE
BLOOMFIELD HILLS MI

A

48013

LEWIS E MAIRE MD
1633 PECK ST
MUSKEGON MICH

49441

F JAMES STUBBART M D
2416 PECK ST
MUSKEGON HEIGHTS MI

49444

BURTON J WOLTERS MD
103 MEDICAL ARTS CTR
MUSKEGON MI

49440

DOUGLAS E MAPLES MO
2 SOUTH BUYS RD
MUSKEGON MI

49445

RONALD L STUK MD
MED ARTS CTR #103
MUSKEGON MI

49440

NEWAYGO

JACK WINTON MARRS MD
308 MEDICAL ARTS CTR
MUSKEGON MICHIGAN

49440

RAYMOND E SWANSON MD
1315 RUDDIMAN AVE
NORTH MUSKEGON MI

49445

MAYNARD DEKRYGER MD
220 W PINE ST
FREMONT MI

49412

E BRIAN MCHUGH MD
1810 RUDDIMAN
NO MUSKEGON MI

49445

ROBT D SWEDENBURG MD
1470 PECK STREET
MUSKEGON MICH

49441

JESS DE YOUNG MD
111 W DAYTON
FREMONT MI

49412

JOHN N MC NAIR MD
936 SECOND ST
MUSKEGON MICH

49440

LELAND L SWENSON MD
1706 PECK ST
MUSKEGON MICH

49441

ROBT W EMERICK MD
BOX 147
FREMONT MI

49412

LAMBERT J GEERLINGS MD L
194 N HILLCREST DR

FREMONT MI 49412

J PAUL KLEIN MD R

40 E PINE ST

FREMONT MI 49412

BROOKER L MASTERS MD
111 W DAYTON

FREMONT MI 49412

ROBT E PAXTON MD
220 M PINE

FREMONT MI 49412

NORMAN PEDELTY MD
38 STATE RD

NEWAYGO MI 49337

TUNIS VANDEN BERG MD
220 W PINE

FREMONT MI 49412

NORTH CENTRAL

THOMAS A BAKER MD A

8783 BRUCE COLLINS CT

STERLING HEIGHTS MI 48077

STANLEY M BECK JR MD
GAYLORD STATE HOME
GAYLORD MI 49735

VERNON B BLAHA MD
P 0 BOX 414

GRAYLING MICH 49738

JOHN D BOEHM MD R

STATE HOSPITAL

TRAVERSE CITY MI 49684

W E BONTRAGER MD
P 0 BOX 8

MIO MICHIGAN 48647

DONALD D BURKLEY MD
P 0 BOX 428

GRAYLING MI 49738

D E CHRISTENSEN MD
N MICH TB SAN

GAYLORD MICH 49735

C G CLIPPERT M D R

504 PLUM ST

GRAYLING MI 49738

KEITH D COULTER MD R

1150 TARPON CENTER DR
THE TOWER S-AP T #703

V7EN ICE FL 33595

CLARE H CRANDELL MD R

WEST BRANCH MI 48661

PAUL DOSCH MD
300 MCCLELLAN

GRAYLING MICH 49738

KONRAD A GARSTKA MD

401 W GREENLAWN

LANSING MI 48910

HERMAN J HE INEMANN MD
126 E MAIN

GAYLORD MI 49735

BEN J E HENIG M D

604 PENINSULAR

GRAYLING MI 49738

THOS W HOWARTH MD

GLADWIN MI 48624

HUGH M JARDINE M D

WEST BRANCH MI 48661

JANUARY, 1972/Michigan Medicine 39

48653

49735

49735

48636

48653

48624

48661

48624

L

49738

48624

49735

ID

48661

48661

;an

49770

49770

49770

49770

49770

49770

(

49782

49770

49770

49770

2/Mic

LISTED BY COMPONENT MEDICAL SOCIETIES

HARRY R CUSTER MO
723 PARK AVE

CHARLEVOIX Ml 49720

A 0 OAMSCHRODER MD
BURNS CLINIC MED CTR
PETOSKEY MI 49770

WILLIAM A DAWSON MD
BURNS CLINIC

PETOSKEY MICHIGAN 49770

GERALD DRAKE MD
511 WAUKAZOO

PETOSKEY MICH 49770

DEAN C ELLIOTT MD
BURNS CLINIC

PETOSKEY MICH 49770

JOHN A FOCHTMAN MD
BURNS CLINIC MED CTR
PETOSKEY MI 49770

BRADFORD S FOSTER MD
226 PARK AVE

PETOSKEY MI 49770

W L MCCULLOUGH MO

115 CLINTON ST

PETOSKEY MICHIGAN 49770

JOHN E MCENROE MD
1005 E MITCHELL ST
PETOSKEY MICHIGAN 49770

ROBT D MC KNIGHT MD
LINCOLN PLACE

PETOSKEY MICH 49770

ROBERT A MENGEBIER MD
BLANCHARD RD

PETOSKEY MI 49770

JOANNE E MERTZ MD
RESORT PIKE

PETOSKEY MICH 49770

DONALD C MOORE MD
BURNS CLINIC MtD CTR
PETOSKEY MI 49770

N THOMAS 0 KEEFE
516 BAY ST

PETOSKEY MI 49770

R D VANDEN BRINK MD
BURNS CLINIC

PETOSKEY MI 49770

WILLIAM L WATERS MD
618 E LAKE ST

PETOSKEY MI 49770

RICHARD WEBER MD
ROUTE 4 GRUBB RD
LIMA OHIO 45806

JEAN H WEBSTER MD
200 SUNSET ST

PETOSKEY MICH 49770

KATHRYN D WEBURG MD R

ROUTE 3

PETOSKEY MI 49770

IAN D WILSON MD
611 E LAKE

PETOSKEY MI 49770

BEVERLY A ZELT MD
BURNS CLINIC MEO CTR
PETOSKEY MI 49770

SANDERS A FRYE MD
8URNS CLINIC

PETOSKEY MICHIGAN 49770

JOHN W HALL MD
BURNS CLINIC MED CTR
PETOSKEY MI 49770

ALOYSIUS J HEGENER MO

1020 HOWARD ST

PETOSKEY MICH 49770

H M HILAL MD

BURNS CLINIC MED CTR

PETOSKEY MI 49770

PHILIP E HILL MD
BURNS CLINIC MED CTR
PETOSKEY MI 49770

RATES HOMSI MD
430 S MAIN ST

CHEBOYGAN MI 49721

JACK R POSTLE MD
ARLINGTON HEIGHTS
PETOSKEY MICH 49770

CARL T RAUCH MD
420 RIVERSIDE DR
CHEBOYGAN MICH 49721

LEONARD W REUS MD
226 PARK AVE

PETOSKEY MICH 49770

JOHN R RODGER MD

BELLAIRE MI 49615

G B SALTONSTALL MD L

112 CLINTON ST
CHARLEVOIX MI 49720

JOHN H SAVORY MD

EAST JORDAN MI 49727

OAKLAND

VERNON C ABBOTT MD L

1405 PONTIAC ST BK
PONTIAC MI 48058

MARTIN M ABBRECHT MD

800 S ADAMS RO

BIRMINGHAM MI 48011

H R ACKERMAN JR MD
909 WOODWARD AVE #104
PONTIAC MI 48053

ROBIN AOAIR MD
800 S ADAMS

BIRMINGHAM MICH 48011

FREDERICK M ADAMS MD
800 S ADAMS

BIRMINGHAM MI 48011

JAMES A KILEY MD
348 COUNTRY CLUB RO
PETOSKEY MI 49770

BEN J J KLEINSTIVER MD
517 E LAKE ST

PETOSKEY MI 49770

RICHARD A KNECHT MD
P 0 BOX 657

PETOSKEY MICHIGAN 49770

R A KUTCIPAL MD
211 SUNSET

PETOSKEY MI 49770

ROBT E SHANAHAN MD

1125 VALLEY VIEW

PETOSKEY MICHIGAN 49770

JOHN A SHEETS MD
BURNS CLINIC

PETOSKEY MI 49770

J E HENRI SIMARD MD
PENNSYLVANIA PLAZA
PETOSKEY MI 49770

ROLL IN F SNIDE MD
125 N MAIN ST

CHEBOYGAN MICHIGAN 49721

SEYMOUR S ADELSON MD
20905 GREENFIELD RO
SOUTHFIELD MI 48075

KRISHAN L AGGARWAL MD
PONTIAC STATE HOSPITAL
PONTIAC MI 48053

ASIRUDOIN AHMAD MD
5770 M-15

CLARKSTON MI 48016

DONALD G ALBERT MD

3535 W 13 MILE RD

ROYAL OAK MICHIGAN 48072

WALTER E LARSON MD
456 S HURON

CHEBOYGAN MICH 49721

RONALD D SNYDER MD
BURNS CLINIC MED CTR
PETOSKEY MI 49770

ROBT W ALBRECHT MD

2111 CASS LAKE RD

KEEGO HARBOR MI 48033

NICHOLAS LENTINI MO

CHEBOYGAN MI 49721

JOHN H LIGNELL MD
R 3 DIVISION ST
CHARLEVOIX MICHIGAN 49720

JOHN G L IPSKI MD

ROUTE 4 BOX 48

PETOSKEY MI 49770

ROBT G MARTIN MD
707 BRIDGE

CHARLEVOIX MICHIGAN 49720

VICTOR S MATESKON MD
SUNSET BLVD

PETOSKEY MICH 49770

FREDERICK C MAYNE M D L
P 0 BOX 387

CHEBOYGAN MI 49721

LOREN C SPADEMAN MO L

524 E BAY ST

HARBOR SPRINGS MI 49740

JOHN H TANTON MD
BURNS CLINIC

PETOSKEY MICHIGAN 49770

ROBT M TAYLOR MD
LINCOLN PLACE

PETOSKEY MICH 49770

VICTOR TSALOFF MD
BURNS CLINIC

PETOSKEY MI 49770

GUSTAV A UHLICH MD
E MITCHELL RD

PETOSKEY MICHIGAN 49770

JERRIAN VAN DELLEN MO
WATER ST

EAST JORDAN MICH 49727

YASAR M ALKAR MD
159 PIERCE ST NO 202

BIRMINGHAM MI 48011

ADNAN ALSHABKHOUN MD
33100 12 MILE RD
FARMINGTON MI 48024

F ANDRAKOVICH MD

5554 LAHSER RD

BIRMINGHAM MI 48010

JAIME V ARAGONES MD
134 W UNIVERSITY DR
ROCHESTER MI 48063

FEDERICO A ARCARI MD
606 N WOODWARD AVE
BIRMINGHAM MI 48011

JOSEPH A ARENA JR M 0
503 PIERCE

BIRMINGHAM MICHIGAN 48009

ian Medicine

DIRECTORY OF MSMS MEMBERS

Oakland County

ROY E ARONS MD

7133 LINDENMERE

BIRMINGHAM MI 48010

RAYMONO ASHARE MD
35 S JOHNSON

PONTIAC MICHIGAN 48053

SABAH H ATCHU MD

21240 VIRGINIA

SOUTHFIELD MI 48075

HAL G AULIE MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

MOHSEN AVAREGAN MO
6707 HEATHER HEATH LN
BIRMINGHAM MI 48010

MUSTAFA AVC I MO
1990 UNION LAKE
UNION LAKE MI 48085

LORRAINE E AWES MO

500 W HURON ST

PONTIAC MICH 48053

JOHN J BACK MD
21701 W 11 MILE RD
SOUTHFIELD MI 48076

KURT BAIER MD
3816 CRESTLAKE DR
BLOOMFIELD HILLS MI 48013

FREDERICK A BAKER MD L

1936 W ANKLAM RD

TUCSON AZ 85705

JOHN V BALIAN MD
134 W UN I V OR #201
ROCHESTER MI 48063

ROBT J BANNOW MD
880 WOODWARD AVE
PONTIAC MICH 48053

CHAS P BARKER MD
214 WABEEK BLDG
BIRMINGHAM MICH 48011

HOWARD B BARKER MD L

1006 STRATFORD LANE
BLOOMFIELD HILLS MI 48013

NASSER BARKHORD AR I MD
29510 FOXGROVE
FARMINGTON MI 48024

PETER P BARLOW MD
31815 SOUTHFIELD RD
BIRMINGHAM MICHIGAN 48009

BRADLEY T BARNES MD
P 0 BOX 349

ROCHESTER MI 48063

DONALD J BARNES MD L

2134 A VIA PUERTA

LAGUNA HILLS CALIF 92653

CHARLES G BARONE MD
751 CHESTNUT ST
BIRMINGHAM MI 48008

NORMAN L BARR MD
965 ORCHARD RIDGE RD
BLOOMFIELD HILLS MI 48013

JOHN L BARRETT M D
3535 W 13 MILE RD #608
ROYAL OAK MICHIGAN 48072

ROBERT A BARRON MD
4256 ORCHARD LAKE RD
ORCHARD LAKE MI 48033

BRUCE D BAUER MD

3229 WOODWARD AVE

BERKLEY MI 48072

EDWARD G BAUER MD
6756 DESMOND

WATERFORD MI 48095

E WILLIAM BAUER MO
3229 WOODWARD AVE
BERKLEY MI

48072

OSHIN BOHJALIAN MD
16001 W NINE MILE RD
SOUTHFIELD MI

48075

FRANZ BAUER MD
909 WOODWARD AVE
PONTIAC MICHIGAN

48053

THORNTON I BOILEAU MD
2075 E 14 MILE RD
BIRMINGHAM MICH

48008

BILLY B BAUMANN MD
2021 KLINGENSMITH #7
PONTIAC MI

48053

ALAN E BOLTON MD
25101 COOL l OGE
OAK PARK MI

48237

SHELBY M BAYLIS MD
35 S JOHNSON
PONTIAC MICHIGAN

48053

ROBT M BOOKMYER MD
31815 SOUTHFIELD RD
BIRMINGHAM MICH

48009

WM L BEAUREGARD MD
1665 W 12 MILE RD
BERKLEY MI

48072

PETER E BOSS MD
15901 W NINE MILE RD
SOUTHFIELD MI

48075

OTTO 0 BECK MO
701 BARCELONA AVE
VENICE FL

L

33595

ROMAN E BOUCHER MD
4200 N WOODWARD AVE
ROYAL OAK MICHIGAN

48072

PAUL M BECKER MD
1890 SOUTHFIELD RD
BIRMINGHAM MI

48009

NABIL R BOUTROS MD
1100 W UNIVERSITY DR
ROCHESTER MI

48063

WARREN F BELKNAP MD
1809 S MAIN ST
PLEASANT RIDGE MICH

48069

CHAS L BOWERS MD
909 WOODWARD AVE
PONTIAC MI

48053

DURAND BENJAMIN JR MD

35 S JOHNSON 3-D

PONTIAC MI 48053

NEAL C BRADY MD
3535 W 13 MILE RD
ROYAL OAK MICHIGAN

48072

MERRILL P BENOIT MD
PONTIAC MTR DIV GMC
PONTIAC MICHIGAN

48053

SANDER J BREINER MD
7410 FRANKLIN RD
BIRMINGHAM MI

48010

GARY D BERGMAN MD
26615 GREENFIELD
SOUTHFIELD MI

48076

BARRY S BRONSON MD
4541 PINE VILLAGE DR
ORCHARD LAKE MI

48033

BERNARD D BERMAN MD
1200 N TELEGRAPH RD
PONTIAC MICHIGAN

48053

WM W BRONSON MD
444 W UNIVERSITY DR
ROCHESTER MI

48063

CHARLES BERMAN MO
461 WEST HURON ST
PONTIAC MI

48053

ARNOLD L BROWN MO
35 S JOHNSON
PONTIAC MICH

48053

GILBERT M BERMAN MO
24601 COOL I DGE
OAK PARK MI

48237

DONALD BROWN MD
1100 W UNIVERSITY DR
ROCHESTER MI

48063

JAY BERNSTEIN MD
3601 W 13 MILE RD
ROYAL OAK Ml

48072

RICHARD T BROWNE MD
880 WOODWARD #105
PONTIAC MI

48053

JOHN T BEUKER MO
15901 W 9 MILE RD #206
SOUTHFIELD MI 48075

HENRY G BRYAN MD
22100 COOL l OGE
OAK PARK MICHIGAN

48237

HANS A BEYER MD
5675 KOLLY RD
BIRMINGHAM MICHIGAN

48010

JOHN B BRYAN MD
4045 W 13 MILE RD
ROYAL OAK MICHIGAN

48072

OSCAR BIGMAN MD
18597 W 10 MILE RD
SOUTHFIELD MI

48075

F W BRYANT MD
3535 W 13 MILE RD
ROYAL OAK MI

48072

JOHN R BIRMINGHAM MD
29632 POND RIDGE
FARMINGTON MI

48024

ALEXANDER S Z BUDD MD
P 0 BOX 275

BLOOMFIELD HILLS MI 48013

JAMES R BLAKENEY MD
449 E PIKE ST
PONTIAC MI

48058

ROBERT C BUEHRIG
5790 M 15
CLARKSTON MICH

48016

JANE BLUE MD
19125 HILLCREST
BIRMINGHAM MICH

48009

R W BULLARO JR MD
5790 M 15

CLARKSTON MICHIGAN

48016

MALCOLM D BOESKY MD
26789 WOODWARD AVE
HUNTINGTON WDS MICH

48070

WILLIAM G BUNTO MD
970 IRONWOOD APT 352
ROCHESTER MI

48063

CHESTER J BOGUCKI MO
MICH DEPT OF HL TH
155 N SAGINAW ST
CRIPPLED CHLDRN DIV
PONTIAC MI

48058

JOHN H BURGER MD
31815 SOUTHFIELD RD
BIRMINGHAM MICHIGAN

BRUNO BURGESS MD
29250 LONGVIEW ST
WARREN MICHIGAN

48009

48093

CHAUNCEY G BURKE MD L

35 W HURON ST
PONTIAC MI

JOSEPH F BURTKA MD
26505 JOHN R ST
MADISON HGTS MI

ROBT A BYBERG MO
3535 W 13 MILE RD
ROYAL OAK MI

G P CABRERA MD
3535 W 13 MILE RD
ROYAL OAK MI

ETHEL T CALHOUN MD
707 LAKEVIEW AVE
BIRMINGHAM MI

DAVIO R CALVER MD
PONTIAC GEN HOSPITAL
PONTIAC Ml 48053

MALCOLM D CAMPBELL MD R
435 RIDGEWOOD RD
KEY BISCAYNE FL

JUAN C CAR I ON I MD
25101 COOL I OGE
OAK PARK MI

JOS D CARLISLE MD
3535 W 13 MILE RD
ROYAL OAK MICHIGAN

BARBARA F CARLSON MD
33120 W 12 MILE RD
FARMINGTON MI 48024

G B CARPENTER JR MD

622 N WOODWARD

BIRMINGHAM MICHIGAN 48011

JOYCE M CARROW MD A

1469 HIGHMOOR WAY
BLOOMFIELD HILLS MI 48013

EDWARD F CASHMAN MD
15908 GLASTONBURY RD
DETROIT MI 48223

NICANOR F CASTEDO MD
4189 SUNNINGDALE DR
BLOOMFIELD HILLS MI 48013

RICARDO E CECCHINI MD
4415 PARK LANE CT
BLOOMFIELD HILLS MI 48008

ANTHONY F CEFAI MD
35 S JOHNSON

PONTIAC MICH 48053

C T CERKEZ MD
134 W UNIVERSITY
ROCHESTER MI 48063

DOUGLAS CHANDLER MD
1890 SOUTHFIELD RD
BIRMINGHAM MICH 48009

JOS H CHANDLER MD

309 NORTHLAND MED BLDG

SOUTHFIELD MICHIGAN 48075

JAMES T CHENG MD R

9 BUTTERWORTH OR
MORRISTOWN N J 07960

NICHOLAS CHERUP MD
PONTIAC GENERAL HOSP
PONTIAC MICHIGAN 48053

MERLE A CHILDERS MD
134 W UNIVERSITY DR
ROCHESTER MI 48063

NELOAGAE CHISA MD
26711 WOODWARD AVE
HUNTINGTON WDS MICH 48070

CYNTHIA CHOW MD
134 W UN I V DR #308
ROCHESTER MI 48063

33149

48237

48072

48058

48071

48072

48072

L

48009

A

JANUARY, 1972/Michigan Medicine 41

48053

48053

48020

48053

3

48053

48075

48075

48070

48075

48053

L

48230

48072

48072

48072

48053

48072

48072

A

48009

48076

48063

A

48053

48053

48053

48033

2/Micl

LISTED BY

ROBERT M CUTLER MD

909 WOODWARD AYE

PONTIAC MI 48053

WM M CUTLER MD
800 S ADAMS RD
BIRMINGHAM MICH 48011

N P CZAJKOWSKI MD
189 TOWNSEND

BIRMINGHAM MI 48009

CARL W DAHLGREN MD L

3023 ORCHARD LAKE

KEEGO HARBOR MICH 48033

JAMES 0 DARNLEY MD
26711 WOOOWARD AVE
HUNTINGTON WOODS MI 48070

DONALD N DAWSON MD
PONTIAC STATE HOSP
PONTIAC MI 48053

RICHARD C DAYTON MD
427 W UNIVERSITY OR
ROCHESTER MICHIGAN 48063

MURRAY N DEIGHTON MD
23023 ORCHARO LAKE RD
FARMINGTON MICHIGAN 48024

MALCOLM J DELANEY MD
23023 ORCHARD LAKE RO
FARMINGTON MICHIGAN 48024

HILBERT H DE LAWTER MD

3535 W 13 MILE RD

ROYAL OAK MICHIGAN 48072

JACOB B DELEVIE MD
35 W HURON ST #700
PONTIAC MI 48058

J WILLIAM DERR MD
3535 W 13 MILE RD #506
ROYAL OAK MI 48072

WM L DEUTSCH MD

600 W 11 MILE RD

ROYAL OAK MICH 48067

H LOUIS DE VITO MD

3115 ANGELUS DR

PONTIAC MICHIGAN 48055

DAVID H DINGER MD
2561 ELIZABETH LK RD
PONTIAC MI 48054

WILLIAM R DITO MD
PONTIAC GENERAL HOSP
PONTIAC MICHIGAN 48053

EDWIN J D08SKI MD

909 WOODWARD AVE

PONTIAC MICH 48053

GERALD G OURAK MD
7105 SHERWOOD DR
BIRMINGHAM MICHIGAN 48010

NORMAND E DUROCHER MO

35 S JOHNSON

PONTIAC MICH 48053

R08T W DUSTIN MD

122 E BROWN ST

BIRMINGHAM MI 48011

K ESWARA DUTT MD A

PONTIAC GENERAL HOSP
PONTIAC MI 48053

HOWARD J DWORKIN MD

3601 W 13 MILE RD

ROYAL OAK MI 48072

MILAGROS T EBREO MD
31772 ALLERTON DR
BIRMINGHAM MI 48009

EDWARD E ELDER JR MD
1116 VOORHEIS

PONTIAC MICH 48053

ROBT N ELLIOTT MD
3535 W 13 MILE RD
ROYAL OAK MI 48072

RICHARD F ELTON MD
15901 W 9 MILE RD #620
SOUTHFIELD MI 48075

CECIL W ELY JR MD
189 TOWNSEND #200
BIRMINGHAM MI 48011

Z F ENDRESS MD
35 S JOHNSON

PONTIAC MI 48053

JOHN B ENGEL MD R

15463 ASBURY PARK
DETROIT MI 48227

JACK F ENSROTH MO
1100 N WOOOWARD
BIRMINGHAM MICHIGAN 48011

NEVIT 0 ERGIN MD
860 LONE PINE RD
8L00MF I EL D HILLS MI 48013

JOHN 0 ESSLINGER M D
622 N WOODWARD AVE
BIRMINGHAM MICH 48011

VALENTINE ESSLINGER MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

A P ESTANISLAO MD

3329 WEST SHORE

ORCHARD LAKE MI 48033

LOUIS E DOERR JR MD

1413 S WASHINGTON

ROYAL OAK MI 48067

MASSOUD OOROSTKAR MD
45455 HARMONY LANE
BELLEVILLE MI 48111

JOHN M DORSEY JR MD
31815 SOUTHFIELD RO
BIRMINGHAM MICH 48009

DALE R DREW MD

909 WOODWARD AVE

PONTIAC MICHIGAN 48053

EDWARD J DROGOWSKI MD
134 W UNIVERSITY DR
ROCHESTER MICHIGAN 48063

GEO S EVSEEFF MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

LOUIS A FABIAN MD
2351 SOMERSET

TROY MI 48084

JAL1L FARAH MD
3525 BROOKSIDE
BLOOMFIELD HILLS MI 48013

ROBERT A FARGHER MD
660 SOUTH BOULEVARO E
PONTIAC MI 48053

PAUL FECKO MD
189 TOWNSEND #302
BIRMINGHAM MI 48009

PETER A DUHAMEL MD
134 W UN I V DR #103
ROCHESTER MICHIGAN 48063

MICHAEL J FEDERMAN MD
23551 SUTTON OR
SOUTHFIELO MI 48075

GREGG L DUNLAP MD
2870 ORCHARD LAKE RD
KEEGO HARBOR MICH 48033

JEROME E FELDSTEIN MD

502 N CROOKS RD

CLAWSON MI 48017

Medicine

DIRECTORY OF MSMS MEMBERS

Oakland County

MAX J GARBER M 0
23023 ORCHARD LAKE RD
FARMINGTON MICHIGAN 48024

DONALD M GARLAND MD
PONT MOTOR GLENW000 A V
PONTIAC MI 48053

JOANN M GATES MD

65 S TELEGRAPH RD

PONTIAC MI 48053

RICHARD C GAUSE MD
31815 SOUTHFIELD RD
BIRMINGHAM MICHIGAN 48009

NORMAN F GEHRINGER MD
2335 S COMMERCE RD
WALLED LAKE MI 48088

EDGAR J GEIST JR MD
1500 WALTON BLVD
ROCHESTER MICHIGAN 48063

JAMES W GELL MD

35 S JOHNSON AVE

PONTIAC MICH 48053

LAZARO GELSTEIN MD

909 WOODWARD AVE

PONTIAC MI 48053

EUGENE A GELZAYD MO
20905 GREENFIELD RD
SOUTHFIELD MI 48075

GEORGE R GERBER MD
310 W UNIVERSITY DR
ROCHESTER MI 48063

FRANK B GERLS MD L

4425 MOTORWAY DR

PONTIAC MI 48054

NORMAN J GERSABECK MD
29226 ORCHARD LAKE RD
FARMINGTON MI 48024

PIERRE F G I AMMANCO MD
880 WOODWARD AVE #110
PONTIAC MI 48053

WELLINGTON C GIBSON MD

216 COMMERCE ST

MILFORD MICH 48042

MATTHEW J GILL MD

1030 RIKER BLDG

PONTIAC MI 48058

HAROLD GLEN MD

26684 GRAND RIVER

DETROIT MICHIGAN 48240

DOROTHY M GOERNER MD A

338 PILGRIM

BIRMINGHAM MI 48009

DARRYL T GOLDBERG MO
26789 WOODWARD AVE 101

HUNTINGTON WOODS MI 48070

HOWARD S GOLDBERG MD
24777 GREENFIELD RD
SOUTHFIELD MI 48075

ROBERT GOLDBERGER MD
PONTIAC GENERAL HOSP
PONTIAC MI 48053

HERBERT GOLDSTEIN MD

22100 COOLIDGE HWY

OAK PARK MI 48237

ROGER L GONDA MD
15901 W 9 MILE RD #110
SOUTHFIELD MI 48075

WAYNE T GOOD MD

3306 AUBURN RD

AUBURN HEIGHTS MICH 48057

NORMAN J GOODE JR MD

2000 SECOND AVE

DETROIT MI 48226

CLAYTON H GORDON MD
1099 N CRANBROOK RD
BIRMINGHAM MICH 48009

SEYMOUR GORDON MO
3535 W 13 MILE RD
ROYAL OAK MI 48072

JOSEPH G GOUGH MD

900 WOODWARD AVE

PONTIAC MI 48053

PAUL L GRADOLPH MD
23338 WOODWARD AVE
FERNDALE MI 48220

P MIGUEL A GRANADOS MD
30838 BARRINGTON
WESTLAND MI 48185

J DONALD GREEN MD
6405 TELEGRAPH RD
BLDG D SUITE 2

BIRMINGHAM MI 48010

RALPH S GREEN MD
23300 GREENFLD RD #223
OAK PARK MI 48237

WILLARO M GREEN MD
35 S JOHNSON

PONTIAC MICH 48053

FRANK J GREENE MD
2655 GOLFVIEW DR #202
TROY Ml 48084

JOHN N GREKIN MD
15901 W 9 MILE RD #620
SOUTHFIELD MI 48075

THOS D GREKIN MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

M A GRISHKOFF MD
909 WOODWARD AVE #15
PONTIAC MI 48053

FREDERICK J GROSE MD
23077 GREENFIELD
SOUTHFIELD MI 48075

SOLOMON C GROSSMAN MD
26339 WOODWARD AVE
HUNTINGTON WOODS MI 48070

LOVELL I GUANCO MD
140 ELIZABETH LAKE RD

PONTIAC MI 48053

FERIDUN GUROL MD
32316 GRANO RIVER
FARMINGTON MI 48024

DAVIO C GUSTAFSON MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

EVERETTE GUSTAFSON MD
35 S JOHNSON

PONTIAC MICH 48053

ROSEMARIE B GUSTILO MD
PONTIAC STATE HOSP
PONTIAC MI 48053

MARIA A GUTIERREZ MD
P 0 BOX 587

BLOOMFIELD HILLS MI 48013

MEYER A GUTTERMAN MD

25085 COOLIDGE HWY

OAK PARK MI 48237

MERLE A HAANES MD

909 WOODWARD AVE

PONTIAC MICHIGAN 48053

GILBERT W HAGUE MD
739 WESTVIEW RD
BLOOMFIELD HILLS MI 48013

JOHN HALICKI MD
PONTIAC STATE HOSP
PONTIAC MI 48053

LEE H HALSTED MD
23023 ORCHARD LAKE RD
FARMINGTON MICHIGAN 48024

GEORGE J HAMBALGO MD
4045 WEST 13 MILE RD
ROYAL OAK MI 48072

JOEL I HAMBURGER MD
20905 GREENFIELD RD
SOUTHFIELD MICHIGAN 48075

OUENTIN P HAMILTON MD
20905 GREENFIELD
SOUTHFIELD MICHIGAN 48075

MAOLIN HAN MD

3725 AUBURN RD

AUBURN HEIGHTS MICH 48057

JOSEPH W HANCE MD
210 COVE CREEK LN

HOUSTON TEXAS 77042

M SHAMSUL HAQUE MD
6405 TELEGRAPH RD
BIRMINGHAM MI 48010

LEWIS G HARMON MD
1775 E 14 MILE RD
BIRMINGHAM MICH 48008

JOHN A HARROLD MD

534 FRANKLIN RD

PONTIAC MICHIGAN 48053

MARTIN HART MD

880 N WOODWARD AVE #19

PONTIAC MI 48053

CHARLES F HARTLEY MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

CAMPBELL HARVEY MD L

SAN MIGUEL DE ALLENDE

APTADO POSTAL 127
GUANAJUATO MEXICO

CARL M HASEGAWA MD

2953 PALMERSTON

TROY MI 48084

JOHN B HASSBERGER MD L

620 N WOODWARD AVE
BIRMINGHAM MICH 48011

WM S HATHAWAY MD R

425 WALNUT ST

ROCHESTER MI 48063

H S HAYDEN PH D A

300 WARREN COURT
BIRMINGHAM MI 48009

MANES S HECHT MD

26711 WOODWARD

HUNTINGTON WOODS MI 48070

JAMES E HENDERSON MD

909 WOODWARD AVE

PONTIAC MICHIGAN 48053

WORTH W HENDERSON MD

1307 S WASHINGTON

ROYAL OAK MICH 48067

OWEN S HENDREN MD L

2672 W CASAS DRIVE
TUCSON ARIZONA 85704

FRANK R HENDRICKS MD
21701 W 11 MILE RD
SOUTHFIELD MICHIGAN 48075

COLONEL R HENRY MD L

125 W NINE MILE RD
FERNDALE MI 48220

EDWARD L HERMAN MD
909 WOODWARD

PONTIAC MI 48053

CHARLES R HERMES MD
4680 DIXIE HIGHWAY
DRAYTON PLAINS MI 48020

DONALD J HEYBOER MD
ST JOSEPH MERCY HOSP
PONTIAC MI 48053

WILLIAM E HILL MD

534 FRANKLIN RD

PONTIAC MI 48053

SIDNEY J HILLENBERG MD
23077 GREENFIELD
SOUTHFIELD MI 48075

C JACK HIPPS MD
17100 W 12 MILE RD
SOUTHFIELD MI 48076

ABEN HOEKMAN MD R

BOX 66

COM INS MI 48619

LAWRENCE D HOFFMAN MD
27600 FARMINGTON
FARMINGTON MI 48024

LOUIS HOFFMAN MD
21701 W 11 MILE RD #9
SOUTHFIELD MI 48075

KEITH M HOLMES MD

880 WOODWARD AVE

PONTIAC MI 48053

MELVIN HOPKINS JR MD

900 BALDWIN AVE

PONTIAC MI 48055

WM J HOPKINS MO
17000 W EIGHT MILE RD
SOUTHFIELD MICHIGAN 48075

WILLARD E HOUSE MD
FORD MOTOR CO
P 0 BOX 238

UTICA MI 48087

MARJORIE E HOWARD MD
30500 GLENMUER RD
FARMINGTON MI 48024

LYNN E HOWELL MD
909 WOODWARD AVE
PONTIAC MICHIGAN 48053

MYROSLAW HRUSHKA MD
PONTIAC STATE HOSP
PONTIAC MI 48053

JOHN J HSU MD

35 WEST HURON ST

PONTIAC MI 48058

YUAN-CHAO HUANG MD
606 N WOODWARD AVE
BIRMINGHAM MI 48011

JOHN R HUBERT MD
880 WOODWARD AVE
PONTIAC MI 48053

JAMES V HUEBNER MD
287 WINRY

ROCHESTER MI 48063

ARAM A IGNATIUS MD
1915 E NINE MILE RD
FERNDALE MI 48220

H J INCHAUSTEGU I MD

4045 W 13 MILE RD

ROYAL OAK MI 48072

JOHN A INGOLD MD

3535 W 13 MILE RD #608

ROYAL OAK MI 48072

JANUARY, 1972/Michigan Medicine 43

Oakland County

LISTED BY COMPONENT MEDICAL SOCIETIES

HERBERT L ISAAC MD

F S KAPADIA MD

H A KLEWICKI MD

909 WOODWARD AVE 115

4299 ROSEBERRY

22720 WOODWARD

PONTIAC MI

48053

DRAYTON PLAINS MI

48020

FERNDALE MI

48220

JOHN W ISON MD

MICHAEL K APR I EL IAN MO

EDWIN M KNIGHTS JR MD

16019 MARGUERITE

189 TOWNSEND #210

16001 9 MILE RD

BIRMINGHAM MI

48009

BIRMINGHAM MI

48011

SOUTHFIELO MICHIGAN

48075

PHILIP J JACKSON MO

TURGUT A KARABEY MD

RICHARD S KNOX MD

6960 POST OAK DR

159 PIERCE ST

422 WASHINGTON SQ PL

BIRMINGHAM MI

48010

BIRMINGHAM MI

48011

ROYAL OAK MI

48067

RODMAN C JACOBI MD

RAYMOND J KARAKUC MD

WM H KOEHLER MO

91 S WASHINGTON

35 S JOHNSON ST

3535 W 13 MILE RO

OXFORD MICH

48051

PONTIAC MI

48053

ROYAL OAK MICHIGAN

48072

HERBERT S JACOBSON MD

N NACI KARCA MD

KARL F KOERNER MD

20905 GREENFIELD #400

5045 CHARING CROSS

1820 CROOKS RD

SOUTHFIELD MI

48075

BLOOMFIELD HILLS MI

48013

TROY MI

48084

NANETTE JAGNOW MO

G REZA KARIMIPUUR MD

LAWRENCE KOLTONOW MD

525 SOUTHFIELD RD

909 WOOOWARD AVE #21

304 NORTHLAND MED BLDG

BIRMINGHAM MICHIGAN

48009

PONTIAC MI

48053

SOUTHFIELD MICHIGAN

*8075

ROBT E JAMES JR MD

SIONEY F KATZ MD

LARRY L KOMPUS MD

2561 ELIZABETH LK RD

1379 STUYVESSANT RD

500 W HURON ST

PONTIAC MI

48054

BIRMINGHAM MI

48010

PONTIAC MI

*8053

THOMAS P JAMES MD

JACK M KAUFMAN MD

JAMES G KORNMESSER MD

2411 PINEVIEW

26711 WOODWARD AVE

27600 FARMINGTON RD

PONTIAC MI

48053

HUNTINGTON WOODS MI

48070

FARMINGTON MICHIGAN

48024

HENRY L JENKINS MD

SHERMAN A KAY MD

UJAMLAL C KOTHARI MD

161 STATE ST

26657 WOODWARD AVE

PONTIAC STATE HOSP

PONTIAC MICHIGAN

48053

HUNTINGTON WOODS MI

48070

PONTIAC MI

48053

JEFFERY M JENNINGS MD

LOUIS L KAZDAN MD

CLIFFORO S KOZLOW MD

202 WALNUT BLVD

13801 W NINE MILE RD

1201 BROOKWOOD

ROCHESTER MI

48063

OAK PARK MI

48237

BIRMINGHAM MI

48009

JOHN A JENNINGS MD

EUGENE J KEEFFE MD

L ANGE KOZLOW MD

3535 W 13 MILE RD

880 WOODWARD AVE

3535 W THIRTEEN MI RO

ROYAL OAK MI

48072

PONTIAC MI

48053

ROYAL OAK MI

48072

CLARE G JOHNSON MD

MAXIMILIAN KELIN MD

MICHAEL C KOZONIS MD

2260 PRIVATE DR

3713 ELIZABETH LK RD

880 WOODWARD AVE

PONTIAC MI

48055

PONTIAC MI

48054

PONTIAC MICHIGAN

48053

GARFIELD JOHNSON JR

MD

ANTHONY S KELLER MD

ELMER J KOZORA MD

35 S JOHNSON

1705 BEDFORD SO #102

17650 W 12 MILE RD

PONTIAC MI

48053

ROCHESTER MI

48063

SOUTHFIELD MICHIGAN

48075

J FREDERIC JOHNSON MD

FELIX J KEMP MD

MARK KRANE MD

23760 N WOODWARD

880 WOODWARD AVE

2335 S COMMERCE RD

PLEASANT RIDGE MICH

48069

PONTIAC MICH

48053

WALLED LAKE. MI

48088

JAMES W JOHNSON MD

H F KENDRICK JR MD

ALFRED M KREINDLER MD

2581 MCCLINTOCK RD

35 S JOHNSON

200 ELM ST

PONTIAC MI

48053

PONTIAC MICHIGAN

48053

BIRMINGHAM MI

48008

ROBERT H JOHNSON MD

EDWIN C KERR MD

BRUCE A KRESGE MD

310 W UNIVERSITY DR

32749 FRANKLIN RD

1500 WALTON 8LVD

ROCHESTER MI

48063

FRANKLIN MICHIGAN

48025

ROCHESTER MICHIGAN

48063

CYRIL 0 JONES MD

HANS J KETTLER MD

NORMAN N KRIEGER MD

800 IRONWOOD DR #321

25160 EDGEMONT RD

402 UNION ST

ROCHESTER MI

48063

SOUTHFIELD MICHIGAN

48075

MILFORD MICHIGAN

48042

ANTOINE L JOSEPH MD

SATISH C KHANEJA MD

DON R KROHN MD

4045 W 13 MILE RO

140 ELIZABETH LAKE RD

27600 FARMINGTON RO

ROYAL OAK MI

48072

PONTIAC MI

48053

FARMINGTON MI

48024

JOHN A JOYCE MD

BAHRAM KHOOADADEH MD

HENRY KRYSTAL MD

134 W UNIVERSITY

4400 ORCHARD LAKE RD

20905 GREENFIELD RD

ROCHESTER MICHIGAN

48063

ORCHARD LAKE MI

48033

SOUTHFIELD MI

48075

SAMBA JUNG MD

THEODORE W KILAR MD

EL I H KUHEL MD

5571 PRKVIEW DR Cl#304

503 PIERCE ST

25415 SOUTHFIELD RD

CLARKSTON MI

48016

BIRMINGHAM MI

48009

SOUTHFIELD MICHIGAN

48075

E PATRICK JURAS MD

GEORGE KINSLEY MO

ANNE K KUHN MD

2036 STONE HOLLOW CT

909 WOODWARD AVE

4203 W 13 MILE RD

BLOOMFIELD HILLS MI

48013

PONTIAC MICHIGAN

48053

ROYAL OAK MICH

48072

DONALD B JURY MD

R

ARTHUR KLASS MD

ROBT E KUHN MD

7765 ESTEREL DRIVE

26657 WOODWARD AVE

4203 W 13 MILE RD

LAJOLLA CA

92037

HUNTINGTON WOODS MI

48070

ROYAL OAK MICH

48072

GEORGE K AD I AN MD

JEROME H KLEGMAN MD

G KRISHNA KUMAR MD

18211 W 12 MILE RD

17000 W EIGHT MILE RO

16216 W 13 MILE RD

LATHRUP VILLAGE MI

48076

SOUTHFIELD MICHIGAN

48075

BIRMINGHAM MI

48009

ROBERT L KAMM MD

MARVIN E KLEIN MD

CARL E KUNTZMAN MD

240 DAINES ST

18400 W 12 MILE RD

134 W UNIVERSITY DR

BIRMINGHAM MI

48009

SOUTHFIELD MI

48075

ROCHESTER MI

48063

RUBEN KURNETZ MD
511 PIERCE ST
BIRMINGHAM MI

48009

MYRON M LABAN MO
WM BEAUMONT MED BLDG
ROYAL OAK MI 48072

JAMES E LADD MU
503 PIERCE ST
BIRMINGHAM MICHIGAN

48009

SOOSUP LAH MD A

ST JOSEPH MERCY HOSP
PONTIAC MI 48053

PAUL T LAHTI MD
3600 W 13 MILE RD
ROYAL OAK MICH

48072

ALVIN G LAMBERT MD
3535 W 13 MILE 505
ROYAL OAK MI 48072

FRANCIS W LANARD MD
31504 SUNSET DR
BIRMINGHAM MI

48009

LAWRENCE A LAPORTE MD
356 N CLIFTON RD
BIRMINGHAM MI 48010

ALVIN R LARSON MD

880 WOODWARD AVE

PONTIAC MICH 48053

PHILIP J LAUX JR MD

3027 N WOOOWARD

ROYAL OAK MICH 48072

JAMES M LAWSON MO
17100 W 12 MILE RD
SOUTHFIELD MI 48075

ANTONIO A LAXA MD

3329 WEST SHORE

ORCHARD LAKE MI 48033

CHAS A LEACH MD
525 SOUTHFIELD RD
BIRMINGHAM MI 48009

ETTA LINK LEAHY MD R

1616 WILTSHIRE

BERKLEY MI 48072

HAHN J LEE MD

24601 COOL I DGE

OAK PARK MI 48237

LEONARD H LERNER MD
26615 GREENFIELD
SOUTHFIELD MI 48076

NASI D LESSANI MD
27600 FARMINGTON RD
FARMINGTON MI 48024

BRUCE T LESSIEN MD
4045 W THIRTEEN MILE
ROYAL OAK MICHIGAN 48072

MURRAY B LEVIN MD
7046 CATHERDRAL OR
BIRMINGHAM MICHIGAN 48010

ALLAN J LEVINE MD
WM BEAUMONT HOSP
3601 W 13 MILE RD

ROYAL OAK MI 48072

BERNARD LEVINE MD
25835 PARKWOOD DR
HUNTINGTON WOODS MI 48070

MARVIN B LEVY MD
23200 WOODWARD AVE
FERNDALE MI 48220

SOL M LEWIS MD L

541 W UAKRIDGE

FERNDALE MI 48220

44 JANUARY, 1972/Michigan Medicine

48053

i '

48072

48072

48010

48024

48053

48009

48075

48072

48053

R

48095

A

48053

48010

48013

48033

48010

48053

48072

48008

48053

48013

48072

48033

Oakland County

CHARLES A MAIN JR MD
2143 BRENTHAVEN DR
BLOOMFIELD HILLS MI 48013

WM F MALARNEY MD

880 WOODWARD AVE #106

PONTIAC MI 48053

HOWARD N MANZ MD
23023 ORCHARD LAKE RD
FARMINGTON MICHIGAN 48024

OLIVER J MARCOTTE MD R

25000 W TEN MILE RD
SOUTHFIELD MI 48075

R RALPH MARGULIS MD
503 PIERCE ST

BIRMINGHAM MICHIGAN 48009

JOHN M MARKLEY MD

4120 SANDYLANE

BIRMINGHAM MI 48010

SIMON W MAROKO MD
2416 AVONDALE

PONTIAC MI 48053

JOHN J MARRA MD

909 WOODWARD AVE

PONTIAC MICH 48053

GORDON L MARSA MD A

HENRY FORD HOSP

OETROIT MI 48202

PERCY S MARSA MO

785 N LAPEER RD

LAKE ORION MICHIGAN 48035

JOSEPH F MARSHALL MD

2056 FOX GLEN CT

BLOOMF I ELO HILLS MI 48013

DONALD W MARTIN MD
PONTIAC STATE HOSP
PONTIAC MI 48053

FRANCIS A MARTIN MD
880 WOOOWARD

PONTIAC MICH 48053

ROBT J MASON MD L

618 N WOODWARD AVE
BIRMINGHAM MICH 48011

ROBERT T MAST MD
189 TOWNSEND

BIRMINGHAM MI 48011

G R MATHURA MD
212 RIKER BLDG
PONTIAC MICHIGAN 48058

W E BARRY MAYO MD

2338 N WOODWARD AVE

ROYAL OAK MICHIGAN 48073

RAYMUND L MAYOR MD
35 S JOHNSON

PONTIAC MICHIGAN 48053

FRENCH H MC CAIN MD
628 N WOODWARD AVE
BIRMINGHAM MICH 48011

TALMAGE D MCCALLON MD

1307 S WASHINGTON

ROYAL OAK MI 48067

D H MC CANDLISS MD
35 S JOHNSON

PONTIAC MICH 48053

SUE A MCCUTCHEON MD
1100 W UNIVERSITY DR
ROCHESTER MI 48063

ROBERT J MCDONALD MD
4200 N WOODWARD AVE
ROYAL OAK MICHIGAN 48072

WM J MC ELROY JR MD
3415 W 14 MILE RD #11
ROYAL OAK MI 48073

FRANCIS J MC EVOY MD L

1715 CROOKS RD

ROYAL OAK MICH 48067

RODNEY MCFARLAND MD
880 WOODWARD AVE #104
PONTIAC MI 48053

DANIEL E MCGUNEGLE MD A
PONTIAC GEN HOSPITAL
PONTIAC MI 48053

JAMES M MC HUGH MD
20905 GREENFIELD RD
SOUTHFIELD MICHIGAN 48075

THOS S MC INERNEY MD
2026 LAUROME

ROYAL OAK MICHIGAN 48073

JACK B MC INTYRE MD
625 PURDY

BIRMINGHAM MICHIGAN 48009

ROY J MCKINNEY MD
3535 W 13 MILE RD #306
ROYAL OAK MI 48072

J H MC LAUGHLIN MD
604 NORTH WOOOWARD
BIRMINGHAM MICHIGAN 48011

HOWARD H MC NEILL MD L

225 W HICKORY GROVE RD
BLOOMFIELD HILLS MI 48013

EDWARD C MC PHEE MD
909 WOODWARD

PONTIAC MICH 48053

MARK C MCQUIGGAN MD
29653 CLUB HOUSE LANE
FARMINGTON MI 48024

PETER P MEDRANO MD

32310 SCHOOLCRAFT

LIVONIA MI 48154

MIHAEL A MEGLER MD
4548 BRIGHTMORE
BLOOMFIELD HILLS MI 48013

CONSTANTINE P MEHAS MD

1060 TRAILWOOD PATH
BIRMINGHAM MICHIGAN 48010

DONALD A MEIER MD
20905 GREENFIELD RD
SOUTHFIELO MI 48075

RICHARD K MEILS MD
310 W UNIVERSITY DR
ROCHESTER MI 48063

HARRY E MEISNER MD
24777 GREENFIELD RD
SOUTHFIELD MI 48075

A N MENDELSSOHN MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

HENRY P MENDOZA MD A

PONTIAC GENERAL HOSP
PONTIAC MI 48053

MICHAEL S MENGE MD
134 W UNIVERSITY DR
ROCHESTER MI 48063

FRANK A MERCER MD L

3333 NE 34TH ST APT615
FORT LAUDERDALE FL 33308

RICHARD B MERKLE MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

MR M S MERRY AOMIN A

ARDMORE HOSPITAL
814 W NINE MILE RD

FERNDALE MI 48220

ALVIN B MICHAELS MD
18777 W 10 MILE RD
SOUTHFIELD MI 48075

DOROTHY M MIKAT MD
PONTIAC GENERAL HOSP
PONTIAC MI 48053

ANIS A MILAD MD

3535 W 13 MILE RD #602

ROYAL OAK MI 48072

ARTHUR C MILLER MD
31723 WALTHAM CT
BIRMINGHAM MI 48009

HAZEN L MILLER MD L

STAR ROUTE BOX 247A
GRAYLING MI 49738

HUBERT MILLER MD
16210 W 9 MILE RD #109
SOUTHFIELD MICHIGAN 48075

IRVING M MILLER MD
23023 ORCHARO LAKE RD
FARMINGTON MICH 48024

SIDNEY MILLER MD
709 TOTTENHAM RD
BIRMINGHAM MI 48008

JAMES T MIMURA MD
31815 SOUTHFIELD
BIRMINGHAM MICH 48009

CANDIDA C MISRA MO
2933 E BRADFORD
BIRMINGHAM MI 48010

MOUFID MITRI MD
134 W UN I V DR #103
ROCHESTER MI 48063

R MOHAJER-SHOJAEE MD

2959 CROOKS RD

TROY MI 48084

ARTURO L MOJARES MD
31112 PICKWICK LN
BIRMINGHAM MI 48009

E D MOJICA MD

140 ELIZABETH LK RD

PONTIAC MI 48053

PABLO A MOJICA MD
140 ELIZABETH LK RD
PONTIAC MI 48053

JAMES C MOLONEY MD N

13125 SHAKER SQ
CLEVELAND OHIO 44120

AHMOD S MOOLA MD
30744 LINCOLNSHIRE E
BIRMINGHAM MI 48010

JOHN S MORAN MD
20101 JMS COUZENS HWY
DETRUIT MI 48235

LEONARD A MORIN MD
29929 VERNON DR
SOUTHFIELD MICHIGAN 48076

FRANK L MORTON MD
27725 GREENFIELD RD
SOUTHFIELD MI 48075

ELMER J MUELLER MD
31315 SOUTHFIELD RD
BIRMINGHAM MICHIGAN 48009

CLINTON J MUMBY MD
26789 WOODWARD AVE
HUNTINGTON WDS MICH 48070

LUIS H MUNOZ MD
4400 ORCHARD LK RD
ORCHARD LAKE MI 48033

BARBARA J MUNSON MD

207 KENILWORTH ST

ROYAL OAK MI 48067

JANUARY, 1972/Michigan Medicine 45

Oakland County

LISTED BY COMPONENT MEDICAL SOCIETIES

HARRY L MUNSON MD
2335 S COMMERCE RD
WALLED LAKE MI

48088

BAHA ONDER MO

23023 ORCHARD LAKE RD

FARMINGTON MI 48024

JOHN R PFEIFER MD
15990 W NINE MILE RD
SOUTHFIELD MI

48075

JAMES R MURPHY MD
433 FOX HILLS DR APT1
BLOOMFIELD HILLS MI 48013

JAMES A 0 NEILL MD
5790 M 15

CLARKSTON MICHIGAN

48016

A D PITONYAK MD
ST JOSEPH MERCY HOSP
PONTIAC MICHIGAN

48053

KENNETH W MURRAY MD
31815 SOUTHFIELD RD
BIRMINGHAM MI

48009

DONNA L OPIE MD
959 JAMES K
PONTIAC MI

48053

KENNETH E PITTS MD
6235 MIDDLEBELT
BIRMINGHAM MI

48010

GORDON S MUSICK MD
31327 W RUTLAND
BIRMINGHAM MI

48009

JOHN K ORMOND MD
909 WOODWARD AVE
PONTIAC MI

L

48053

MERLE 0 PLAGGE MD
4680 DIXIE HIGHWAY
DRAYTON PLAINS MI

48020

EUGENE J NALEPA MD
880 WOODWARD AVE
PONTIAC MICH

48053

GIRARDIN S 0 SULLIVAN
26520 WILLOWGREEN WAY
FRANKLIN MICHIGAN 48025

ROBERT POOL MD
800 S ADAMS RD
BIRMINGHAM MICH

48011

MILTON L NATHANSON MD
17000 W 8 MILE RD
SOUTHFIELD MI 48075

HAROLD A OTT MU
3019 N WOODWARD AVE
ROYAL OAK MI

48072

KENNETH F PORTER MD
900 WOODWARD AVE
PONTIAC MI

48053

JOHN F NAZ MD
2826 ORANGE GROVE
WATERFORD MI

48095

DONALD C OVERY
880 WOODWARD AVE
PONTIAC MICHIGAN

48053

HAROLD D PORTNOY MD
445 W HURON ST
PONTIAC MICHIGAN

48053

PAUL L NE I SWANDER MD
30001 VAN DYKE
WARREN MI

48093

VIRGINIA T PACI S MO
PONTIAC STATE HOSP
PONTIAC MI

48053

WALTER A POZNANSKI MO
1100 N WOODWARD AVE
BIRMINGHAM MICH 48011

ROGER B NELSON MD
PONTIAC GEN HOSP
PONTIAC MI

48053

DAVID C PACKARD MD
5770 HIGHLAND RD
PONTIAC MICHIGAN

48054

BRUCE PROCTOR MD
3431 BALDWIN RO RR4
PONTIAC MICHIGAN

48055

JACK H NESSEL MD
880 WOODWARD
PONTIAC MICHIGAN

48053

HAYDEN D PALMER MD
35 W HURON ST
PONTIAC MI

L

48058

CONRAD A PROCTOR MD
3535 W 13 MILE RD
ROYAL OAK MI

48072

ROBERT J NETZEL MD
2700 COLONIAL WAY
BLOOMFIELD HILLS MI

48013

JALAL PANAH MD
2696 RED FOX TRAIL
TROY MI

48084

FRANK W PRUST MD

3535 W 13 MILE RD #602

ROYAL OAK MI 48072

BURNS G NEWBY MD
20905 GREENFIELD
SOUTHFIELD MICHIGAN

48075

S WILLIAM PARIS MD
27970 ORCHARD LAKE RO
FARMINGTON MICHIGAN 48024

ALBERT E OUARTON JR
542 PILGRIM RD
BIRMINGHAM MICH

MD

48009

ARNOLD B NEWCOMB MD
19834 RIVERSIDE DR
BIRMINGHAM MICH

48009

0 A PATEL MD
WM BEAUMONT HOSP
ROYAL OAK MI

A

48072

J PATRICK QUIGLEY MD
31815 SOUTHFLD RD #14
BIRMINGHAM MI 48009

VICENTE T NG TSAI MD
PONTIAC GENERAL HOSP
PONTIAC MI

A

48053

L RAJ S PATIL MD
23030 MOONEY
FARMINGTON MI

48024

JAMES R QUINN JR MD
2070 W VALLEY RD
BLOOMFIELD HILLS MI

48013

SAMUEL J N I CHAM IN M
20905 GREENFIELD RD
SOUTHFIELD MICHIGAN

D

48075

CHAS I PATRICK MD
4721 DIXIE HWY
DRAYTON PLAINS MICH

48020

IRAJ RAFANI MD
4045 W 13 MILE RD
ROYAL OAK MI

48072

IVEY D NICKERSON MO
6245 GOLFVIEW DR
BIRMINGHAM MICH

48010

J C PATTERSON MD
3535 W 13 MILE RD
ROYAL UAK MI

48072

ABNER I RAGINS MD
909 WOODWARD AVE
PONTIAC MICHIGAN

48053

D C NIEDERLUECKE MD
35 S JOHNSON
PONTIAC MICHIGAN

48053

CHAS F PAYTON MD
626 N CROOKS RD
CLAWSON MI

48017

IGNACIO 0 RAMIREZ MO
3321 ROCHESTER
ROYAL OAK MI

48073

EDWARD A NOL MD
240 DA I NE S ST
BIRMINGHAM MI

48009

ERWIN G PEAR MD
3027 N WOODWARD AVE
ROYAL OAK MICH

48072

JOAQUIN J RAMIREZ MD
751 CHESTNUT
BIRMINGHAM MICHIGAN

48008

JOS I NOSANCHUK MD
35 S JOHNSON
PONTIAC MICHIGAN

48053

JAMES F PEARCE MD
3535 W 13 MILE RD
ROYAL OAK MICHIGAN

48072

RENATO G RAMOS MD
3535 W 13 MILE RD #205
ROYAL OAK MI 48072

ANTONIO S NUCUM MD
5725 TIPPERARY TRAIL
WATERFORO MI

48095

WM H PEIRCE MD
800 S ADAMS RD
BIRMINGHAM MICHIGAN

48011

KENNETH I RANNEY MD
122 E BROWN ST
BIRMINGHAM MI

48011

JAMES W NUNN MD

FAA MED OFFICER BX518

WAKE ISLANO

CHAS J PELLETIER MD
1111 N CAMPBELL
ROYAL OAK MICHIGAN

48067

SANFORD J RAUTBORT MD
5111 LAKE BLUFF RD
WALLED LAKE MI 48088

CHARLES H 0 OONNELL
23338 WOODWARD AVE
FERNDALE MI

MD

48220

J S PENSAVECCHIA MO
2680 GARLAND
PONTIAC MICHIGAN

48053

MARY A RAVIN MD

31237 SLEEPY HOLLOW LN

BIRMINGHAM MI 48010

YOSHIO OKUMURA MD
900 WOODWARD AVE
PONTIAC MI

48053

PANAYOTIS PESAROS MO
648 N WOODWARD AVE
BIRMINGHAM MI

48011

JAMES A READ MD
610 N WOODWARD
BIRMINGHAM MICHIGAN

48011

WM W OLIPHANT MO
785 N LAPEER RD
LAKE ORION MICHIGAN

48035

EDWARD PETROVICH MD
960 WESTVIEW RD
BLOOMFIELD HILLS MI

48013

WM R RECH MD
2335 S COMMERCE RD
WALLED LAKE MI

48088

ROBERT E REID MD

3535 W 13 MILE RO

ROYAL OAK MI 48072

RICHARD C REILLY MO

909 WOODWARD AVE

PONTIAC MI 48053

N C RENDZ I PER I S MD
1100 W UN I VERS I TY OR
ROCHESTER MI 48063

ROBERT E RICHARD MD

626 N CROOKS RO

CLAWSON MI 48017

WILSON P RICHARDS MD
3500 W MAPLE RD
BIRMINGHAM MICHIGAN 48010

ROBT P RICHARDSON MD
26711 WOODWARD
HUNTINGTON WOODS MI 48070

HARRY L RIGGS MD
149 FRANKLIN BLVD

PONTIAC MICH 48053

AARON D RIKER MO L

640 RIKER BLDG

PONTIAC MI 48058

WILLIAM R RISK MD
909 WOODWARD AVE #14
PONTIAC MI 48053

GEORGE RITTER MD
28245 SOUTHFIELD
LATHRUP VILLAGE MI 48075

EMIL I ANO RIVERA JR MD

3495 ROCHESTER RD

TROY MI 48084

BRUCE H ROBINSON MD
15990 W NINE MILE RD
SOUTHFIELD MI 48075

HAROLD RODNER MD
27078 ARDEN PARK CIR
FARMINGTON MI 48024

HAROLD R RUEHM MD L

970 LONE PINE RD
BLOOMFIELD HILLS MI 48013

JOHN H ROMANIK MD
31601 W 13 MILE RD
FARMINGTON MICH 48024

LINO A ROMERO MD
1880 S WOODWARD AVE
BIRMINGHAM Ml 48011

ROBERT ROONEY MD
667 KINGSLEY

BLOOMFIELD HILLS MI 48013

GLENN A ROSIN MD
149 S CRNBK CROSS RD

BIRMINGHAM MI 48010

HERBERT W ROSSIN MD
18211 W 12 MILE RD
LATHRUP VILLAGE MI 48076

THEODORE L ROUMELL MD
1100 W UNIVERSITY DR
ROCHESTER MI 48063

LAURIE G ROWLEY MD L

10401 NO CAVE CREEK RD
PHOENIX ARIZONA 85020

DONALD E RUESINK MD
127 FERNDALE

ROCHESTER MICHIGAN 48063

EDSON C RUPP MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

DONALD F RUPPRtCHT MD
310 w UNIVERSITY DR
ROCHESTER MI 48063

46 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Oakland County

ALVA D RUSH MD
391 HAMILTON
BIRMINGHAM MICH

48011

OANL R SCHOLES MD
3535 W 13 MILE RD
ROYAL OAK MI

48072

JOEL J S I L BERG MD
16800 GREENFIELD RD
DETROIT MI

48235

DAVID S RUSKIN MO
20905 GREENFIELD RD
SOUTHFIELD MICHIGAN

48075

LEONARD SCHREIER MD
909 S WOODWARD AVE
PONTIAC MI

48053

WILLIAM G SILLS MD
1223 S WASHINGTON
ROYAL OAK MI

48067

VINCENT P RUSSELL MD
3535 W 13 MILE RD
ROYAL OAK MI

48072

HOWARD A SCHUNEMAN MD
23760 WOODWARD AVE
PLEASANT RIDGE MICH

48069

JOHN SILVANI MD
909 WOODWARD AVE
PONTIAC MICHIGAN

48053

EDW J RUTKOWSKI MD

A

DAVID SCHWARTZ MD

A

MARVIN D SILVER MD

3235 BELLE COURT
ROYAL OAK MI

48072

17363 SHERVILLA PL
SOUTHFIELD MI

48075

3535 W 13 MILE RD
ROYAL OAK MI

48072

JULIUS RUTZKY M D
3601 W 13 MILE RD
ROYAL OAK MI

48072

OSCAR D SCHWARTZ MD
15901 W 9 MILE RD #620
SOUTHFIELD MI 48075

EDWARD K SIMPSON MD
2 SUNSET AVENUE
CHATHAM ONT CANADA

L

JOS J RUVA MD
4463 DIXIE HWY
DRAYTON PLAINS MICH

48020

S A SCHWARTZ MD
4680 DIXIE HWY
DRAYTON PLAINS MI

48020

JOHN R SIMPSON MD
200 ELM ST
BIRMINGHAM MI

48008

MERLE F RYDESKY MD
16001 W 9 MILE RD
SOUTHFIELD MI

48075

S SCHWE INSBERG MD
4117 SUNNINGDALE DR
BLOOMFIELD HILLS MI

48013

ROBERT B SKLAR MO
3535 W 13 MILE RD #304
ROYAL OAK MI 48072

ENRIQUE SABBAGH MD

ARTHUR J SEABORN MD

R

RICHARO A SMALL MD

A

17100 W 12 MILE RD
SOUTHFIELD MI

48076

885 N WOODWARD AVE
BIRMINGHAM MI

48009

WM BEAUMONT HOSP
ROYAL OAK MI

48072

NISON SABIN MO
23077 GREENFIELD RD
SOUTHFIELD MI

48075

ROBT L SEGULA MD
35 S JOHNSON
PONTIAC MICHIGAN

48053

CARLETON A SMITH MD
880 WOODWARD AVE
PONTIAC MICHIGAN

48053

VINCENT J SADOVSKY MD

880 WOODWARD AVE

PONTIAC MICHIGAN 48053

ROBERT SELMAN MD
500 W HURON ST
PONTIAC MICHIGAN

48053

DONALD S SMITH MD
1010 RIKER BLOG
PONTIAC MICHIGAN

48058

HAROLD A ST JOHN MD
35 WEST HURON ST
PONTIAC MI

L

48058

CHAS R SEMPERE MD
35 S JOHNSON
PONTIAC MICH

48053

GEO E SMITH MD
3535 W 13 MILE RD
ROYAL OAK MICHIGAN

48072

MICHEL I SALIB MD
2928 RAMBLING WAY
BLOOMFIELD HILLS MI

48013

ISMAIL B SENDI MD
140 ELIZABETH LAKE RD
PONTIAC MI 48053

ALLEN R SOBLE MD
23077 GREENFIELD RO
SOUTHFIELD Ml

48075

CAROLYN S SALISBURY MD

21580 GREENFIELD

OAK PARK MI 48237

GEO R SEWELL MD
411 WEST TEN MILE RD
PLEASANT RIDGE MICH

48069

M Z SOKOLOWSKI MD
3721 MILLSPRING
BLOOMFIELD HILLS MI

48013

ANNE H SAMBORSKI MD
32600 GRAND RIVER
FARMINGTON MI

48024

MAXWELL L SHADLEY MD
94 OTTAWA OR
PONTIAC MICH

48053

WM J SOMERVILLE MD
3535 W 13 MILE RD 308
ROYAL OAK MI 48072

NORMAN T SAMET MO
1100 N WOODWARD AVE
BIRMINGHAM MI

48011

JEROLD W SHAGRIN MD
4223 PINECROFT CT
ORCHARD LAKE MI

48033

ALLEN SOSIN MD

23023 ORCHARD LAKE RD

FARMINGTON MICHIGAN 48024

GLENN A SANFORD MD
35 S JOHNSON
PONTIAC MICHIGAN

48053

LOREN C SHEFFIELD MD
617 S W ELM TREE LN
BOCA RATON FL

L

33432

MARY A SOULE MD
166 NO GLENHURST
BIRMINGHAM MI

48009

THOS J SANSONE MD
909 WOODWARD AVE
PONTIAC MICHIGAN

48053

WARREN E SHELDEN MD
21721 W 11 MILE RD
SOUTHFIELD MI

48076

LLOYD H SPENCER MD L

1219 S WASHINGTON AVE
ROYAL OAK MICH 48067

RAJKUMAR L SARDA MD

A

F MICHAEL SHERIDAN MD

HENRY J SPIRO MD

PONTIAC GEN HOSP
PONTIAC MI

48053

1307 S WASHINGTON ST
ROYAL OAK MICH

48067

27046 PIERCE
SOUTHFIELD MI

48075

USHA R SARDA MO

A

HENRY A SHE V 1 TZ MD

A

EUGENE L SPOEHR MD

L

PONTIAC GENERAL HOSP
PONTIAC MI

48053

WM BEAUMONT HOSP
ROYAL OAK MI

48072

22832 WOODWARD AVE
FERNDALE MI

48220

THEODORE SATERSMOEN

MD

EON SHIN MD

EARLE W SPOHN MD

L

6405 TELEGRAPH E-4
BIRMINGHAM MI

48010

1100 W UNIVERSI TY DR
ROCHESTER MI

48063

324 WASHINGTON SQ PL
ROYAL OAK MI

48067

NORMAN SCHAKNE MD
26711 WOODWARD AVE
HUNTINGTON WOODS MI

48070

MARVIN D SIEGEL MD
1095 W HURON ST
PONTIAC MICHIGAN

48053

JOHN C STAGEMAN MD
909 WOODWARD
PONTIAC MICHIGAN

48053

JOS L SCHIRLE JR MD
1116 VOORHEIS RD
PONTIAC MICH

48053

PETER SIEGEL MD
880 WOODWARD AVE
PONTIAC MI

48053

S STANISAVLJEVIC MD
2338 WOODWARD AVE
ROYAL OAK MICHIGAN

48073

JEROME J SCHNEYER MD
25000 W TEN MILE RD
SOUTHFIELD MICHIGAN

48075

SHELDON N SIEGEL MD
18239 WEST 12 MILE RD
LATHRUP VILLAGE MI

48075

REGINALDO STANLEY MD
2828 CHARTER BLVD
TROY MI

48084

ROBT J SCHUENFELD MD
800 S ADAMS RD
BIRMINGHAM MICH

48011

LOREN W SIFFRING MO
427 W UNIVERSITY
ROCHESTER MICHIGAN

48063

WM F STANLEY MO
1148 S WOODWARD
ROYAL OAK MICH

48067

MARVIN L STARMAN MD
21701 M 11 MILE RD #10

SOUTHFIELD MI 48075

ROBERT D STEELE JR MO A
5860 SHAUN RD

ORCHARD LAKE MI 48033

EVERETTE M STEFFES MD
3345 COOLIOGE HIGHWAY
BERKLEY MICH 48072

HANS J STEIN MD A

WM BEAUMONT HOSP

ROYAL OAK MI 48072

W H STEPHENS JR MO
189 TOWNSEND

BIRMINGHAM MI 48011

SHELDON D STERN MD

802 MUTUAL BLDG

DETROIT MI 48226

MILAN STOJANOVIC MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

A KENNETH STOLPMAN MD
640 N WOODWARD
BIRMINGHAM MICH 48011

JON L STOLTE MD A

36 CHARLES LANE

PONTIAC MI 48053

DAVID Q STONE MD
WIXOM ASSEMBLY PLANT
P 0 BOX 1

WIXOM MI 48096

JOHN M STONE MD

3924 W TWELVE MILE RD

BERKLEY MI 48072

RICHARD E STRAITH MD
17100 W 12 MILE RO
SOUTHFIELD MI 48075

BERNARO J STREMLER MD
1460 CHESTERFIELD
BIRMINGHAM MICHIGAN 48009

JAMES D STROUD MD
15901 W NINE MILE RD
SOUTHFIELD MI 48075

MILTON B STUECHEL I MD
1084 WILLOW LANE
BIRMINGHAM MICH 48009

PALMER E SUTTON MD L

1413 ORMSBY DR

SUNNYVALE CA 94087

WM H SWARTZ MD
2335 SO COMMERCE RD
WALLED LAKE MI 48088

WILLIAM C SWATEK MD

900 WOUDWARD AVE

PONTIAC MI 48053

NORMAN E SWINGLE MD
1775 E 14 MILE RD
BIRMINGHAM MICH 48008

BELA J SZAPPANYOS MD
3325 BURNING BUSH RD
BIRMINGHAM MI 48010

ELAINE HART JE TAN MD
1800 CAMPUS COURT
ROCHESTER MI 46063

KING L TAN MD

134 W UN I V DR #301

ROCHESTER MI 48063

THIAN LAI TAN MD
805 SPARTAN

ROCHESTER MI 48063

JANUARY, 1972/Michigan Medicine 47

Oakland County

LISTED BY COMPONENT MEDICAL SOCIETIES

ANTOINETTE TANAY MD

HA S LAFAYETTE

ROYAL OAK MI 48067

DICK A TARPINIAN MD

3535 W 13 MILE RO

ROYAL OAK MICHIGAN 48072

ABRAHAM TAUBER MD

500 W HURON ST

PONTIAC MICHIGAN 48053

JOHN Y TESHIMA M D

3535 W 13 MILE RO

ROYAL OAK MI 48072

D EUGENE THOMPSON MD
1052 HADDINGTON
BIRMINGHAM MI 48009

ALLAN K THORBURN MD

231 S HOOOHARD

BIRMINGHAM MI 48011

ROBERT R THRELKELD MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

GERALD C TIMMIS MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

F T TOLEDO MD A

ST JOSEPH MERCY HOSP
PONTIAC MI 48053

THOS S TORGERSON MD
751 CHESTNUT

BIRMINGHAM MICH 48008

ALFRED TOUMA MD
26789 WOODWARD AVE
HUNTINGTON WDS MICH 48070

KENNETH N TRADER MD
15901 W 9 MILE RD *720
SOUTHFIELD MI 48075

WM K TREGENZA MD
20905 GREENFIELD
SOUTHFIELD MICHIGAN 48075

RAYMOND L TREMBLAY MD
2370 WALTON BLVO
ROCHESTER MI 48063

DONALD J TRUMPOUR MD
461 W HURON ST
PONTIAC GEN HOSP

PONTIAC MI 48053

GEORGE TSIATALAS MD

4045 W 13 MILE RD

ROYAL OAK MICHIGAN 48072

CONSTANCE J TUBBS MD
15901 W 9 MILE RD
SOUTHFIELD MI 48075

ROBERT L TUPPER MD
86 OTTAWA DR

PONTIAC MICHIGAN 48053

ATTILA 0 ULGENALP MD

909 WOODWARD AVE

PONTIAC MI 48053

A S ULLMANN MD

1101 W UNIVERSITY DR

ROCHESTER MI 48063

ROBERT A ULVELING MD

500 W HURON ST

PONTIAC MICHIGAN 48053

ROBERT S UNDERHILL MO
26789 WOODWARD AVE
HUNTINGTON WOOOS MI 48070

K L URWILLER MD

909 WOODWARD AVE

PONTIAC MICHIGAN 48053

JOHN H VAN DE LEUV MD

91 S WASHINGTON ST
OXFORD MICHIGAN

48051

KENNETH VANDEN BERG MD

35 S JOHNSON
PONTIAC MICH

48053

SEYMOUR A VANDER M D
20905 GREENFIELD RD
SOUTHFIELD MI

48075

JAY J VAN ZOEREN MD
937 ROCK SPRING RD
BLOOMFIELD HILLS MI

48013

THOS G VARBEO I AN MD
195 W BROWN ST
BIRMINGHAM MICHIGAN

48011

RICHARD K VAUGHT MD
2009 CROOKS RD
ROYAL OAK MICH

48073

JIMMIE J VERLEE MD
PONTIAC GENERAL HOSP
PONTIAC MI

48053

M A VICTORIA MD
PONTIAC STATE HOSP
PONTIAC MICH

48053

SATISH K VIJ MD

A

WM BEAUMONT HOSP
ROYAL OAK MI

48072

RADY I VILLAFLOR MD
4851 BURNLEY DR
BLOOMF I ELO HILLS MI

48013

WM F VON VALUER MD
134 W UN I V DR RM 102
ROCHESTER MI

48063

NIELS R WAEHNELDT MD
4755 DOVER CT
BLOOMFIELD HILLS MI

48013

DOUGLAS L WAKE MD
1406 W00DS80R0
ROYAL OAK MICHIGAN

48067

RICHARD H WALKER MD
3601 W 13 MILE RD
ROYAL OAK Ml

48072

DONALD B WALLACE MD
1579 W BIG BEAVER RD
TROY MI

48084

ERWIN N WALLACK MD
15660 W TEN MILE RD
SOUTHFIELD MICHIGAN

48075

HOWARD C WALSER MD

R

1300 NORTHLAWN
BIRMINGHAM MI

48009

WILLIAM F WANGNER M 1

D

1401 S WASHINGTON
ROYAL OAK MICH

48067

W PAUL WARD MD
3535 W 13 MILE RD
ROYAL OAK MI

48072

FREDK H 0 WARNER MD
3400 SASHA8AW RD
DRAYTON PLAINS MICH

48020

J E WASHINGTON JR MD

A

900 WOODWARD AVE
PONTIAC MI

48053

THOS Y WATSON MO
640 N WOODWARD
BIRMINGHAM MICH

48011

WILLIAM F WEAVER MD

33750 FREEDOM RD
FARMINGTON MI

48024

LYNN F WEBBER MD

R

461 COLONIAL CT
GROSSE PTE MI

48236

J COPNER WEBSTER MD
22000 GREENFIELD RD
OAK PARK MI 48237

MARVIN S WECKSTE I N MD
28290 TAVISTOCK TRAIL
SOUTHFIELD MI 48075

GEORGE C WEGRZYN MD

1380 BROOKWOOD

BIRMINGHAM MICHIGAN 48009

JOEL E WEINGARTEN MD
18905 CARMONA

SOUTHFIELD MI 48075

G S WEINTRAUB MD
3535 W 13 MILE RD 305
ROYAL OAK MI 48072

ROSALYN Y WEINTRAUB MD A
6990 HOLIDAY DRIVE
BIRMINGHAM MI 48010

LAWRENCE S WEISMAN MD
28780 JOHN R

MADISON HGTS MI 48071

MORRIS WEISS MO
26339 WOOOWARD AVE
HUNTINGTON WOOOS MI 48070

DIETER WENDLING MD
31815 SOUTHFIELD RD
BIRMINGHAM MICHIGAN 48009

ROBT R WESSELS MD
302 WABEEK BLDG
BIRMINGHAM MICHIGAN 48011

EDWIN J WESTFALL MD

3535 W 13 MILE RO

ROYAL UAK MICHIGAN 48072

WM J WESTMAAS MD
134 JAIKINS BLDG
1100 N WOODWARD AVE

BIRMINGHAM MI 48011

RICHARD A WETZEL MD

WM BEAUMONT HOSP

ROYAL OAK MI 48072

DANIEL B WHITE MD
134 W UN I V DR *309
ROCHESTER MI 48063

ROBERT H WHITE MD
384 HAMILTON AVE
BIRMINGHAM MICHIGAN 48011

JOHN L W I ANT MO
6405 TELEGRAPH RD
BUILDING C
SUITE 2

BIRMINGHAM MI 48010

RALPH D WIGENT MD
PONT MOTOR GLENWOOD AV
PONTIAC MI 48053

WM C WILKINSON MD

680 WOODWARD AVE

PONTIAC MICHIGAN 48053

JOHN P WILLIAMS MD
35 S JOHNSON

PONTIAC MICHIGAN 48053

MAURICE E WILLIS MD

500 W HURON ST

PONTIAC MICHIGAN 48053

V WINKLER-PRINS MO
4256 ORCHARD LK RD
ORCHARD LAKE MI 48033

E M WISNIEWSKI MD
950 E MAPLE

BIRMINGHAM MI 48011

WARREN E WOLFE MD
6290 WING LAKE RD
BIRMINGHAM MI 48010

NAC I ANCENO V WOO MD

1101 W UN I V DR

ROCHESTER MI 48063

WARREN A WOOD JR MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

CHARLES J WOODS MD A

WM BEAUMONT HOSPITAL
3601 W 13 MILE RD

ROYAL OAK MI 48072

HANNA L WOODWARD MD

3856 NORMANWOOD

ORCHARD LAKE MI 48033

ROBERT D WOODWARD MD
1100 N WOODWARD AVE
BIRMINGHAM MICH 48011

CHARLES E YEE MD
5790 M-15

CLARKSTON MI 48016

VELDORA C YESKO MO

1148 S WOODWARD AVE

ROYAL OAK MI 48067

JOHN R YLVISAKER MD
ST JOSEPH MERCY HOSP
PONTIAC MI 48053

DAVID 8 YOUEL MD

35 S JOHNSON ST

PONTIAC MI 48053

ARTHUR R YOUNG MO L

35 W HURON ST

PONTIAC MI 48058

FRANK A YOUNG MD
134 W UNIVERSITY DR
ROCHESTER MI 48063

RICARDO A YUZON MD
949 JOSLYN RD

LAKE ORION MI 48035

WALTER J ZIMMERMAN MO
32340 SYLVAN LANE
BIRMINGHAM MICHIGAN 48009

J J ZINTERHOFER MD L

17187 SCHAEFER

DETROIT MI 48235

ALPHONSE J ZUJKO MD

606 RIKER BLDG

PONTIAC MICHIGAN 48058

OCEANA

V D BARKER MD
601 E MAIN ST

HART MICHIGAN 49420

LINFORD J OAVIS M 0
601 E MAIN ST

HART MICHIGAN 49420

DEAN A GERIG DO

218 N MICHIGAN AVE

SHELBY MI 49455

WILL IS A HASTY MD

204 N MICHIGAN

SHELBY MICH 49455

C A JOHNSON MD
P 0 BOX 6

NEW ERA MICHIGAN 49446

WARREN R MULLEN MD

PENTWATER MI 49449

JOHN J VRBANAC MD
601 E MAIN ST

HART MICHIGAN 49420

48 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Saginaw County

MERLE G WOOD MD
178 H MEARS ST
PENTWATER MI

R

49449

HAROLD G DE VRIES MD
30 E 9TH ST
HOLLAND MICH

49423

MARY F S KITCHEL MD
P 0 BOX 521
GRAND HAVEN Ml

49417

ONTONAGON

PETER J DE VRIES MD
321 WASHINGTON
GRAND HAVEN MI

49417

WM C KOOLS MD
194 W 1 1TH ST
HOLLAND MICH

L

49423

DONALD H ARCHIBALD
BOX 223

ONTONAGON MICH

MO

49953

DONALD E DE WITT MD
390 FAIRHILL DR
HOLLAND MICHIGAN

49423

SIEBE W KUIPERS MD
144 W 26TH ST
HOLLAND MICH

49423

KARL E HILL MD
9 HEMLOCK ST
WHITE PINE MI

49971

FREDK W DE YOUNG MD
109 S JACKSON ST
SPRING LAKE MI

49456

DERICK J LENTERS MD
121 WEST 24TH ST
HOLLAND MI

49423

CARL R LAHTI MD
R 2

ONTONAGON MICH

49953

ARNOLD R DOOD MD
598 CENTRAL AVE
HOLLAND MICHIGAN

49423

RICHARD A LEPPINK MD
601 MICHIGAN
HOLLAND MICHIGAN

49423

JOHN PIERPONT MD
141 MAPLE

WHITE PINE MICHIGAN

49971

PAUL DYKEMA MD
788 COLUMBIA AVE
HOLLAND MI

49423

ROBERT C MAHANEY MD
601 MICHIGAN AVE
HOLLAND MI

49423

JAMES P STRONG MD
R 1 BOX 406
ONTONAGON MI

49953

JEROME H DYKSTRA MD
680 S WASHINGTON
HOLLAND MICHIGAN

49423

PETER A MC ARTHUR MD
1310 WISCONSIN
GRAND HAVEN MICHIGAN

49417

OTTAWA

DONALD H ENDEAN MD
121 WEST 24TH ST
HOLLAND MICHIGAN

49423

BERNARD MEEUHSEN M D
601 MICHIGAN AVE
HOLLAND Ml

49423

ROBT ALBERS MO
601 MICHIGAN
HOLLAND MICHIGAN

49423

MELVIN J FRIESWYK MD
241 E MAIN ST
ZEELAND MICH

49464

WM J MOERDYK MD
120 W 1 4TH ST
HOLLAND MI

L

49423

WM ARENDSHORST MO
144 WEST 26 TH ST
HOLLAND MI

49423

ROBERT N GAMBLE MD
1310 WISCONSIN AVE
GRAND HAVEN MI

49417

RUSSEL R NYKAMP MD
111 E MAIN ST
ZEELAND MICH

R

49464

WM C BAUM M D
601 MICHIGAN
HOLLAND MI

49423

ROGER J GEMMEN MD
342 W 33RD ST
HOLLAND MI

49423

J JAY POST MD
11219 BROWN AVE
ALLENDALE MI

49401

RAYMOND E 8ECKERING
P 0 BOX 684
GRAND HAVEN MI

MD

49417

OWEN J GESINK MD
148 W 39TH ST
HOLLAND MICHIGAN

49423

M GARY ROBERTSON MD
1310 WISCONSIN AVE
GRAND HAVEN MI

49417

DIRK C BLOEMENDAAL
38 S STATE ST
ZEELAND MI

MD L

49464

FRANK L GROAT MD
631 FRANKLIN ST
GRAND HAVEN MICHIGAN

49417

WM ROTTSCHAEFER MD
601 MICHIGAN
HOLLAND MICH

49423

W B BLOEMENDAL MD
411 WOODLAWN
GRAND HAVEN Ml

A

49417

RALPH HAGER MD
3593 VAN BUREN ST
HUDSONVILLE MI

49426

LLOYD ROTZ MD
575 ROBBINS RD
GRAND HAVEN MICHIGAN

49417

VERNON L BOERSMA MD
121 W 24 ST
HOLLAND MICH

49423

MARINUS H HAMELINK MO
700 W 26TH ST

HOLLAND MICH 49423

WILLARD M RYPKEMA MD
22 SOUTH 2ND STREET
GRAND HAVEN MICH

49417

ALVIN BONZELAAR MD
144 WEST 26TH
HOLLAND MICHIGAN

49423

HERMAN P HARMS MO
17 W 10TH ST
HOLLAND MICH

49423

R H SCHAFTENAAR MD
5 E 8TH ST *405
HOLLAND MI

49423

WM S BOUTWELL MD
967 SOUTH SHORE DR
HOLLAND MI

49423

DENNIS W HARVEY MO
575 ROBBINS RO
GRAND HAVEN MI

49417

DONALD E SIKKEMA MD
1310 WISCONSIN
GRAND HAVEN MI

49417

PHILLIP 8RADF0R0 MD
115 E 26TH
HOLLAND MI

49423

WM HEARD MD
504 PARK ST
GRAND HAVEN MI

R

49417

JAMES M SIMPSON MD
1310 WISCONSIN AVE
GRAND HAVEN MI

49417

JERRY E BULTHUIS MD
3165 24TH ST
JAMESTOWN MI

49427

EOW J HEL8ING JR MD
17 W 10TH STREET
HOLLAND MI

49423

GEORGE J SMIT MD
601 MICHIGAN AVE
HOLLAND MI

49423

JAMES K CHAMNESS MD
121 W 24 TH STREET
HOLLAND MICHIGAN

49423

JACK A HENDERSON MD '
1310 WISCONSIN AVE
GRAND HAVEN MICHIGAN

49417

THOMAS A SMITH MD
1310 WISCONSIN ST
GRAND HAVEN MI

49417

NELSON H CLARK MD
17 W 10 ST
HOLLAND MICH

49423

H J HOMMERSON MD
3559 M40

HAMILTON MICHIGAN

A

49419

ROBT H STOBBELAAR MD
1310 WISCONSIN
GRAND HAVEN MICH

49417

CARL S COOK MD

R

JOS B KEARNEY MD

RALPH TEN HAVE MD

L

121 W 24TH ST
HOLLAND MICH

49423

121 W 24 ST
HOLLAND MI

49423

1030 ORCHARD
GRAND HAVEN MI

49417

DONALD A DEPHOUSE MD
30 E NINTH ST

HOLLAND MI 49423

GERRIT J KEMME MD
R NO 3
ZEELANO MICH

49464

HENRY W TEN PAS MD
110 W 22ND ST
HOLLAND MICH

49423

BERNADINE DEVALOIS

MD

JOHN H KITCHEL MD

EUGENE C TIMMERMAN MD

766 W 24TH ST
HOLLAND MI

49423

414 FRANKLIN ST
GRAND HAVEN MICH

49417

126 EASTMANVILLE
COGPERSVILLE MI

49404

THOMAS H TOWNSEND MD
1310 WISCONSIN AVE
GRAND HAVEN MI

OTTO VAN DER VELDE

33 W 8TH ST
HOLLAND MI

ALFRED J VANDE WAA
152 E CHERRY ST
ZEELAND MI

CARL E VAN KRIMPEN
601 MICHIGAN AVE
HOLLAND MICHIGAN

BERNARD M VEENSTRA
1310 WISCONSIN AVE
GRAND HAVEN MICH

JOHN W VER DU l N MD
1618 GLADYS AVE
GRAND HAVEN MI

PETER J VERKA I K MD
3425 KELLY
HUDSONV ILLE MICH

CHARLES WANG MD
14 EAST 25TH STREET
HOLLAND MICHIGAN 49423

JEROME H WASSINK MD

34 E 33RD

HOLLAND MICHIGAN 49423

R L WEELDREYER MD

121 WEST 24TH ST

HOLLAND MI 49423

FLOYD WESTENDORP MD
549 W 1 8TH ST

HOLLAND MI 49423

WARREN K WESTRATE MD
17 W 10TH ST

HOLLAND MICH 49423

WM WESTRATE JR MO
17 W 10TH ST

HOLLAND MICH 49423

JOHN K WINTER MD
726 STATE ST

HOLLAND MICH 49423

WM G WINTER JR MD

655 COLLEGE AVE

HOLLAND MICH 49423

JOHN H YFF MO

430 W LAWRENCE

ZEELAND MICHIGAN 49464

FREDK F YONKMAN MD R

80 CONVERSE RD

MARION MASS 02738

ATAOLLAH ZAHED MD
39 E MAIN ST

ZEELAND MI 49464

BENJAMIN ZANDSTRA DO 0

3337 VAN BUREN ST
HUDSONVILLE MI 49426

49417
MD L
49423
MD

49464

MD

49423

MD

49417

A

49417

49426

SAGINAW

GERALD L ACKERMAN MD R

4700 PINE HAVEN DR
SAGINAW MICH 48603

MILLARD J ALBERS MD
1227 N MICHIGAN AVE
SAGINAW MICH 48602

WM K ANDERSON MD L

BOX 827 BLIND RIVER
ONTARIO CANADA

ROB T G APP MD

3422 DAVENPORT

SAGINAW MICHIGAN 48602

JANUARY, 1972/Michigan Medicine 49

Saginaw County

LISTED BY COMPONENT MEDICAL SOCIETIES

JOSEPH N AQUILINA MO

3406 DAVENPORT

SAGINAW MI 48602

GEORGE C ARNAS MD
1600 N MICHIGAN AVE
SAGINAW MI 48602

WALTER C AVERILL MO
2110 MORSON

SAGINAW MICHIGAN 48602

EDGAR P BALCUEUA MD

3614 DAVENPORT

SAGINAW MI 48602

JACK L BARRY MO

5670 DIXIE HWY

SAGINAW MI 48601

LEROY C BARRY MO
705 ADAMS ST

SAGINAW MI 48602

VERNON V BASS MD

3322 DAVENPORT

SAGINAW MICH 48602

C PETER BEHME MD
5160 HELGA DR

SAGINAW MICHIGAN 48603

MICHAEL T BERGEON MD

2115 BAY ST

SAGINAW MI 48602

MARC G BERTRAND MD

27 W HANNUM BLVO

SAGINAW MICHIGAN 48602

HARRY M BISHOP MD R

4810 CENTENNIAL DR
SAGINAW MI 48603

LELANO M BITNER MD
1705 COURT

SAGINAW MI 48602

WILLIAM A BOW MD

4987 STATE STREET

SAGINAW MICHIGAN 48603

EDWARD BRADLEY MD

4981 SHATTUCK RD

SAGINAW MI 48603

FRIEDRICH P BRENDER MD

FRANKENMUTH MI 48734

GORDON BRIGGS MD
350 W WASHINGTON
HEMLOCK MICHIGAN 48626

LAURENCE BRUGGERS MD
1703 N MICHIGAN AVE
SAGINAW MICH 48602

BERT M BULLINGTON MO
2000 COURT ST

SAGINAW MICH 48602

QUINTER M BURNETT MO
4385 CONCORD

SAGINAW MICH 48603

FRANK J BUSCH MD
1731 N MICHIGAN ST
SAGINAW MICH 48602

MILTON G BUTLER MD R

1600 N MICHIGAN AVE
SAGINAW MICH 48602

DONATO CABRERA JR MD
1600 N MICHIGAN *404
SAGINAW MI 48602

DONALD J CADY MD
2002 COURT ST

SAGINAW MICH 48602

FREDK J CADY JR MD
402 S JEFFERSON AVE
SAGINAW MICH 48607

V W CAMBRIDGE MD
POTTER AT JEFFERSON
SAGINAW MICH

48607

JOHN E FINGER MO
29 BRIAN SCOTT PLACE
SAGINAW MICHIGAN

48602

ALLAN K CAMERON MD

THOS E FLESCHNER MO

R

1314 S JEFFERSON AVE
SAGINAW MICH

48601

951 79TH AVE #320
ST PETERSBURG FL

33702

LLOYD A CAMPBELL MD

R

FREDERICK W FOLTZ MO

335 BROCKWAY PL
SAGINAW MI

48602

1703 N MICHIGAN
SAGINAW MI

48602

FRANCISCO P CARREON

MD

KENNETH J FORSTER MD

1600 N MICH AVE #308
SAGINAW MI

48604

27 BENTON RD
SAGINAW MICHIGAN

48602

HUGH T CAUMARTIN MD
1537 S WASHINGTON AVE

JOE H GARDNER MD
815 N MICHIGAN AVE

SAGINAW MICH

48601

SAGINAW MICH

48602

PETER R CHI SENA MD
6221 DIXIE
BRIDGEPORT MICH

48722

ROY J GERARD MD
2419 MACKINAW
SAGINAW MICHIGAN

48602

FRANCES S CHOATE MD
1600 N MICHIGAN
SAGINAW MICHIGAN

48602

ROBT 0 GILMORE MO
234 W SAGINAW
MERRILL MICH

48637

ROBERT A CLOWATER MD

RICHARD D GOLDNER M

3

SAG COMMUNITY HOSP
SAGINAW MI

48605

1024 N MICHIGAN
SAGINAW MICH

48602

VITAL E CORTOPASSI MD

LOUIS 0 GOMON MO

324 S WASHINGTON AVE
SAGINAW MICH

48607

1203 N MICHIGAN AVE
SAGINAW MICH

48602

CHAS W CORY MO

J ORTON GOODSELL DOS

A

1227 N MICHIGAN
SAGINAW MI

48602

1305 S OCEAN BLVD
POMPANO BEACH FL

33062

T A CRESSWELL MD
1236 N MICHIGAN
SAGINAW MICH

48602

JOHN 0 GOODSELL MO
1600 N MICHIGAN
SAGINAW MICHIGAN

48602

GEO CULLEN MD

A

JACK E GOODWIN MO

2529 N CLINTON ST
SAGINAW Ml

48602

1600 N MICH AVE #301
SAGINAW MICH

48602

CLYDE P OAVENPORT MD
2110 MORSON
SAGINAW MICHIGAN

48602

MICHAEL GRANT MD
101 MARCY
ST CHARLES MI

48655

R S OERIFIELD MD

A

BETTY LOU GRUNDY MO

25 BRETTON CT
SAGINAW MI

48602

8771 WHITE BEECH DR
SAGINAW MI

48603

WILL I AM A DEYOUNG MD
CENTRAL LABORATORIES
1100 S WASHINGTON

GEORGE J GUGINO MD
1941 GATE ST
REESE MI

48757

SAGINAW MI

48601

REB I I M HANKAN MD

OONALD C DURMAN MD

R

3340 HOSPITAL RD
SAGINAW MI

48603

555 ESPLANADE NW #505
VENICE FL 33595

RICHARD C HAUSLER MD

THOMAS A EGGLESTON MD

206 S WEBSTER
SAGINAW MI

48602

382 CANTERBURY LN

SAGINAW MI

48603

ROBT M HEAVENRICH MD

GEORGE A ELLIS MO

1107 GRATIOT AVE
SAGINAW MICH

48602

16 E HANNUM BLVD

SAGINAW MI

48602

DUANE B HE I LBRONN MD

CECIL W ELY MD

L

1703 N MICHIGAN
SAGINAW MICHIGAN

48602

1820 JANES AVE

SAGINAW MICH

48601

E C HEINMILLER MD

JERRY J EVANS MD

SAGINAW GEN HOSPITAL
SAGINAW MI

48605

3160 CHRISTY WAY

SAGINAw MI

48603

HERBERT 0 HELMKAMP MD

ALBERT W FARLEY MD

333 S JEFFERSON
SAGINAW MI

48607

1013 N MICHIGAN

SAGINAW MI

48602

VALERIANO D HEREZA MD

ROBERT D FEEHELEY MO

2125 BAY STREET
SAGINAW MICHIGAN

48602

3521 STATE

SAGINAW MI

48602

MARY HERLIHY MU

E MALCOLM FIELD MD

101 MARCY
ST CHARLES MI

48655

1600 N MICHIGAN

SAGINAW MICHIGAN

48602

RICHARD P HEUSCHELE MD

1909 COOLIOGE ST
SAGINAW MI

48603

VICTOR HILL JR MD
1703 N MICHIGAN AVE

SAGINAW MICHIGAN 48602

RONALD G HINES MD
ST MARYS HOSPITAL
SAGINAw MI 48605

SEAN J HOBAN MU
1709 N MICHIGAN
SAGINAW MI 48602

H L HUBINGER 00 S A

501 2ND NATL BNK BLDG
SAGINAW MICHIGAN 48607

HENRY R HUG MD

1731 N MICHIGAN

SAGINAW MI 48602

WM T HYSLOP MD

1610 GRATIOT AVE

SAGINAW MICH 48602

ROBERT JAROINICO MD

3 CENTER WOODS

SAGINAW MICHIGAN 48603

RUDOLPH M JARVI MD

1107 GRATIOT AVE

SAGINAW MICH 48602

KERMIT T JOHNSTONE MD

1050 FISHER DR

SAGINAW MICH 48601

WM B KERR MD

300 S MICHIGAN ST

SAGINAW MICH 48602

VICTOR W KERSHUL MD
4343 STATE

SAGINAW MI 48603

JAMES T KEYES MD

10222 MAPLE RD

BIRCH RUN MICH 48415

EDWARD F KICKHAM MD
705 ADAMS ST

SAGINAW MICH 48602

KENNETH I KILUK MD

1600 N MICHIGAN

SAGINAW MI 48602

HERBERT G KLEEKAMP MD R
1776 S ROGERS RD R 1
CLARE MI 48617

EARL E KLEINSCHMIDT MD

3625 WEBBER ST

SAGINAW MICH 48601

CHARLES N KOENIG MD
3521 STATE ST

SAGINAW MI 48602

ROB T C KULESAR MO
1005 GRATIOT

SAGINAW MICH 48602

CHARLES J KOUCKY MD

14 CENTER WOODS

SAGINAW MI 48603

FRANCIS V KOWALS MD R

MED DIR CHEC SER GMC
SAGINAW MI 48603

JOHN A KREMSKI MD
1100 S WASHINGTON
SAGINAW MI 48601

THOS V KRETSCHMER MO
1232 N MICHIGAN AVE
SAGINAW MICHIGAN 48602

H F LABSAN MD
1115 COURT

SAGINAW MI 48602

JULES C LASSIGNAL MD

1587 DELTA DRIVE

SAGINAW MICH 48603

50 JANUARY, 1972 Michigan Medicine

48602

48626

48602

48602

48734

48601

48602

i

48602

48602

48602

48602

R

48602

48602

48601

48602

48602

48602

48602

L

48722

48601

48602

48602

48602

“10

48602

St. Clair County

RICHARD D MUDD MO R

1001 HOYT ST

SAGINAW MI 48607

DONAL T MULHERN MD
2716 S JEFFERSON AVE
SAGINAW MI 48607

ALBERT P MURPHY MO
303 N MICHIGAN AVE
SAGINAW MI 48602

RICHARD T MURPHY DOS A

1718 N MICHIGAN

SAGINAW MI 48602

MORRIS J MURRAY MD

3424 DAVENPORT

SAGINAW MICHIGAN 48602

DAVE B RUSKIN MD

1600 N MICHIGAN

SAGINAW MICH 48602

RICHARD S RYAN MD
1581 S WASHINGTON AVE
SAGINAW MI 48601

DONALD V SARGENT MD
1703 N MICHIGAN AVE
SAGINAW MICH 48602

G A SARMIENTO MD
1600 N MICHIGAN AVE
SAGINAW MI 48602

A J N SCHNEIDER MD
502 W TINKHAM

LUDINGTON MI 49431

FRANK R SCHULTZ MD

243 W BROAD ST

CHESANING MI 48616

GERARD SCOTT MD M

5670 DIXIE HWY

SAGINAW MI 48601

MELVIN E TRAMITZ MD

711 SOMERSET RD

SAGINAW MICHIGAN 48603

DONALD TUCKEY MD
1227 N MICHIGAN AVE
SAGINAW MI 48602

TERENCE K TUTTLE MD

1109 COURT sr

SAGINAW MICHIGAN 48602

WM G UNDERHILL MD
8 FIVE OAKS

SAGINAW MICHIGAN 48603

ALFONSO A VILLEGAS MD
1232 N MICHIGAN AVE
SAGINAW MI 48602

JOHN H VINCENT MD

4158 ATWOOD LN

BRIDGEPORT MI 48722

ROBERT L VITU M D
703 W GENESEE

SAGINAW MICHIGAN 48602

OSCAR A NELSON MD

3324 DAVENPORT

SAGINAW MICHIGAN 48602

PAUL R NOBLE MD
1447 N HARRISON
SAGINAW MICHIGAN 48602

ROBERT T NOLTA MD
1805 VET MEMORIAL PKWY

SAGINAW MI 48601

ROBT 0 NORTHWAY MD

1811 N MICHIGAN

SAGINAW MI 48602

FRANK 0 NOVY MD L

P 0 BOX 1814

SAGINAW MI 48605

CARLOS OBREGON MD
17162 STAMWICH BLVD
LIVONIA MI 48152

MARTIN C SHARP MD
1803 N MICHIGAN AVE

SAGINAW MICH 48602

JOHN L SHEK MD
803 N MICHIGAN
SAGINAW MICHIGAN 48602

SUEL A SHELDON MD L

77 ELMVIEW CT

SAGINAW MICH 48602

JOHN W SHERMAN MD
403 S FAYETTE

SAGINAW MICHIGAN 48602

VLAOIMIR K VOLK MD L

1238 AVALON

SAGINAW MI 48603

BARRY F WAITE MD
4291 STATE RD

SAGINAW Ml 48603

PETER R WALSH MD

331 S JEFFERSON

SAGINAW MI 48607

PETER 0 WAYS MD
4444 STATE APT C307
SAGINAW Ml 48603

JAMES E PACKER MD
5230 STATE ST

SAGINAW MICHIGAN 48603

MANUEL M PEREA MD

599 N FROST DR

SAGINAW MI 48603

GERALD A SI EGGREEN MD

1227 N MICHIGAN

SAGINAW MI 48602

C A SKOWRONSKI MD
1401 E GENESEE ST
SAGINAW MI 48607

LESTER E WEBB MD
2419 MACKINAW

SAGINAW MI 48602

ARNO W WEISS MD
3521 STATE ST

SAGINAW MICH 48602

CLIFFORD D POTVIN MD

202 PROVINCIAL

SAGINAW MI 48602

HOMER G SLADE MD R

1667 S WASHINGTON AVE
SAGINAW MI 48601

NORMAN WESTLUND MD
3253 CONGRESS

SAGINAW MICHIGAN 48602

ROBT F POWERS MD

1600 N MICHIGAN

SAGINAW MICHIGAN 48602

T A SMITH MD

1600 N MICHIGAN AVE

SAGINAW MI 48602

EDWIN M WRIGHT MD

1311 N MICHIGAN

SAGINAW MICH 48602

PERRY E PRATHER MD

1227 N MICH AVE

SAGINAW MICH 48602

JOSEPH M PRICE MD
4680 E SANILAC RD
CARSONVILLE MI 48419

J EUGENE RANK MD
1107 GRATIOT AVENUE
SAGINAW MICHIGAN 48602

NICHOLAS REDFIELD MD
1811 N MICHIGAN AVE
SAGINAW MI 48602

JOS J REICHMAN MD

1455 SHEFFIELD

SAGINAW MI 48605

WILLIAM T RICE MD
1827 N MICHIGAN AVE
SAGINAW MICHIGAN 48602

NED W RICHARDS MD
3518 STATE ST

SAGINAW MICH 48602

HARRY J RICHTER MD R

1401 W DELTA DR

SAGINAW MICH 48603

IVAN J ROGGEN MD

1227 N MICHIGAN

SAGINAW MICH 48602

DONALD E SPENGLER DOS A
4291 STATE ST

SAGINAW MI 48603

AARON C STANDER MD
1411 COURT ST

SAGINAW MICH 48602

HUGH L SULFRIDGE JR MD
1011 N MICHIGAN AVE
SAGINAW MI 48602

JOSEPH E TALBOT MD
1311 N MICHIGAN AVE
SAGINAW MI 48602

ROBERT E TAYLOR MD

1447 N HARRISON

SAGINAW MICHIGAN 48602

ARTHUR B THOMPSON MD

2144 OTTAWA ST

SAGINAW MICH 48602

DENNIS M TIBBLE MD

1203 N MICHIGAN

SAGINAW MI 48602

GUNTHER E TIEDKE MD
120 N MICHIGAN AVE
SAGINAW MICH 48602

ROBERT J TOTEFF MD
2110 MORSON

SAGINAW MICHIGAN 48602

MAURICE C WYNES MD
SAGINAW COUNTY HOSP
SAGINAW MI 48605

JOHN YOUNG MD
705 COOPER ST

SAGINAW MICHIGAN 48602

ST. CLAIR

ROBT S BAILEY MD
2425 MILITARY ST
PORT HURON MICHIGAN 48060

RONALDO S BALBOA MD
1216 SIXTH ST

PORT HURON MI 48060

KENNETH C BANTING MD

403 PEOPLES BK BLDG

PORT HURON MICH 48060

J A BAR SS MD
1225 10TH ST

PORT HURON MICH 48060

JOHN C S BATTLEY MD L

2038 MILITARY ST

PORT HURON MI 48060

JOS F SEER MD

104 N RIVERSIDE AVE

SAINT CLAIR MICH 48079

JANUARY, 1972/Michigan Medicine 51

St. Clair County

LISTED BY COMPONENT MEDICAL SOCIETIES

WM G BENNETT MD
210 S MAIN ST
YALE MICH

48097

ERWIN J FUERST MD
1322 N RIVER RD
ST CLAIR MI

48079

ALVIN N MORRIS MD
621 RIVER ST
PORT HURON MICH

48060

RICHARD M BERG MO
2425 MILITARY ST
PORT HURON MI

48060

JAMES F GERRITS MD
1322 N RIVER RD
ST CLAIR MI

48079

FRED NERUDA MD
640 N THIRD ST
ST CLAIR MI

48079

ERWIN W BLATTER MD
3864 GRATIOT AVE
PORT HURON MICH

L

48060

ANTHONY C GHOLZ MD
1209 10TH ST
PORT HURON MICH

48060

WALTER S NOVAK MD
1501 N RIVER RD #301
ST CLAIR MI

R

48077

CHAS L BORDEN MD
4520 LAKESHORE RD
PORT HURON MICHIGAN

L

48060

JOHN R GILMORE MD
317 MICH BANK BLDG
PORT HURON MICH

48060

JUAN E OLIVERA MD
2425 MILITARY ST
PORT HURON MI

48060

THOS H 80TT0MLE Y JR
1102 SIXTH ST
PORT HURON MICH

MO

48060

H J HAZLEDINE MD
4685 LAKESHORE RD
PORT HURON MICH

48060

MICHAEL RAFTERY MD
2425 MILITARY
PORT HURON MICHIGAN

48060

WALTER H BOUGHNER MD
325 PLEASANT ST
ALGONAC MICH

48001

DAVID M C HISLOP MD
5076 LAKESHORE RD
PORT HURON MI

48060

RICHARD C RELKEN MD
2920 PINE GROVE
PORT HURON MI

48060

WM S BOWDEN MD
130 WASHINGTON
MARINE CITY MICH

48039

ALEXANDER E HL I VKO MD
1605 FRED W MOORE HWY
ST CLAIR MICHIGAN 48079

ROBT E ROWE MD
108 MCMORR AN BLVD
PORT HURON MICHIGAN

48060

EZRA V BRIDGE MD
416 EDISON BLVD
PORT HURON MICH

48060

RUSSELL J HOLCOMB MD
140 S MARKET
MARINE CITY MICH

48039

JOHN J RUTLEDGE MD
521 PEOPLES BANK BLDG
PORT HURON MI 48060

COLMAN J BURKE MD

311 PINE ST

PORT HURON MICHIGAN

48060

CHARLES N HOYT MD
1501 KRAFFT RD
PORT HURON MI

48060

MICHAEL I SABBAGH MD
1322 N RIVER RD
ST CLAIR MI

48079

CLARENCE L CANDLER MD L

1611 HAWTHORNE RD
GROSSE PTE WOODS MI 48236

THOMAS C JOHNSTON MO
2425 MILITARY ST
PORT HURON MICH

48060

JOS L SANDERSON MD
515 PINE ST
PORT HURON MICH

48060

JOHN D CANTWELL JR MD
2425 MILITARY

PORT HURON MICHIGAN 48060

OSCAR B KAHN MO
CAPAC MICH

48014

WALDO A SCHAEFER MD
302 MICH BANK BLDG
PORT HURON MICH

48060

MAHMOUD CHAFTY MD
2425 MILITARY
PORT HURON MICH

48060

AUSTIN M KATZ MD
1017 HURON ST
PORT HURON MI

48060

JOHN A SERNIAK MO
104 S MAIN ST
YALE MICH

48097

WM D CLELAND JR MD
1209 10TH ST
PORT HURON MICH

48060

HARRY N KIRBAN MD
5500 LAKESHORE RD
PORT HURON MICHIGAN

48060

JAMES W SHARPE MD
1209 10TH ST
PORT HURON MI

48060

ROBT P CLIFFORD MD
506 S RIVERSIDE DR
ST CLAIR MICH

48079

DONALD A KOCH MO
4291 NORTH RD
NORTH ST MI

R

48049

ELMORE D SHOUDY MD
902 TENTH AVE
PORT HURON MICHIGAN

48060

BEN J C CLYNE MD
103 N MAIN ST
YALE MICH

48097

CLEMENS M KOPP MD
1209 WILLOW ST
PORT HURON MI

48060

JAMES J SNIDER MD
2425 MILITARY
PORT HURON MICH

48060

JAMES W COPPING JR MD
1225 TENTH ST

PORT HURON MI 48060

HAROLD R KOSTOFF MD
1025 HURON AVE
PORT HURON MICHIGAN

48060

JAMES H TISDEL MD
1209 10TH ST
PORT HURON MI

48060

JOHN J COURY JR MD
1225 10TH ST
PORT HURON MICH

48060

JAMES LAURIDSEN MD
621 RIVER ST
PORT HURON MICH

48060

GLENN F TOMSU MD
1209 10TH ST
PORT HURON MICH

48060

WM T DAVISON MD
2425 MILITARY ST
PORT HURON MICH

48060

REUBEN R LICKER MD
2425 MILITARY ST
PORT HURON MICHIGAN

48060

CHAS 0 TOWNLEY MD
1209 TENTH ST
PORT HURON MICH

48060

WM J DINNEN JR MD
2425 MILITARY
PORT HURON MICH

48060

CLAUDE A LUDWIG MD
916 SEVENTH ST
PORT HURON MICH

48060

ARTHUR H ULMER JR MD
1209 TENTH ST
PORT HURON MICH

48060

NICHOLAS G OOUVAS MD
4200 GRATIOT
PORT HURON MI

48060

FREDK E LUDWIG MD
916 7TH ST
PORT HURON MICH

48060

SIDNEY C WALKER MD
1209 TENTH ST
PORT HURON MICH

48060

JEAN PAUL DUPUIS MD
1502 SHUMAKER
PORT HURON MICH

48060

ROBT M LUGG MO

P 0 BOX 228

PORT HURON MICHIGAN

48060

J RALEIGH WARE MD
3107 24TH ST
PORT HURON MI

R

48060

EDWIN H FENTON MD
4620 TRI PAR DR
SARASOTA FL

R

33580

HARRY E MAYHEW MD
613 N RIVERSIDE DR
ST CLAIR MI

48079

GOROON H WEBB MD
875 MICHIGAN AVE
MARYSVILLE MI

48040

E W FITZGERALD JR MD
1102 SIXTH ST

PORT HURON MICHIGAN 48060

JOHN M MILLER
1025 HURON AVE
PORT HURON MICHIGAN

48060

W C WECKESSER MD
1602 MILITARY
PORT HURON MICHIGAN

48060

ARM I N T FRANKE M D
2425 MILITARY
PORT HURON MICH

48060

GLENN E MOHNEY MD
1131 ERIE ST
PORT HURON MI

48060

DANIEL J WILHELM MD
P 0 BOX 228
PORT HURON MI

48060

JAMES G WOLTER MD
1017 HURON AVE
PORT HURON MI

KENNETH W YOST MO
1305 GRATIOT AVE
MARYSVILLE MICH

JOHN A YOUNGS MD
718 GRISWOLD ST
PORT HURON MICHIGAN

ARTHUR B YULL MD

1225 10TH ST

PORT HURON MICHIGAN

ST. JOSEPH

CHARLES R BABER MD
204 E WEST ST
STURGIS MI

LAWRENCE A BERG MD
106 E CHICAGO RD
STURGIS MICH

D E BRADLEY MD
234 S MAIN ST
COLON MICHIGAN

WILBUR G BRAHAM MD
111 S MONROE
STURGIS MICH

PAUL L BROTHERS M D
1313 ROLLING RIDGE LN

STURGIS Ml 49091

ROBT H EVANS MD
111 S MONROE ST
STURGIS MICH 49091

S ALBERT FIEGEL MD
111 S MONROE

STURGIS MICH 49091

ROSCOE J FORTNER MD

137 PORTAGE AVE

THREE RIVERS MICH 49093

JASON K HAR T JEN MD
206 E WEST ST

STURGIS MI 49091

JOHN M JACOBOWITZ MD
LINCOLN AT MILLARD
THREE RIVERS MICH

OLIN L LEPARD MO
KNOL L WOOD DR R#5
STURGIS MICH

ROBERT LEWIS MU
104 S LAKEVIEW ST
STURGIS MI

DOUGLAS A MACK MD
COUNTY HLTH DEPT
CENTREVILLE MI

HUGH MCCULLOGH MD
111 S MONROE ST
STURGIS MI

CHARLES W 0 DELL MD

117 SPRING ST

THREE RIVERS MICH 49093

HARRY C PENNINGTON MD

118 S KALAMAZOO

WHITE PIGEON MICH 49099

STANLEY C PENZOTTI MD
117 SPRING ST

THREE RIVERS MICH 49093

CLARK G PORTER MO
226 EAST ST

THREE RIVERS MICH 49093

DONALD R SCHIMNOSKI MD
THREE RIVERS MED CLNC

THREE RIVERS MICH 49093

49093

49091

49091

49032

49091

48060

48040

48060

48060

49091

49091

49040

49091

52 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Van Buren County

GEO D SHAW MD
117 SPRING ST
THREE RIVERS MICH

JOHN P SHELDON MO
206 E WEST ST
STURGIS MICH

ROBT D SMITH MD

COLON MI

HEINZ R WEI SHE I T MD
ROUTE 1
STURGIS MI

CHAS R ZIMONT MO
160 E WATER
CONSTANTINE MICH

RAYMOND 0 ZIMONT MD
160 E WATER ST
CONSTANTINE MI

49093

49091

49040

49091

49042

49042

SANILAC

JAMES R CRIPPS MD

MARLETTE MICH 48453

DOROTHY DUVALL MD A

817 PATTERSON AVE

BAY CITY MI 48706

LARRY G ELLIS MD
426 W SPEAKER

SANDUSKY MI 48471

WELDON A GIFT MD L

MARLETTE MI 48453

GERALD L GROAT MD
47 AUSTIN ST

SANDUSKY MI 48471

ROBT K HART MD L

CROSWELL MI 48422

MICHAEL H JAYSON MD
2764 LORRAINE ST
MARLETTE MICHIGAN

JOHN W MC CREA MD

MARLETTE MI

KEATE T MC GUNEGLE MD

SANDUSKY MI

NEIL MUIR MD

CROSWELL Ml

M COLE SEAGER MO
4325 W MAIN ST
BROWN CITY MI

DUANE E SMITH MD

BROWN CITY MI

G EVANS TWEED I E MD

SANDUSKY MI

S MARTIN TWEED I E MD

SANDUSKY MI

J C WEBSTER MD

MARLETTE MI

48453

48453

I

48471

48422

L

48416

48416

L

48471

L

48471

L

48453

SHIAWASSEE

ALFRED L ARNOLD JR MD
R 1

OVIO MI

L

48866

EUGENE S AUSTIN MD
1260 ADA ST

OWOSSO MICH 48867

PHILLIP J MOORE MD
221 E NORTH ST
OWOSSO MI

JOHN E MOROVITZ MD
113 E WILLIAMS
OWOSSO MI 48867

GEORGE M AWAIS MD
113 E WILLIAMS ST
OWOSSO MI

48867

NORMAN F BACH MD
113 E WILLIAMS
OWOSSO MICH 48867

CHAS E BLACK MD
529 W GRAND RIVER
WILL I AMSTON MI 48895

RICHARD C BROWN MD
113 E WILLIAMS ST
OWOSSO MICHIGAN 48867

WALTER D BUZZARD MD

CHESANING MI 48616

EL WOOD M CHIPMAN MD R

COLDWATER MI 49036

ROBERT CLIFFORD MD
MATTHEWS BLDG

OWOSSO MICHIGAN 48867

ALFRED W FOERSTER MD
113 E WILLIAMS ST
OWOSSO MICHIGAN 48867

WM J A FORD JR MD
113 E WILLIAMS ST
OWOSSO MICHIGAN 48867

HENRY T FORSYTH MD
137 S SAGINAW ST
CHESANING MI 48616

JAMES H GRAVES MD R

150 S NORTON

CORUNNA MI 48817

ELIZABETH A L GURDEN
113 E WILLIAMS ST
OWOSSO MICH 48867

JOHN B HANNAH MD
MATTHEWS BLDG

OWOSSO MI 48867

JOHN E HARRUUN MD
323 N BALL ST

OWOSSO MI 48867

R V HARROUN MD
323 N BALL ST

OWOSSO MICHIGAN 48867

JOHN HOFSTRA MD

OWOSSO MICHIGAN 48867

VERNE L HOSHAL MD
104 W CLINTON

DURAND MICH 48429

SUN HYOO KIM MD
203 N CEDAR ST
OWOSSO MI 48867

JAMES H PARK MD
812 BRADLEY ST
OWOSSO MICH

ROLLAND PHILLIPS MD
NORTH ST PROF BLOG
OWOSSO MI 48867

CHESTER J RICHARDS MD
101 E MONROE ST
DURAND MI 48429

ROBERT L ROTY MO
MATTHEWS BLDG
OWOSSO MI

ELMER H MERRILL MD
506 GILFORO RD
48867 | CARO MICH

EDWARD J MILES MD
261 GOLFVIEW DR
CARO MI

HERBERT L NIGG MD

48867 | CARO MI

EWALD C SWANSON MD
220 N MAIN
VASSAR MICH

MITCHELL URBAN MD
CARO STATE HOSPITAL
CARO MI

OTTO VON RENNER MD
BOX 396

48867 | REESE Ml

L

48723

48723

48723

L

48768

48723

L

48757

JOS F SAHLMARK MD
812 BRADLEY ST
OWOSSO MICH 48867

PETER SAUER MD
113 E WILLIAMS
OWOSSO MICH

WALTER F SHEPHERD MD
BOX 148

COLDWATER MI 49036

WM F WEINKAUF MD
203 N SHIAWASSEE ST
CORUNNA MI 48817

GEO B WICKSTROM MD
529 CLARK AVE

OWOSSO MICH 48867

VAN BUREN

CARL F BOOTHBY MO
19 S CENTER
48867 I HARTFORD MI

FREOK M BOOTHBY MD

LAWRENCE MI

49057

R

49064

ROBERT B YUHN MD
826 W KING
OWOSSO MI

48867

RAYMOND J WINFIELD MD
3014 MAIN ST

MARLETTE MICH 48453

JOHN F MAC GREGOR MD
113 E WILLIAMS ST
OWOSSO MICH 48867

J S MCGEEHAN MO
MATTHEWS BLDG
OWOSSO MICHIGAN

48867

EDWIN R MC KNIGHT MD
320 N WASHINGTON ST
OWOSSO MICH 48867

TUSCOLA

NORMA ANDERSON MD
206 ELLINGTON

CARO MICHIGAN 48723

JAMES H BALLARD MD

CASS CITY MI 48726

MAUR ICE H CHAPIN MD
P 0 BOX 323

MILLINGTON MICHIGAN 48746

VERSA V COLE MD
3340 SAGINAW RD
SAGINAW MI 48605

WILLARD W DICKERSON MD R

1149 N 92ND ST
SCOTTSDALE AR I Z 85256

HAROLD T DONAHUE MO
4674 HILL ST

CASS CITY MICH 48726

E N ELMENDORF II MD

VASSAR MI 48768

MELIH ERHAN MD
CARO STATE HOSPITAL
CARO MI 48723

ROBT R HOWLETT MO R

MCMASTERS BRIDGE RO
STAR RTE 221A

GRAYLING MI 49738

GEZA KOVACS MD
861 GILFORD ROAD
CARO MICHIGAN 48723

MAURICE D BUSKIRK MD

215 N KALAMAZOO

PAW PAW Ml 49079

JOS E COOPER MO
M-43 WEST

BANGOR MICH 49013

JAMES M DAVIS MD
424 HURON ST

SOUTH HAVEN MICHIGAN 49090

BERT DIEPHUIS MD
511 HURON ST

SOUTH HAVEN MI 49090

H DAVID FENSKE MD

412 PHOENIX ST

SOUTH HAVEN MI 49090

AVISON GANO MD
417 MONROE ST

BANGOR MICH 49013

GEORGE E HUG MD
81 MONROE ST

SOUTH HAVEN MI 49090

JOHN F ITZEN MD L

PO BOX 485

SOUTH HAVEN MICH 49090

JOHN A KLEBER MD
365 BROADWAY

SOUTH HAVEN MICH 49090

JOHN LAWTHER MD
PO BOX 191

HARTFORD MICHIGAN 49057

FRANK J LOOMIS MD

304 OAK

PAW PAW MI 49079

HENRY J LUKASZEK MD

77 N SHORE DRIVE

SOUTH HAVEN MI 49090

ROSCOE I MCFADDEN MD
P 0 BOX 280

GOBLES MI 49055

DAVID J MILLARD MD

305 E OAK ST

PAW PAW MI 49079

DALE K MORGAN MD

403 PHOENIX ST

SOUTH HAVEN MICHIGAN 49090

JANUARY, 1972/Michigan Medicine 53

Van Buren County

LISTED BY COMPONENT MEDICAL SOCIETIES

NEIL D MULLINS MD

RUSSELL M ATCHISON MD

LEONARD F BENDER MO

P 0 BOX 283

501 W DUNLAP

1405 E ANN UN I V HOSP

BLOOMINGDALE MI

49026

NORTHV I LLE MICH

48167

ANN ARBOR MI

48104

ARTHUR E PARKS MD

ROBERT G AUSE MD

R M BENSON MAJ MC

A

148 N MAIN

1821 SHERIDAN

4601 PRISCILLA LN

LAWTON MI

49065

ANN ARBOR MICHIGAN

48104

WICHITA FALLS TX

76306

R W SPALDING M D

CARL E BADGLEY MD

L

FREDK E BENTLEY MD

PO BOX 280

1257 ISLAND DR

851 S MAIN ST

GOBLES MI

49055

ANN ARBOR MI

48105

PLYMOUTH MICH

48170

AOELBERT L STAGG MD

ROBT W BAILEY MO

TERRY J BERGSTROM MD

A

9 N MAPLE ST

UNIVERSITY HOSP

375 MARAVILLA DR

HARTFORD MICH

49057

ANN ARBOR MICH

48104

RIVERSIDE CA

92507

G LEE STAGG MD

DALE E BAKER MD

CARL F BERNER MD

A

BOX 307

ST JOSEPH MERCY HOSP

UN I V MEDICAL CTR

HARTFORD MICHIGAN

49057

ANN ARBOR MI

48104

ANN ARBOR MI

48104

RUTH E A STAGG MD

EMILY A BANDERA MD

R C BERNREUTER MD

BOX 38

4200 E HURON RIVER DR

213 CLARK ST

HARTFORD MICH

49057

ANN ARBOR MICHIGAN

48104

SALINE MI

48176

PAUL W SUNDIN MD

JAROSLAV M BANOERA MD

JOHN N BICKNELL MD

4200 E HURON RIVER DR

703 FIRST NATL BLDG

DECATUR MI

49045

ANN ARBOR MICHIGAN

48104

ANN ARBOR MICHIGAN

48106

CHARLES TEN HOUTEN MD

NORMAN L BANGHART MD

GERALD E BLANCHARD MD

215 N KALAMAZOO

1950 MANCHESTER RD

775 SO MAIN ST

PAW PAW MI

49079

ANN ARBOR MICH

48104

CHELSEA MI

48118

EDWIN H TERWILLIGER MD R

PAUL S BARKER MD

R

LYNN W BLUNT MD

10428 SPOONBILL RD W

BOX 87

P 0 BOX 2060

BRADENTON FL

33505

BONNOTS MILL MO

65016

ANN ARBOR MI

48106

MARTIN J URIST MD

R

R CRAIG BARLOW MD

DELBERT E BOBLITT MD

ROUTE 5

326 N INGALLS ST

2112 WALLINGFORD

SOUTH HAVEN MI

49090

ANN ARBOR MICH

48104

ANN ARBOR MICHIGAN

48104

DAVID B WITTE MD

WALTER L BARRON MD

WILLIAM J BOGARD MO

A

403 PHOENIX ST

2201 DELAWARE

BOX A

SOUTH HAVEN MI

49090

ANN ARBOR MICHIGAN

48103

YPSILANTI MI

48197

WM R YOUNG MO

L

WM A BARSS MD

ROGER BOLES MD

THIRD ST

525 W CROSS ST

980 COUNTRY CLUB RD

LAWTON MI

49065

YPSILANTI MICH

48197

ANN ARBOR MICHIGAN

48105

LEE E BARTHOLOMEW MD

JAMES H BOTSFORD MO

1355 FAIRLANE DR

775 S MAIN ST

WASHTENAW

ANN ARBOR MI

48104

CHELSEA MICHIGAN

48118

MAURICE S ALB I N MD

GAIL M BARTON MD

A

JOHN E BOUOEMAN MD

180 UNDERDOWN DR

N P I UN I V HOSP

425 E WASHINGTON ST

ANN ARBOR MI

48105

ANN ARBOR MI

48104

ANN ARBOR Ml

48108

DON K ALEXANDER MD

THOMAS J BASS MD

RALPH L BRANDT MD

301 N INGALLS ST

201 S HAMILTON

326 N INGALLS

ANN ARBOR MI

48104

YPSILANTI MICH

48197

ANN ARBOR MICHIGAN

48104

BARRY H ALFORD MD

PAUL H BASSOW MO

L

BARRY A BREAKEY MD

385 N MILL

ST JOSEPH HOSP

2216 MEDFORO

PLYMOUTH MICHIGAN

48170

ANN ARBOR MI

48104

ANN ARBOR MICHIGAN

48104

RICHARD J ALLEN MD

BARRY F BATES MD

WILSON K BREWER MD

R

UNIVERSITY HOSPITAL

ST JOSEPH MERCY HOSP

4255 WASHTENAW

ANN ARBOR MICHIGAN

48104

ANN ARBOR MI

48104

ANN ARBOR MI

48104

LYLE M ALLIS MD

JOHN G BATSAKIS MD

EUGENE M BRITT PHD

A

2355 E STAOIUM BLVD

U OF M - PATH DEPT

1411 BAROSTOWN TR

ANN ARBOR MI

48104

ANN ARBOR MI

48104

ANN ARBOR MI

48105

DAVID G ANDERSON MO

GERHARD H BAUER MD

ROBERT H BROUGHER MD

2490 ADARE

2015 MANCHESTER RD

606 W STADIUM BLVD

ANN ARBOR MICH

48104

ANN ARBOR MICH

48104

ANN ARBOR MI

48103

GERHARD D ANDERSON MD

A

JERE M BAUER MD

WALTER G BROVINS MD

9500 E ORCHARD DR

1313 E ANN ST

YPSILANTI STATE HOSP

ENGLEWOOD CO

80110

ANN ARBOR MICH

48104

YPSILANTI MICHIGAN

48197

ROBT E ANDERSON MD

SAME BEHRMAN MD

PHILIP N BROWN MD

R

2136 S SEVENTH

2866 PROVINCIAL DR

1265 LONG LAKE COURT

ANN ARBOR MI

48103

ANN ARBOR MICH

48104

BRIGHTON MI

48116

RUSSELL C ANDERSON MO

A

WM H BEIERWALTES MD

WM E BROWN III MD

UN I V MEDICAL CTR

U M MEDICAL CENTER

2101 BELMONT RD

ANN ARBOR MI

48104

ANN ARBOR MICHIGAN

48104

ANN ARBOR MICH

48104

HENRY D APPELMAN MD

RICHARD A BE I SON MD

PAUL J BROWNSON MD

UN I V MEDICAL CENTER

1795 W STAOIUM

CHELSEA MEDICAL CLINI

C

ANN ARBOR MI

48104.

ANN ARBOR MICHIGAN

48103

CHELSEA MI

48118

ROSITA N AQUINO MD

A

WALTER BELSER MD

H C BRYANT M D

ST JOSEPH MERCY HOSP

2310 E STAOIUM BLVD

425 E WASHINGTON

ANN ARGOR MI

48104

ANN ARBOR MICH

48104

ANN ARBOR MICHIGAN

48108

HARRY D 8UCAL0 JR MD

2207 S SEVENTH

ANN ARBOR MICHIGAN 48103

ROBERT A BUCHANAN MO
3045 FOXCROFT

ANN ARBOR MICHIGAN 48104

ROY E BUCK MO A

1 AO 5 E ANN ST

ANN ARBOR MI 48104

JACK L BUSH MO

1950 MANCHESTER RD

ANN ARBOR MICHIGAN 48104

GERALD E BUTLER MO

2311 E STADIUM BLVD

ANN ARBOR MICHIGAN 48104

GEORGE H CAMERUN MO

2311 E STADIUM

ANN ARBOR MI 48104

COLIN CAMPBELL MO

2110 WOMENS HOSPITAL

ANN ARBOR MI 48104

DARRELL A CAMPBELL MO
617 STRATFORD

ANN ARBOR MICH 48104

A M CAP I L I MD
840 MAUS

YPSILANTI MI 48197

E ESQUEJO CAPILI MD
840 MAUS

YPSILANTI MI 48197

ROBT B CAR8ECK MD
3080 EXMOOR

ANN ARBOR MICHIGAN 48104

CATHERINE CARROLL MD
1130 HILL ST

ANN ARBOR MICH 48104

DEAN P CARRON MD
425 E WASHINGTON
ANN ARBOR MICHIGAN 48108

SAMUEL H CARTER MD

ST JOSEPH MERCY HOSP

ANN ARBOR MI 48104

JAMES T CASSIDY MD
590 LANSWAY

ANN ARBOR MI 48103

JOSEPH C CERNY MD

3021 PROVINCIAL DR

ANN ARBOR MICHIGAN 48104

OANIEL D CHAPMAN MD

825 PACKARO RD

ANN ARBOR MI 48104

GEORGE J CHATAS MD

2984 HICKORY LANE

ANN ARBOR MICHIGAN 48104

ROBERT H CHESKY MD
2020 HALL AVE

ANN ARBOR MI 48104

CHAS G CHILD 111 MD
UNIVERSITY HOSPITAL
ANN ARBOR MICHIGAN 48104

EUGENE F CLAEYS MO

3775 GREENBRIAR #234A

ANN ARBOR MI 48105

ALLAN G CLAGUE MD
3444 ROB I NWOOD DR
ANN ARBOR MI 48103

ENSIGN E CLYDE MD

1181 S MAIN ST

PLYMOUTH MICH 48170

BRUCt E COHAN MD

2355 E STADIUM BLVD

ANN ARBOR MICHIGAN 48104

54 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Washtenaw County

JEROME W CONN MD

CARA G DOANE MD

JUAN V FAYOS MD

200 ORCHARD HILL DR

1715 WASHTENAW AVE

UNIVERSITY MED CENTER

ANN ARBOR MI

48104

YPSILANTI MI

48197

ANN ARBOR MICHIGAN

48104

RALPH R COOK MD

A

EDWARD R DOEZEMA MD

IRVING FELLER MD

W-5641 UN I V HOSPITAL

1111 E CATHERINE

2023 DEVONSHIRE

ANN ARBOR MI

48104

ANN ARBOR MI

48104

ANN ARBOR MI

48104

MORTON S COX JR MD

WILBUR E DOLFIN MD

SHELDON L FELLMAN MD

3991 PENBURTON LN

2210 MELROSE

2216 MEDFORD RD

ANN ARBOR MI

48105

ANN ARBOR MICHIGAN

48104

ANN ARBOR MICHIGAN

48104

CLARENCE E CROOK MD

EDWARD F DOMINO MD

JAY S FINCH MO

1657 GLENNWOOD RD

3071 EXMOOR

51259 MURRAY HILL DR

ANN ARBOR MICHIGAN

48104

ANN ARBOR MICHIGAN

48104

PLYMOUTH MI

48170

THOMAS N CROSS MD

RICHARD P DORR MD

STUART M FINCH M D

UN I V MEDICAL CENTER

ST JOSEPH MERCY HOSP

CHILD PSYCHIATRIC HOSP

ANN ARBOR MICHIGAN

48104

ANN ARBOR MI

48104

ANN ARBOR MI

48104

EDWARD G CURTIS MD

RUDENZ T DOUTHAT MD

GEO C FINK MD

1825 W STADIUM BLVD

1415 BEECHWOOD

411 LINDA VISTA

ANN ARBOR MICHIGAN

48103

ANN ARBOR MI

48103

ANN ARBOR MICH

48104

CHARLES W DAVENPORT

MD

JAMES R DRIVER MD

JOHN A FINK MD

A

CHILDREN S PSYCH HOSP

155 UNDERDOWN

UN I V medical center

ANN ARBOR MI

48104

ANN ARBOR MI

48105

ANN ARBOR MI

48104

FRED M OAVENPORT MD

CLYDE K DRYER MD

JOS V FISHER MO

1038 MARTIN PL

3033 SOPHIA ST

116 PARK ST

ANN ARBOR MICH

48104

WAYNE MICH

48184

CHELSEA MI

48118

PAULA G DAVEY MD

MAX L DURFEE MD

ROBERT J FISHER MD

425 E WASHINGTON

207 FLETCHER

750 TOWNER

ANN ARBOR MI

48108

ANN ARBOR MI

48104

YPSILANTI MI

48197

WINTHROP N DAVEY MD

JOHN E DWYER MD

ARTHUR W FLEMING MD

331-F LAKEMOORE DR NE

425 E WASHINGTON

2126 PAULINE 304

ATLANTA GA

30342

ANN ARBOR MI

48108

ANN ARBOR MI

48103

RICHARD W DEATRICK MD

WM P EDMUNDS MD

WILLIAM J FOLEY MD

623 WATERSEDGE

750 TOWNER

1075 BARTON DR #116

ANN ARBOR MICH

48105

YPSILANTI MICH

48197

ANN ARBOR MI

48105

P F ROBERT DECA IRES

MD

MELVIN L EDWARDS JR

MD

WINSLOW G FOX M D

2730 N RANDOLPH

1210 MAPLE RD

715 N UNIVERSITY

ARLINGTON VA

22207

ANN ARBOR MI

48103

ANN ARBOR MICH

48104

RUSSELL N DE JONG MD

JOHAN W ELIOT MD

F BRUCE FRALICK MD

1526 HARDING RD

SCH OF PUB HEALTH

UNIVERSITY HOSP

ANN ARBOR MICH

48104

ANN ARBOR MI

48104

D-2137 N OUT PATIENT

THOMAS J DEKORNFELD

MD

LYLE D ELLIOTT MD

ANN ARBOR MI

48104

2581 HAWTHORN RD

750 TOWNER ST

ANN ARBOR MICHIGAN

48104

YPSILANTI MICH

48197

ROBT L FRANSWAY MD
2785 PARK RIDGE DR

THOMAS A DELL MD

WARREN E EMLEY MD

A

ANN ARBOR MI

48103

2900 BRANDYWINE

UN I V MEDICAL CTR

ANN ARBOR MI

48104

ANN ARBOR MI

48104

ARTHUR B FRENCH MD
280 OAKWAY

W 0 DEN HOUTER MD

OTTO K ENGELKE MD

L

ANN ARBOR MI

48105

225 N SHELDON

313 WASHTENAW CO BLDG

PLYMOUTH MI

48170

ANN ARBOR MICHIGAN

48108

A JAMES FRENCH MD
356 AUSABLE PLACE

JOHN S DE TAR MD

L

JEROME L EPSTEIN MD

ANN ARBOR MICH

48104

55 W MAIN ST

27 SO PROSPECT

MILAN MI

48160

YPSILANTI MI

48197

MARGARET S FRENCH MD
VET ADMIN HOSPITAL

RICHARD C DEW MD

MEHMET E ERDEM MD

ANN ARBOR MI

48105

2355 E STADIUM BLVD

PLYMOUTH STATE HOME

ANN ARBOR MI

48104

NORTHVILLE MI

48167

CHARLES F FREY MD
3555 DALEVIEW DR

RODRIGO DIAZ PEREZ MD

ELWIN C FALK MD

ANN ARBOR MI

48103

2959 HICKORY LN

461 N MANSFIELD

ANN ARBOR MICHIGAN

48104

YPSILANTI MICHIGAN

48197

MOSES M FROHLICH MD
1313 E ANN ST

L

GORDON C DIETERICH MD

DANIEL J FALL MD

ANN ARBOR MICH

48104

4038 JACKSON RD

ST JOSEPH MERCY HOSP

ANN ARBOR MICH

48106

ANN ARBOR MI

48104

LYLE W FROST MD
309 N WASHINGTON ST

RICHARD S DILLMAN MD

HAROLD F FALLS MD

YPSILANTI MICH

48197

1450 COVINGTON

UNIVERSITY HOSP

ANN ARBOR MI

48103

ANN ARBOR MICH

48104

CARL M FRYE MD
301 N INGALLS

REED 0 DINGMAN MD

SAEED M FARHAT MD

ANN ARBOR MICHIGAN

48104

221 N INGALLS

424 ONAWAY

ANN ARBOR MICHIGAN

48104

ANN ARBOR MI

48104

T 0 GABRIELSEN MD

UNIVERSITY MED CENTER

BERTRAM D DINMAN MD

ARMANDO R FAVAZZA MD

A

OCCUP SAFETY £ HLTH

N P I UN I V OF MICH

DEPT OF RADIOLOGY

CASE POSTALE 500
CH- 1211

ANN ARBOR MI

48104

ANN ARBOR MI

48103

GENE VE22 SWITZERLAND

BARBARA S FAVAZZA MD

A

JOHN C GALL MD

N P I UN I V OF MICH

2912 SHEFFIELD CT

ANN ARBOR MI

48104

ANN ARBOR MI

48105

JAMES E GALL IGAN MO
18471 HAGGERTY RD
NORTHVILLE Ml 48167

0 E GARRISON MO
205 S DAVENPORT
SALINE MI 48176

CHARLES F GEHRKE MD

ST JOSEPH MERCY HSOP

ANN ARBOR MI 48104

PAUL F GERIGK MD
2410 MOLLN
KRS LAUENBURG
NEUES LAND 9
WEST GERMANY

VLADO A GETTING MD
SCH OF PUB HLTH U OF M

ANN ARBOR MICH 48104

RALPH M GIGNAC MD

32320 MICHIGAN

WAYNE MICH 48184

PAUL W GIKAS MD
1900 MERSHON

ANN ARBOR MI 48103

ROSALIE J GING MD
VETERANS ADM HOSP
ANN ARBOR MI 48105

DONALD W GO IN MD

3210 DELRAY DR

FT WAYNE IND 46805

ROBT I GOLDSMITH MD

216 MICH THEATRE BLDG

ANN ARBOR MI 48106

F E GONZALEZ-VIDELA MD A
3501 WILLIS RD
YPSILANTI MI

LOWELL I GOODMAN MD
2800 PLYMOUTH RD
ANN ARBOR MI

J R G GOSLING MD
315 CORRIE RD
ANN ARBOR MICHIGAN

JOEL D GOTTLIEB MD
3946 PEN8ER TON
ANN ARBOR MICHIGAN

ALEXANDER GOTZ MD
2201 MEDFORD RO
ANN ARBOR MICH

STUART M GOULD JR MO
MERCYWOOD HOSP BOX 65
ANN ARBOR MICHIGAN 48107

WILLIAM C GRABB MD

221 N INGALLS ST

ANN ARBOR MICHIGAN 48104

WM A GRACIE JR MD
2441 SHANNONDALE

ANN ARBOR MICHIGAN 48104

WM H GRAVES III MD

1825 W STADIUM BLVD

ANN ARBOR MI 48103

JERRY M GRAY MD

ST JOSEPH MERCY HOSP

ANN ARBOR MI 48104

GEORGE W GREENMAN MD

2311 E STADIUM BLVD

ANN ARBOR MI 48104

S PHILLIP GRILLO MD
265 MAIN ST

BELLEVILLE MI 48111

GERARD GROS MD
5300 BOLSOM TERRACE
PLANTATION FL 33314

48197

48105

48105

48105

48104

JANUARY, 1972/Michigan Medicine 55

Washtenaw County

LISTED BY COMPONENT MEDICAL SOCIETIES

GLENN R GROUSTRA MO

555 E WILLIAMS

ANN ARBOR MI 48108

NORMA 8 GUTIERREZ MD
1507 PINE VALLY 6LVO

ANN ARBOR MI 48104

OAN W HABEL MO M

WEST 104 5TH ST

SPOKANE WA 99204

GEO W HAGERMAN MO

321 N INGALLS ST

ANN ARBOR MICH 48104

WALTER W HAMMONO JR MO
221 N SHELDON RO
PLYMOUTH MI 48170

HEINRICH H HANOORF MO L
455 PARK PLACE
NORTHVILLE MI 48167

LAMAR J HANKAMP MO
2119 WOODS I DE

ANN ARBOR MICH 48104

MARVIN R HANNUM MO
54 W MAIN

MILAN MICH 48160

FREDERICK N HANSON MO
34178 SPRING VALLEY
WESTLAND MI 48185

E R HARRELL JR MO
UN I V MED CTR RM C
ANN ARBOR MICH 48104

BRAOLEY M HARRIS MD L

27 S PROSPECT

YPSILANTI MICH 48197

SCOTT T HARRIS MD
GAYLORD STATE HOME
GAYLORD MI 49735

ROB T T HARTMAN MO
519 W MAIN

MILAN MICH 48160

WM N HAWKS JR MD A

14323 STOFER CT

CHELSEA MI 48118

DAV10 K HEAPS MO A

UN I V MEDICAL CTR

ANN AR80R MI 48104

GERHARDT A HEIN MD

2890 PEBBLE CREEK RD

ANN ARBOR MI 48104

JOHN W HENDERSON MD

UNIVERSITY HOSP

ANN ARBOR MICH 48104

ROBT C HENDRIX MO

1139 VESPER RO

ANN ARBOR MICH 48103

L OELL HENRY MD L

706 W HURON ST

ANN ARBOR MI 48103

F JAMES HERBERTSON MO

ST JOSEPH MERCY HOSP

ANN ARBOR MI 48104

JAMES E HERLOCHER MO

2355 E STADIUM BLVD

ANN ARBOR MI 48104

KARL R HERWIG MD
UN I V MEOICAL CTR
ANN ARBOR MI 48104

WM M HESTON III MD

720 E CATHERINE

ANN ARBOR MI 48104

SAMUEL P HICKS MO

1112 MEADOWBROOK

ANN ARBOR MICHIGAN 48103

H MARK HILDEBRANDT MD

JOSEPH G JENDER MD

940 MAIOEN LANE

1302 W MAPLE ST

ANN ARBOR MICH

48105

PLYMOUTH MI

48170

CHARLES A HILL MD

ROBERT E JENSEN MD

A

425 E WASHINGTON ST

UN I V MEDICAL CTR

ANN ARBOR MI

48108

ANN ARBOR MI

48104

DORIN L HINERMAN MO

B JIMENEZ MD

R

1313 E ANN ST

2325 DEVONSHIRE

ANN ARBOR MICH

48104

ANN ARBOR MI

48104

NG HARRY HING MO

ROBT D JOHNSON MO

1323 FRANKLIN BLVD

3432 WOODLEA DR

ANN ARBOR MI

48103

ANN ARBOR MICH

48103

MIKIO H HIRAGA MD

SYDNEY JOSEPH MD

1795 W STADIUM

P 0 BOX 1127

ANN ARBOR MICHIGAN

48103

ANN ARBOR MI

48106

FREDERIC L HOCH MD

FRANCIS P JUDGE MD

A

7696 KRESGE BLOG

UN I V OF MICHIGAN

ANN ARBOR MI

48104

NEUROLOGY DEPT

ANN ARBOR MI

48104

FRED J HODGES MO

L

5 HIGHLAND LN

RICHARD D JUDGE MD

ANN ARBOR MI

48104

UN I V MEDICAL CENTER

ANN ARBOR MICHIGAN

48104

JOHN F HOLT MO

1313 E ANN ST

ANDREA C JUNGWIRTH MD A

ANN ARBOR MICH

48104

UN IV HOSP PHYS MEO

ANN ARBOR Ml

48104

FRED HOLTZ MD

326 N INGALLS

THEODORE G KABZ A MD

ANN ARBOR MICHIGAN

48104

326 N INGALLS

ANN ARBOR MICHIGAN

48104

MILTON R HORWITZ MD

A

UN I V OF MICHIGAN

EDGAR A KAHN MD

L

ANN ARBOR MI

48104

500 BURSON PL

ANN ARBOR MICH

48104

VERNE L HOSHAL JR MD

ST JOSEPH MERCY HOSP

ARNOLD H KAMBLY JR MD

ANN ARBOR MI

48104

201 S MAIN ST

ANN ARBOR MICH

48108

PHILLIP A HOSKINS MD

826 EDGEWOOD PL

HERBERT KAUFER MD

ANN ARBOR MI

48103

UN I V MEDICAL CTR

ANN ARBOR MI

48104

FREDERIC B HOUSE MO

7965 N TERRITORIAL RO

DONALD R KAY MD

A

DEXTER MI

48130

UPJOHN CENTER

ANN ARBOR MI

48104

STACY C HOWARD MD

R

1936 WHITEHALL DR

FRANK V KEARY MD

A

WINTER PARK FL

32789

1760 WASHTENAW AVE

YPSILANTI MI

48197

WILLIAM F HOWATT MD

UNIVERSITY HOSPITAL

PAUL A KELLEY MD

ANN ARBOR MICH

48104

326 N INGALLS

ANN ARBOR MICHIGAN

48104

PHILIP B HUIZENGA MD

BOX A

MAHMOOO KELYADERANY

MD A

YPSILANTI MICHIGAN

48197

ST JOSEPH MERCY HOSP

ANN ARBOR MI

48104

RALPH M HULETT MD

2881 PROVINCIAL DR

DAVID C KEM MD

M

ANN ARBOR MICHIGAN

48104

TRIPLER GEN HOSP

APO SAN FRANCISCO CA

96438

RALPH F HULL MD

A

UN I V MEDICAL CTR

W R KEMP JR MD

ANN ARBOR MI

48104

8124 MAIN ST

DEXTER MICH

48130

DAVID W HUNTER MD

A

UN I V MEDICAL CENTER

SUSAN J KENNEDY MD

ANN ARBOR MI

48104

ST JOSEPH MERCY HOSP

ANN ARBOR MI

48104

SAML J HYMAN MD

27342 MICHIGAN AVE

A C KERL I KOWSKE MD

L

INKSTER MICH

48141

7111 S RIVERSIDE DR

MARINE CITY MI

48039

ROBT S IDESON I I MD

2200 VINEWOOD AVE

WHEELER H KERN MD

L

ANN ARBOR MICHIGAN

48104

2011 MIDDLEBELT RD

GARDEN CITY MICHIGAN

48135

JOSEPH E JACKSON MD

A

SCHOOL OF PUBLIC HLTH

ROBERT L KERRY MD

UN I V OF MICH

340 BARTON NORTH DR

ANN ARBOR MI

48104

ANN ARBOR MICHIGAN

48105

JOS S JACOB MD

JAMIL KHEOcR MD

202 E WASHINGTON ST

44526 CLARE BLVD

ANN ARBOR MICH

48108

PLYMOUTH MICHIGAN

48170

FRANK W JEFFRIES MD

CHONGJIN KIM MD

425 E WASHINGTON ST

PLY STATE TRAIN HOME

ANN ARBOR MI

48108

NORTHVILLE MI

48176

WM W KIMBROUGH MO

1230 FAIR OAKS PKWY

ANN ARBOR MICHIGAN 48104

GLENN W KINDT MO
UN I V MEDICAL CTR
ANN ARBOR MI 48104

LOUIS P K I V I MO

5950 W TEXTILE RO

SALINE MI 48176

EDWARD W KLEIN MD

ST JOSEPH MERCY HOSP

ANN ARBOR MI 48104

LEO A KNOLL MO R

2002 SCOTTWOOD

ANN ARBOR Ml 48104

GEO H KOEPKE MO

UNIVERSITY HOSPITAL

ANN ARBOR MICH 48104

EMRE KOKMEN MD

UN I V MEDICAL CENTER

ANN ARBOR MI 48104

KENNETH A KOOI MO

2132 NEEDHAM RO

ANN ARBOR MICHIGAN 48104

RICHARD 0 KRAFT MO

959 MAIDEN LANE

ANN ARBOR MI 48105

CHAS F KRAUSSE MD
116 PARK ST

CHELSEA MICHIGAN 48118

EDMUND M KRIGBAUM MD

3075 OVERRIOGE OR

ANN ARBOR MICHIGAN 48104

GLEN H KUMASAKA MD
1486 CEDAR BEND OR
ANN ARBOR MICHIGAN 48105

ISAOORE LAMPE MD
1313 E ANN ST

ANN ARBOR MICH 48104

JACK LAPIDES MD

UNIVERSITY HOSPITAL

ANN ARBOR MICH 48104

CARLOS M LAUCHU MO

1277 WISTERIA DR

ANN ARBOR MI 48104

JOHN L LAW MD R

1116 41ST AVE E

SEATTLE WA 98102

GLENN 0 LEASE MD

3460 COTTONTAIL LANE

ANN ARBOR MI 48103

FREO LEE MD
1926 DAY ST

ANN ARBOR MI 48104

S M LINOENAUER MD

2711 ANT I E TAM COURT

ANN ARBOR MI 48105

0 1 ANA LITTLE MO

2200 FULLER RD

ANN ARBOR MI 48105

GAIL ANN LOCKEN MD
8255 W HURON RIVER OR
DEXTER MI 48130

HAROLD J LOCKETT MD

319 BROOKSIDE DR

ANN ARBOR MICH 48105

ROBERT G LOVELL M 0

326 N INGALLS ST

ANN ARBOR MICHIGAN 48104

CLAUDE M LOWRY MD

1707 SHAOFORO RD

ANN ARBUR MICH 48104

56 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Washtenaw County

ALEXANDER R LUCAS MD

PARVIZ MEGHNOT MD

GERALD A 0 CONNOR MD

951 E LAFAYETTE

740 EMERICK

ST JOSEPH MERCY HOSP

DETROIT MI

48207

YPSILANTI MI

48197

ANN ARBOR MICH

48104

KENNETH R MAGEE M D

DAVID H MIDDLETON MD

PATRICIA A 0 CONNOR

MD

1313 E ANN ST

UN I V OF MICH MED CTR

110 MASON

ANN ARBOR MICH

48104

ANN ARBOR MICHIGAN

48104

ANN ARBOR MI

48103

JOHN E MAG I EL SK I MD

WM K MILES MD

A

JOHN OLARIU MO

2355 LONDONDERRY RD

UNIVERSITY HOSP

BOX A

ANN ARBOR MICH

48104

ANN ARBOR MI

48104

YPSILANTI MICHIGAN

48197

HAROLD J MAGNUSON MD

A F MILFORD JR M D

ROBERT M ONEAL MD

SCHOOL OF PUBLIC HLTH

419 E MICHIGAN AVE

555 E WILLIAM #25J

ROOM 1522

YPSILANTI MICHIGAN

48197

ANN ARBOR MI

48108

ANN ARBOR MI

48104

BARRY MILLER MD

JAMES B ORWIG MD

A

DUNCAN J J MAGOON MD

326 N INGALLS

1867 FT STOCKTON DR

225 E LIBERTY

ANN ARBOR MI

48104

SAN DIEGO CA

92103

ANN ARBOR MI

48108

IRA I MILLER MD

L D OSTRANDER JR MD

KARL D MALCOLM MD

1718 HERMITAGE RD

2793 MANCHESTER RD

311 N INGALLS ST

ANN ARBOR MICHIGAN

48104

ANN ARBOR MICHIGAN

48104

ANN ARBOR MICH

48104

NORMAN F MILLER MD

L

MUSTAFA E OVACIK MD

JOHN E MALEY MD

820 N E 33RD ST

1130 HILL ST

5441 WALSH RD

BOCA RATON FL

33432

ANN ARBOR MI

48104

WHITMORE LAKE MICH

48189

GEO W MORLEY MD

SELCUK M OZIL MD

JOHN C MALL MD

UNIVERSITY HOSP

PLYMOUTH STATE HOME

16000 SHELDON RD

ANN ARBOR MICH

48104

NORTHVILLE MI

48167

NORTHVILLE MI

48167

JOE D MORRIS MD

GENA R PAHUCKI MD

PHILIP M MARGOLIS MD

1313 E ANN ST

940 MAIDEN LANE

725 CITY CENTER BLDG

ANN ARBOR MI

48104

ANN ARBOR MI

48105

ANN ARBOR MI

48108

AMIR M MOSTAGHIM MD

ALGERNON A PALMER MO

L

SHELDON F MARKEL MD

2480 NEWBURY CT

110 E MIODLE ST

ST JOSPEH MERCY HOSP

ANN ARBOR MI

48103

CHELSEA MI

48118

ANN ARBOR MI

48104

ROBERT H MOYAD MD

MARIA J PALUSZNY MD

WILLIAM MARTEL MD

730 TOWNER

CHILDREN S PSYCH HOSP

2972 PARKRIDGE

YPSILANTI MI

48197

ANN ARBOR MI

48104

ANN ARBOR MI

48103

JOHN MOYYAD MD

PARVIZ PANAHI MD

DONALD W MARTIN MD

740 S EMERICK ST

2355 E STADIUM BLVD

5 NORTH HAMILTON ST

YPSILANTI MICHIGAN

48197

ANN ARBOR MI

48104

YPSILANTI MICH

48197

WM A MURRAY MD

MICHAEL PAPO MD

JOYCE W MASON M D

1705 COVINGTON OR

775 S MAIN ST

1908 SCOTTWOOD

ANN ARBOR MICH

48103

CHELSEA MI

48118

ANN ARBOR MICH

48104

JAMES W MYERS MD

WALTER G PARKER MD

A

STEPHEN C MASON III MD

217 N INGALLS

745 BROOKS ST

820 E UNIVERSITY

ANN ARBOR MI

48104

ANN ARBOR MI

48103

ANN ARBOR MICH

48104

AHMEO N M NA SR MO

FRANCIS C PASLEY MD

KENNETH P MATHEWS MD

1352 MCINTYRE

18471 HAGGERTY RD

1145 ABERDEEN DR

ANN ARBOR MI

48105

NORTHVILLE MI

48167

ANN ARBOR MICH

48104

REED M NESBIT MD

L

SATYA P PASRICHA MD

WOLFGANG W MAY MD

645 N MICHIGAN AVE

YPSILANTI STATE HOSP

BOX A

JNT COMM ACCRED HOSP

YPSILANTI MI

48197

YPSILANTI MI

48197

CHICAGO ILL

60611

FRED E PATTERSON MD

VINCENT MAZZARELLA MD

ST JOSEPH MERCY HOSP

207 FLETCHER

CHAS W NEWTON JR MD

ANN ARBOR MI

48104

ANN ARBOR MI

48104

2310 E STAOIUM BLVD

ANN ARBOR MICH

48104

BEVERLY C PAYNE MD

DAVID R MC CUBBREY MD

425 E WASHINGTON ST

221 N SHELDON RD

RICHARD D NICHOLS MD

ANN ARBOR MICHIGAN

48108

PLYMOUTH MI

48170

HENRY FORD HOSP

DEPT OF OTO

DEL8ERT E PEARSON MD

JAMES A MCLEAN MD

4660 WASHTENAW

1313 E ANN ST

DETROIT MI

48202

ANN ARBOR MI

48104

ANN ARBOR MICH

48104

FAZLOLAH A NICKHAH MD

MARL IN J PEARSON MD

MALCOLM MCPHEE MD

A

132Q ELLIS RD

2205 LAFAYETTE

1308 PHAIR AVE NE

YPSILANTI MI

48197

ANN ARBOR MI

48104

ALBERTA CANADA

R H NISHIYAMA MD

JACK M PERLMAN MD

CALGARY 61

2305 VINEWOOD

2664 ANT I E TAM CT

ANN ARBOR MI

48104

ANN ARBOR MI

48105

JOHN R MC WILLIAMS MD

201 S MAIN ST

JOHN C NIXON MD

EOWIN P PETERSON MD

ANN ARBOR MICH

48108

1155 GREEN RD

L-2212 WOMENS HOSP

ANN ARBOR MICHIGAN

48105

ANN ARBOR MI

48104

JOSEPH M MEAOOWS JR MD

2685 OVERRIDGE DR

RUDOLF E NOBEL MD

THOMAS R PETERSON MD

ANN ARBOR MICH

48104

612 S FOREST

2015 MANCHESTER RD

ANN ARBOR MICH

48104

ANN ARBOR MICH

48104

LOUIS W MEEKS MD

730 TOWNER

JOSEPH R NOVELLO MO

GUST C PETROPOULOS MD

YPSILANTI MI

48197

UN I V OF MICHIGAN

2104 BROCKMAN BLVO

ANN ARBOR MI

48103

ANN ARBOR MI

48104

ROSWELL R PFISTER MD A

RETINA FOUNDATION
2 A3 CHARLES ST
EAR G EYE INFIRMARY
BOSTON MASS 02114

RICHARD E PFRENDER MD M

EDWIN H PLACE MD R

2616 HAWTHORN RD

ANN ARBOR MI 48104

H MARVIN POLLARD MD

2012 VINEWOOD BLVO

ANN ARBOR MICH 48104

ROGER W POSTMUS MD

662 WEMBLEY CT

ANN ARBOR MICHIGAN 48103

MARCIA L POTTER MD

318 W CROSS ST

YPSILANTI MICH 48197

RHODA M POWSNER MD
1050 WALL ST

ANN ARBOR MI 48105

ANDREW K POZNANSKI MD

UN I V HO SP RADIOLOGY

ANN ARBOR MI 48104

STEPHEN N PRESTON MD

PARKE DAVIS £ CO

ANN ARBOR MI 48105

LAWRENCE PREUSS MD

2133 DELAWARE DRIVE

ANN ARBOR MICHIGAN 48103

GORDON J PROUT MD
401 MILLS RD

SALINE MICH 48176

F L PURCELL MD
HYDROMATIC DIV
WILLOW RUN

YPSILANTI MI 48197

HUGO QUIROZ MD

26585 13 MILE RD

FRANKLIN MI 48025

JAMES W RAE JR MD
1313 E ANN ST

ANN ARBOR MICH 48104

HENRY K RANSOM MD L

721 SOUTH FOREST

ANN ARBOR MICH 48104

THEOPHILE RAPHAEL MD L

2734 PEACHTREE (KC201
NW ATLANTA GA 30305

ROBERT RAPP MD

1460 CEDAR BENO DR

ANN ARBOR MI 48105

RIGDON K RATLIFF MD L

326 N INGALLS ST

ANN ARBOR MICH 48104

WM J REGAN JR MD
326 N INGALLS

ANN ARBOR MICH 48104

ROBT C REHNER MD

2378 E STADIUM BLVD

ANN ARBOR MICHIGAN 48104

RUDOLPH E REICHERT JR
1046 BALDWIN

ANN ARBOR MICH 48104

MELVIN J REINHART MD

1921 HAMPTON CT

ANN ARBOR MICHIGAN 48103

WM R REKSHAN MD
47558 N SHORE DR
BELLEVILLE MI 48111

JANUARY, 1972/Michigan Medicine 57

Washtenaw County

LISTED BY COMPONENT MEDICAL SOCIETIES

ELIZABETH J RICH MD

WM E SCHUMACHER MD

L

ELEANOR SMITH MD

1475 STEIN RD

425 E WASHINGTON ST

PEDLAR MILLS VA

24574

ANN ARBOR MI

48103

ANN ARBOR MICHIGAN

48108

KATHRYN E RICHARDS MD

HERBERT SCHUNK MD

RUSSELL F SMITH M D

812 KUEBLER DR

1061 COUNTRY CLUB DR

9569 MAIN ST

ANN ARBOR MI

48103

BLOOMFIELD HILLS MI

48013

WHITMORE LAKE MI

48189

DONALD D RIKER MD

HENRY A SCOVILL MD

THOMAS C SMITH MD

706 W HURON

1313 W CROSS ST

2800 PLYMOUTH RD

ANN ARBOR MI

48103

YPSILANTI MICH

48197

ANN ARBOR MI

48106

FRANK N RITTER MO

MAURICE H SEEVERS MD

L

WILL 1AM S SMITH MD

2675 ENGLAVE OR

740 SPRING VALLEY DR

C4202 UNIVER MED CTR

ANN ARBOR MICH

48103

ANN ARBOR MICH

48105

ANN ARBOR MICHIGAN

48104

AMES ROBEY MD

MARIA Z SEGAT MD

JAMES SONNEGA MD

BOX 2060

455 HUNTINGTON DRIVE

HAWTHORN CENTER

ANN ARBOR MI

48104

ANN ARBOR MICH

48104

NORTHVILLE MI

48167

ORLO J ROBINSON JR MD

MELVIN L SELZER MD

EVANGELINE SPINDLER

MD A

501 DUNLAP

609 E LIBERTY

555 E WILLIAMS

NORTHVILLE MICH

48167

ANN ARBOR MICH

48108

ANN ARBOR MI

48105

WM D ROBINSON MO

JAMES D SHADOAN MO

GERALD A STAIR MD

1405 E ANN ST

314 WASHINGTON ST

740 SO EMERICK

ANN ARBOR MICH

48104

CHELSEA MI

48118

YPSILANTI MI

48197

WALDOMAR M ROESER MD

MOHAMMAD SHAFII MD

A

VERNON A STEHMAN MD

1660 ARLINGTON

CHILDRENS PSYCH HOSP

YPSILANTI STATE HOSP

ANN ARBOR MI

48104

ANN ARBOR MI

48104

YPSILANTI MI

48197

C HOWARD ROSS MD

L

JULES SHAMMAS MD

MAYNARD L STETTEN MD

' M

1725 GLASTONBURY

2260 PRAIRIE

9355 ISLAND DR

ANN ARBOR MI

48103

ANN ARBOR MI

48105

GROSSE ILE MI

48138

DONALD L RUCKNAGEL MD

ROBERT A SHE I MAN MO

A

GEORGINE M STEUDE MD

1141 CLAIRE CIRCLE

80 CARTRIGHT APT 5H

1450 BARDSTOWN

ANN ARBOR MICHIGAN

48103

BRIDGEPORT CONN

06604

ANN ARBOR MI

48105

SAM F RUSSO MD

JOHN C SHELTON MD

CYRUS W STIMSON MD

9551 MAIN ST

105 FERRIS

235 E 78TH ST

WHITMORE LAKE MICH

48189

YPSILANTI MICHIGAN

4.8197

NEW YORK N Y

10021

GARY S SANDALL MO

W W SHERVINGTON MD

A

W INN I FRED E STOREY MO

611 CHURCH ST

2794 PAGE ST

2311 E STADIUM BLVD

ANN ARBOR MI

48104

ANN ARBOR MI

48104

ANN ARBOR MI

48104

ALLEN SAUNDERS MD

MU A I AD SHIHAOEH MD

RUTH H STRANG MD

2361 E STADIUM BLVD

27 S PROSPECT ST

4500 E HURON RIVER DR

ANN ARBOR MICH

48104

YPSILANTI MI

48197

ANN ARBOR MI

48104

GEO S SAYRE MO

HARRIET L SHOECRAFT

MD

GEO J STRASCHNOV MD

750 TOWNER

425 E WASHINGTON

1678 MERRIMAN RD

YPSILANTI MICH

48197

ANN ARBOR MICHIGAN

48108

WAYNE MICHIGAN

48184

DONALD L SCHAEFER MD

LOUIS E SIGLER JR MD

STANLEY R STRASIUS MD A

201 E LI8ERTY

1443 COVINGTON DR

54650 EUSTIS ST

ANN ARBOR MICHIGAN

48108

ANN ARBOR MICH

48103

FORT KNOX KY

40121

EVE M SCHLECTE MD

JOHN F SIMPSON MD

JAMES N P STRUTHERS

MD L

2307 HIGHLAND RD

DEPT OF NEUROLOGY

17617 EDINBOROUGH RD

ANN ARBOR MI

48104

UN I V OF MICH HOSP

DETROIT MI

48219

C M SCHMIDT MD

ANN ARBOR Ml

48104

BRUCE T STUBBS MD

A

959 MAIDEN LANE

812 MCKINLEY

ANN ARBOR MI

48105

MAJ L R SIMSON MC
113 SAGE DR

M

CHELSEA MICHIGAN

48118

DAVIO W SCHMIDT MD

UNIVERSAL CITY TX

78148

ERROL R SWEET MO

1230 N MAPLE RD

1076 ISLAND DR CT 104

ANN ARBOR MI

48103

OLGA S1R0LA MD
1710 COLLEGEWOOD

ANN ARBOR MI

48105

GERARD M SCHMI T MD

YPSILANTI MICH

48197

ROBT B SWEET MD

555 E WILLIAM

1313 E ANN ST

ANN ARBOR MI

48108

JAMES C SISSON MD
2665 BALMORAL CT

ANN ARBOR MICH

48104

CHAS R SCHMITTER MD

ANN ARBOR MICHIGAN

48103

FULTON B TAYLOR MD

2825 SEQUOIA PKWY

8898 ACRONE AVE

ANN ARBOR MI

48103

VERGIL N SLEE MD
P 0 BOX 1809

MILAN MI

48160

RICHARD C SCHNEIDER MD

ANN ARBOR MICH

48106

WM B TAYLOR MD

1313 E ANN ST DEPT N

S

326 N INGALLS

ANN ARBOR MICH

48104

JOHN W SMILLIE MD
1335 FAIRLANE DR

ANN ARBOR MICHIGAN

48104

HENRY K SCHOCH MD

ANN ARBOR MICH

48104

KENNETH W TEICH MD

VETS ADMIN HOSP

1500 FIFTH AVE

ANN ARBOR MI

48105

DONALD C SMITH MD

MCKEESPORT HOSP

326 VICTOR VAUGHAN BLG

MARVIN E SCHROCK MD

ANN ARBOR MI

48104

MCKEESPORT PA

15132

2310 E STADIUM BLVD
ANN ARBOR MI

48104

EDWIN M SMITH MD

R WALLACE TEED MD

L

1815 ARBOROALE

215 S MAIN

EVA P SCHROEDER MD
YPSILANTI STATE HOSP

A

ANN ARBOR MICH

48103

ANN ARBOR MICH

48108

YPSILANTI MI

48197

SIMA TEODOROVIC MO A

ST JOSEPH MERCY HOSP

ANN ARBOR MI 48104

E THURSTON THIEME MO
ST JOSEPH MERCY HOSP
ANN ARBOR MI 48104

GEORGE R THOMPSON MO

2656 PARKRIDGE DR

ANN ARBOR MICH 48103

WM C THOMPSON 111 MO
117 N WASHINGTON ST
YPSILANTI MI 48197

BARBARA A THREATT MO
U OF M HOSP RADIOLOGY
ANN ARBOR MI 48104

JOSEPH J T I 7 I AN I MD
3412 BRASSOW

SALINE MI 48176

HARRY A TOWSLEY MD

W-5610 UN I V HOSP

ANN ARBOR MI 48104

J G TURCOTTE MO

769 HEATHERWAY

ANN ARBOR MICHIGAN 48104

JERROLD G UTSLER MD

ST JOSEPH MERCY HOSP

ANN ARBOR MI 48104

W C VANDER YACHT MO

203 RUSSELL ST

SALINE MI 48176

VERNE L VAN DUZEN MD L

131 E MILLER

MILAN MI 48160

WIECHER H VANHOUTEN MD

UN I V MEDICAL CTR

ANN ARBOR MI 48104

F S VAN REESEMA MD

1608 KIRTLAND DR

ANN ARBOR MI 48103

NEAL A VANSELOW MD

2906 PARKRIDGE DR

ANN ARBOR MI 48103

JOHN J VOORHEES MO

UN I V MEDICAL CTR

ANN ARBOR MI 48104

PIETER D VREEDE MD

PARKE DAVIS £ CO

ANN ARBOR MI 48105

R WALTER WAGGONER MD L

3333 GEODES RD

ANN ARBOR MICH 48105

ALEXANDER M WALDRON MD
309 N INGALLS

ANN ARBOR MICH 48104

JERRY L WALDYKE MD
775 S MAIN ST

CHELSEA MI 48118

J E WALKER MD A

R- 50 22 KRESEGE BLDG

ANN ARBOR MI 48104

SARA E WALKER MO
1405 ANN ST

ANN ARBOR MI 48104

JULIUS M WALLNER MD
1313 E ANN ST

ANN ARBOR MICH 48104

RICHARD D WATKINS MD
4140 MILLER

ANN ARBOR MI 48103

ERNEST H WATSON MD R

834 SUNSET DR

EVANSVILLE IND 47713

58 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

WALTER L WEBB MD

A

R T WOODBURNE PHD

A

JAMES R ADAMS MD

A

ST JOSEPH MERCY HOSP

2520 HAWTHORNE RD

39 SHADY HOLLOW DR

ANN ARBOR MI

48104

ANN ARBOR MI

48104

DEARBORN MI

48128

MYRON E WEGMAN MD

SCOTT W WOODS MD

VINCENT B ADAMS MD

UN I V OF MICH

750 TOWNER

19641 MACK AVE

ANN AR80R MICHIGAN

48104

YPSILANTI MICHIGAN

48197

GROSSE PTE MI

48236

RAOUL L WEISMAN MD

BRUCE A WORK JR MD

ARTHUR ADAMSKI MD

21 SO PROSPECT

L-2019 WOMENS HOSP

19600 VAN DYKE

YPSILANTI MICH

48197

ANN ARBOR MI

48104

DETROIT MI

48234

JOHN M WELLER M D

WALTER P WORK MD

IRWIN P ADELSON MD

A

B2915 UNIVERSITY HOSP

UNIVERSITY MED CENT

DETROIT PSYCH INSTIT

ANN ARBOR MICHIGAN

48104

ANN ARBOR MICHIGAN

48104

1151 TAYLOR

JAMES L WERTH MD

A

HAROLD L WRIGHT MD

DETROIT MI

48202

U OF M HOSPITAL

18741 HAGGERTY

ANN ARBOR MI

48104

NORTHVILLE MICHIGAN

48167

SIDNEY L ADELSON MD
16221 SCHOOLCRAFT

GEO W WESTCOTT MD

JOHN S WYMAN MD

DETROIT MI

48227

511 W MICHIGAN

SNOW HLTH SERVICE-EMU

YPSILANTI MI

48197

YPSILANTI MI

48197

SIDNEY ADLER MD
3011 W GRAND BLVD

MARTHA R WESTERBERG

MD

WILLIAM C YAROCH MD

DETROIT Ml

48202

1313 E ANN ST

2200 FULLER RD

ANN ARBOR MI

48104

ANN ARBOR MI

48105

MANOOCHEHR AGAH HD
6765 ORCHARD LAKE RD

CHAS J WESTOVER MD

FRANK S YELIN MD

A

ORCHARO LAKE MI

48033

1340 ELM

TEXAS MEDICAL CENTER

PLYMOUTH MI

48170

DIV OF NEUROSURGERY

GEO H AGNEW MD
3011 W GRAND BLVD

ROBT G WETTERSTROEM

MD

HOUSTON TEXAS

77025

DETROIT MI

48202

501 W DUNLAP
NORTHVILLE MICH

48167

ORUS R YODER MD

L

RICHARD C AGNEW MD

M

700 CAMBRIDGE RD

564 FISHER BLDG

ARNOLD H WEXLER MAJ
USAF HOSP BITBURG

M

YPSILANTI MI

48197

OETROIT MI

48202

BOX 6057

C J D ZARAFONETIS MD

JOSEPH J AGRESTA MD

A

SIMPSON MEMORIAL INST

WAYNE STATE UNIV

APO NEW YORK N Y

09132

ANN ARBOR MI

48106

DETROIT MI

48207

EDMUND H WHALE MD

VICTOR M ZERBI MD

JAS J AIUTO MD

207 FLETCHER AVE

27 S PROSPECT

660 CADIEUX RO

ANN ARBOR MICH

48104

YPSILANTI MICH

48197

GROSSE PTE MI

48230

W M WHITEHOUSE MD

ROBERT M ZIMMERMAN MD

ISSA S AJLOUNI MO

1313 E ANN STREET

555 E WILLIAMS

2075 E 14 MILE RD

ANN ARBOR MICHIGAH

48104

ANN ARBOR MI

48108

BIRMINGHAM MI

48008

MARIANNE WHOWELL MD

JOEL P ZRULL MD

ROGER M AJLUNI MD

1805 IVYWOOD DR

630 DARTMOOR

17920 FARM RD

ANN ARBOR MICHIGAN

48103

ANN ARBOR MICHIGAN

48103

LIVONIA MI

48152

PAUL J WICHT MD

E K ZSIGMOND MD

EMIL J ALBAN JR MD

750 TOWNER

UNIVERSITY OF MICH

7940 ALLEN RD

YPSILANTI MICH

48197

ANN ARBOR MI

48104

ALLEN PARK MI

48101

HOWARD R WILLIAMS MD

A P ALBARRAN MD

1950 MANCHESTER RD

WAYNE

WAYNE CO GEN HOSP

ANN ARBOR MICH

48104

ELOISE MICH

48132

FREDK B WILLIAMSON MD

ALI A ABBASI MD

ALBERT J ALBRECHT MD

319 W MICHIGAN AVE

DETROIT GENERAL HOSP

15901 W NINE MILE RD

YPSILANTI MICH

48197

DETROIT MI

48226

SOUTHFIELD MI

48075

PARK W WILLIS III MD

A ABBASS I AN MD

ELSA A ALCANTARA MD

UNIVERSITY HOSPITAL

3815 PELHAM

9801 CONANT

ANN ARBOR MICH

48104

DEARBORN Ml

48124

DETROIT MI

48212

J ROBERT WILLSON MD

JAMES A ABBOTT MD

LUC I LO C ALCANTARA MD

UN I V MED CENTER

810 MUTUAL BLDG

9801 CONANT

ANN ARBOR MICHIGAN

48104

DETROIT MI

48226

DETROIT MI

48212

J LEROY WILSON HD

L

GERALD J ABEN MD

ALLEN ALEXANDER MD

1313 E ANN ST

15901 W 9 MILE RD

18881 HILTON

ANN ARBOR MICH

48104

SOUTHFIELD MI

48075

SOUTHFIELD MI

48075

LARRY K WINEGAR MD

A

EL I E D ABOULAFIA MD

EUGENE J ALEXANDER MD

UN I V MEDICAL CTR

18241 GREENFIELD

34830 SPR I NG VALLE Y

ANN ARBOR MI

48104

DETROIT MI

48235

WESTLAND MI

48185

JAMES M WINKLER MD

JOS P ABRAHAM MD

G D ALEXANDER MD

3 REGENT COURT

2799 W GRAND BLVD

25799 LATHRUP BLVD

ANN ARBOR MICH

48104

DETROIT MI

48202

SOUTHFIELD MI

48075

LEONARD H WOLIN MD

JULIO B ACOSTA MD

L C ALEXANDER MD

2216 MEDFORD RD

27634 FIVE MILE RD

1204 KALES BLDG

ANN ARBOR MI

48104

LIVONIA MI

48154

DETROIT MI

48226

J REIMER WOLTER MD

GERALD D AOAMIAN MD

MANUEL A ALFONSO MD

UNIVERSITY MED CENTER

15901 W 9 MILE RD

21501 KELLY RD

ANN ARBOR MICHIGAN

48104

SOUTHFIELD MI

48075

EAST DETROIT MI

48021

ELVIS S ALFORD HD
20 LIBERTY ST

BELLEVILLE MI 48111

SHAFQAT ALI MD
115 E DUNLAP

NORTHVILLE MI 48167

ROBERT D ALLABEN MD
18255 W MCNICHOLS RD
DETROIT MI 48219

HUBERT M ALLEN MD
HENRY FORD HOSPITAL
DETROIT MI 48202

JOHN V ALLEN MD
1336 SOUTHFIELD RD
LINCOLN PARK MI 48146

J SCOTT ALLEN MD
16820 GREENFIELD
DETROIT MI 48235

MUFID B AL-NAJJAR MD A

NORTHVILLE STATE HOSP
NORTHVILLE MI 48167

E BRYCE ALPERN MD

2840 W 7 MILE RD

DETROIT MI 48221

SAM ALPINER MD

2850 E SEVEN MILE RD

DETROIT MI 48234

MUHYI H AL-SARRAF MD

4160 JOHN R ST

DETROIT MI 48201

JULES ALTMAN MD
14633 E SEVEN MILE RD
DETROIT MI 48205

RAPHAEL ALTMAN MD
17000 WEST 8 MILE RD
SOUTHFIELD MI 48075

HERNAN ALVAREZ JR MD

HENRY FORD HOSP

DETROIT MI 48202

JULIAN ALVAREZ MD
260 LAKELAND

GROSSE PTE MI 48236

VICTOR M ALVAREZ MD
3745 MONROE

DEARBORN MI 48124

ROMULO S ANCOG MD
1151 TAYLOR

DETROIT MI 48202

LOURDES V ANDAYA MD

HARPER HOSPITAL

DETROIT MI 48201

BEVERLY L ANDERSON MD
977 SEXTON RD

HOWELL MI 48843

CHAS P ANDERSON MD
MEDICAL DIRECTOR
DEPT OF SOCIAL SERV

640 TEMPLE AVE

DETROIT MI 48201

EUGENE C ANDERSON MD

14801 SOUTHFIELD

ALLEN PARK MI 48101

WALTER L ANDERSON MD
1553 WOODWARD AVE
DETROIT MI 48226

WM B ANDERSON MD

966 FISHER BLDG

DETROIT MI 48202

BYRON ANDREOU MD
460 EASTLAND CTR
HARPER WOODS MI 48237

JANUARY, 1972/Michigan Medicine 59

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

RAHSAN ANISOGLU MD

LOWELL B ASHLEY MD

R

SHARIF BAIG MD

18126 SHADBROOK

5811 N E 21 RD

25750 W OUTER DR

NORTHVILLE MI

48167

FT LAUDERDALE FL

33308

LINCOLN PARK MI

48146

DOMENICO M ANNESSA

MD L

REGIS F ASSELIN MD

LOUIS J BAILEY MD

L

3536 BURNS AVE

11417 WHITTIER

20905 GREENFIELD RO

DETROIT MI

48214

DETROIT Ml

48224

SOUTHFIELD MI

48075

MARY K ANSLEY MD

MOHAMMED A ASSI MD

MARGARET A BA I M A MD

1101 DAV WHITNEY BLDG

18161 W 12 MILE RD

1212 DAV WHITNEY BLDG

DETROIT MI

48226

LATHRUP VILLAGE MI

48075

DETROIT MI

48226

RICHARD D ANSLOW MD

MAX E AU8LE MD

CLARENCE BAKER MD

L

1515 DAV WHITNEY BLDG

15901 W NINE MILE RD

5946 EASY ST

DETROIT MI

48226

SOUTHFIELD MI

48075

BAYSHORE GARDENS K-34

HOWARD B APPELMAN

MD

HARRY E AUGUST MD

L

BRADENTON FL

33505

1553 WOODWARD AVE

26339 WOODWARD

DETROIT MI

48226

HUNTINGTON WOODS MI

48070

GRAEME C BAKER MD
DETROIT GENERAL HOSP

AGUSTIN ARBULU MO

DONALD C AUSTIN MD

DETROIT MI

48226

1400 CHRYSLER FREEWAY

3800 WOODWARD AVE

DETROIT MI

48207

DETROIT MI

48201

JOHN 0 BAKER MD
DETROIT GENERAL HOSP

A

RENE F ARCHAMBAULT

MD

SHIRLEY AUSTIN MD

DETROIT MI

48226

35550 MICHIGAN AVE

5224 ST ANTOINE ST

WAYNE MI

48184

DETROIT MI

48202

NIHAT BAKIRCI MD
2200 E GRAND BLVD

EDUARDO ARC INI EGAS

MD

JOHN D AUSUM MD

DETROIT MI

48211

3535 W 13 MILE RO

*205

16311 MIDDLEBELT

ROYAL OAK MI

48072

LIVONIA MI

48154

JOSEPH A BAKST MO
10 W WARREN

L

BURKE W AREHART MD

IRA AVRIN MD

DETROIT MI

48201

340 EASTLAND BLDG

24777 GREENFIELD RD

DETROIT MI

48236

SOUTHFIELD MI

48075

FRANK T BALAGA MD
13000 ECKLES RD

NORMAN J ARENDS MD

ARNOLD R AXELROD MD

LIVONIA MI

48151

302 EASTLAND PROF

BLDG

15001 W EIGHT MILE RD

DETROIT MI

48236

DETROIT MI

48235

HARRY BALBEROR MD
22341 W 8 MILE RD

JOHN G ARENT MD

MILDRED A AXELROD MD

DETROIT MI

48219

12600 1/2 GR RIVER

AVE

3535 W 13 MILE RD 305

DETROIT Ml

48204

ROYAL OAK MI

48072

MATTHEW A BALCERSKI
855 FISHER BLDG

MD

MOHAMMAD A ARIANI

MD

AHMAD N AZAR MD

DETROIT MI

48202

EASTLAND PROF BLOG

314

20340 HARPER

HARPER WOODS MI

48225

DETROIT MI

48225

DONALD R BALLARD MD
20520 AUDETTE

ULVE E ARIES MD

PARIS J AZOURY MD

DEARBORN MI

48124

HERMAN KIEFER HOSP

OETROIT GENERAL HOSP

DETROIT MI

48202

OETROIT Ml

48226

JANOS BALOG MD
2300 OAK ST

C T ARIES MO

MANUEL AZUARA MD

WYANDOTTE MI

48192

27216 CECILE AVE

19150 KELLY RD

DEARBORN HEIGHTS MI 48127

DETROIT MI

48236

ROSS M BALOW MD

18700 MEYERS RD

SEVERO R ARMADA JR

MO

LLOYD K BABCOCK MD

L

DETROIT MI

48235

32900 FIVE MILE RD

5555 CRABTREE RD

LIVONIA MI

48154

BIRMINGHAM MI

48010

DONALD L BALTZ MD
24230 MICHIGAN

THOS C ARM I NSK I MD

MYRA E BABCOCK MD

L

DEARBORN MI

48124

1066 FISHER BLDG

7 POPLAR PARK

OETROIT MI

48202

PLEASANT RIDGE MI

48069

GERALD BANISH MD
23100 CHERRY HILL

MAC J ARMSTRONG MO

PAUL W BABCOCK MD

DEARBORN MI

48124

441 E JEFFERSON AVE

29927 W SIX MILE RD

DETROIT MI

48226

LIVONIA MI

48152

THOMAS L BANKS MD
18597 W 10 MILE RD

A ROBERT ARNSTEIN

MD

WARREN W BABCOCK MO

R

SOUTHFIELD MI

48075

285 HAWTHORNE

2661 NORTH EAST 9TH CT

BIRMINGHAM MI

48009

POMPANO BEACH FL

33062

LEWIS R BARAK MD
20905 GREENFIELD RD

MORRIS ARNKOFF MD

BURTON J BACHER M D

NORTHLAND MEDICAL BLDG

18241 GREENFIELD

1015 KALES BLDG

SUITE 503

DETROIT MI

48235

DETROIT MI

48226

SOUTHFIELD MI

48075

WM J ARNOLD JR MD

VINTON A BACON MD

L

STUART BARAK MD

12062 BROAD ST

18984 FAIRFIELD

18241 GREENFIELD

OETROIT MI

48204

DETROIT MI

48221

DETROIT MI

48235

FORREST J ARNOLDI

MD

BEN J H BADER MD

ALPHONSE W BARAN MO

HARPER HOSPITAL

2654 W GRAND BLVD

15841 W WARREN ST

DETROIT MI

48201

DETROIT MI

48208

OETROIT MI

48228

ROBYN J ARRINGTON

MO

MARGA BAER MD

LOUIS C BARBAGLIA MD

7811 OAKLAND AVE

16321 MACK AVE

16378 HARPER

DETROIT MI

48211

DETROIT MI

48224

DETROIT MI

48224

MEYER S ASCHER MD

WALTER 8 AER MD

RAD I VO J R 8ARBER MD

1508 DAV BRODERICK

TWR

16321 MACK AVENUE

864 S MAIN ST

DETROIT MI

48226

DETROIT Ml

48224

PLYMOUTH MI

48170

STILSON R ASHE MD

L

ROBT J BAHRA MD

M B BARDENSTEIN MD

23030 CHERRY HILL

20905 GREENFIELD

17000 W 8 MILE RD

DEARBORN MI

48124

SOUTHFIELD MI

48075

SOUTHFIELD MI

48075

ALW1N S BAREFIELD MO
10244 W 7 MILE RO
DETROIT MI 48221

BEN J BARENHOLTZ MD
20905 GREENFIELD
SOUTHFIELD MI 48075

OSCAR G BARILLAS MD

21308 MACK AVE

GROSSE PTE WOODS MI 48236

DAVID H BARKER MD

21510 HARPER AVE

ST CLAIR SHORES MI 48080

OSCAR BARLAND MD A

8401 WOODWARD AVE
OETROIT MI 48202

REUVEN BAR-LEVAV MO

828 FISHER BLDG

DETROIT MI 48202

MYRON BARLOW MD
18050 MACK

GROSSE PTE Ml 48236

MORTON BARNETT HD

735 ARDMOOR RD

BIRMINGHAM MI 48010

DANIEL R BARR MD
1025 DAV WHITNEY 8LDG
DETROIT MI 48226

RAYMOND J BARRETT MD
3800 WOODWARD *1202
DETROIT MI 48201

WYMAN D BARRETT MD L

362 MCKINLEY

GROSSE PTE FARMS MI 48236

WM H BARRON MD A

2147 E MAPLE

BIRMINGHAM MI 48008

DAVIO BARSKY MD
100 OAK ST

WYANDOTTE MI 48192

EDW G BARTHOLOMEW MD

SINAI HOSPITAL

DETROIT MI 48235

ROBERT J BARUCH MD
19181 CHELTON

BIRMINGHAM MI 48009

SIDNEY BASKIN MD

19630 W MCNICHOLS

DETROIT MI 48219

NAIL BASMAJI MO
19647 JOY RD

DETROIT MI 48228

JOSEPH S BASSETT MD
20905 GREENFIELD RD
SOUTHFIELD MI 48075

EROL BASTUG MD
W OUTER DR HOSPITAL
LINCOLN PARK MI 48146

GAYLORD S BATES MD
18101 OAKWOOD BLVD
DEARBORN MI 48124

JOHN M BATTLE MD
6904 CHARLESWORTH
DEARBORN HEIGHTS MI 48127

A ROBT BAUER MD L

19268 GRAND RIVER AVE
DETROIT MI 48223

BENEDICT J BAUER MD
16451 SCHOOLCRAFT
DETROIT MI 48227

RALPH E BAUER MD
HENRY FORD HOSPITAL
DETROIT MI 48202

60 JANUARY, 1972/Michigan Medicine

48201

48224

48124

48224

48201

) L

48236

48236

) M

48234

48010

48227

48224

48236

48126

48226

48224

48201

> A

49502

ID L

48215

48235

48238

48226

48101

48226

Wayne County

BILLY BEEKS HO

8624 PUR I TAN

DETROIT MI 46238

ROBT C BEHAN MO

1 WOODWARD AVE

DETROIT MI 48226

MAX R BE I THAN MO

510 KALES BLOG

DETROIT MI 48226

KHOSROW BEHAI HO

22101 MOROSS RO

DETROIT MI 48236

EDWIN L BERGER MD

7301 SCHAEFER RD

DEARBORN MI 48126

MURRAY S BERGMAN MD
4400 LIVERNOIS AVE
DETROIT MI 48210

HOWARD L BERGO MD

901 W GRAND BLVD

DETROIT MI 48208

KENNETH BERGSMAN MD
DEPT OF MEDICINE
DETROIT GENERAL HOSP

KUNJLATA M BHATT MD

SINAI HOSPITAL

DETROIT MI 48235

MICHAEL H BIALIK MD
15212 MICHIGAN AVE
DEARBORN MI 48126

FRANK B BICKNELL MD
938 DAV WHITNEY BLDG
DETROIT MI 48226

JOHN G BIELAWSKI MD

22190 GARRISON

DEARBORN MI 48124

JUAN BELAMARIC MD
1400 CHRYSLER EXPWY

DETROIT MI 48207

W GEO BELANGER MD
1041 HARVARD

DETROIT MI 48230

DARWIN F BELOEN MD
2424 PURITAN

DETROIT MI 48238

CLAUDE BENAVIDES MD
25750 W OUTER DR
LINCOLN PARK MI 48146

SANDOR F BENDE MD

15863 GARFIELD

ALLEN PARK MI 48101

JOSEPH BENINSON MO

HENRY FORD HOSP

DETROIT MI 48202

GERMANY E BENNETT MD
1446 E FOREST

DETROIT MI 48207

HARRY B 8ENNETT MD L

7015 INTERVALE

DETROIT MI 48238

H STANLEY BENNETT MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

RONALD S BENNETT MD
17727 W 10 MILE RD
SOUTHFIELD MI 48075

SANFORD A BENNETT MD
15301 W NINE MILE RD
OAK PARK MI 48237

W ROBERT C BENNETT MD
3800 WOODWARD AVE
DETROIT MI 48201

ARVIN BENNISH MD
17040 W 12 MILE RD 101
SOUTHFIELD MI 48076

CLIFFORD D BENSON MD
1553 WOODWARD AVE
DETROIT MI 48226

DAVIS A BENSON MD

17563 GREENFIELD

DETROIT MI 48235

PAUL J BENSON MD
227 N SHELDON RD
PLYMOUTH MI 48170

VIRGINIA M 8ENS0N MD L

29224 LANCASTER BLDG 4
SOUTHFIELD MI 48075

ROBERT H BENTLEY MD

21510 HARPER AVE

ST CLAIR SHORES MI 48080

WM G BENTLEY MD

50 WESTMINSTER

DETROIT MI 48202

PEDRO P BERDAYES MD
15345 WINDMILL PTE DR
GROSSE PTE MI 48236

DETROIT MI

ERNEST M BERKAS MD
3815 PELHAM RD
DEARBORN MI

JOSEPH J BERKE MD
3333 E JEFFERSON
DETROIT MI

SYDNEY S BERKE MO
3333 E JEFFERSON
DETROIT MI

LARY R BERKOWER MD
20905 GREENFIELD
SOUTHFIELD MI

ALLEN B BERLIN MD
17000 W 8 MILE RD
SOUTHFIELD MI

MARTIN B BERMAN MD
29927 W SIX MILE RD
LIVONIA MI 48152

ROBT H BERMAN MD L

2111 WOODWARD

DETROIT MI 48201

SIDNEY L BERMAN MD L

60 W HANCOCK

DETROIT Ml 48201

HENRI BERNARD MD
414 DAV WHITNEY BLDG
DETROIT MI 48226

WALTER G BERNARD HD L

910 CHALMER

DETROIT MI 48215

BERNARD BERNBAUM MD L

13345 W SIX MILE RD
DETROIT MI 48235

SAML S BERNSTEIN MD
15901 W 9 MILE RD
SOUTHFIELD MI 48075

CONRAD F 8ERNYS MD
3815 PELHAM

DEARBORN MI 48124

WILLIAM L BERRIDGE MD
CHEVROLET MOTOR CO
LIVONIA MI

JOS E BERRY MD
31648 BELLA VISTA
FARMINGTON MI

KARL R BERTRAM MD
461 FISHER BLDG
OETROIT MI

THOS H E BEST MD
9221 E JEFFERSON AVE
DETROIT MI 48214

48151

48024

48202

L

48226

48124

48207

48207

48075

48075

G BETANZOS MD
22770 KELLY

E DETROIT MI 48021

FRANCIS P BHAGAT MD
861 MONROE

DEARBORN MI 48124

JOHN H BIHL MD
10531 FARMINGTON RD
LIVONIA MI 48150

THOS H BILLINGSLEA MD
3790 WOODWARD
DETROIT MI

PHILIP M BINNS MD
573 FISHER BLDG
DETROIT MI

JOHN R BIRCH MD
1438 S OCEAN BLVD
POMPANO BEACH FL

ROBERT E BIRK MD
17894 MACK AVE
DETROIT MI

ROBERT C BIRKS MD
VA HOSPITAL
ALLEN PARK MI

F ROSS BIRKHILL MD
31 SHADY HOLLOW DR
DEARBORN MI

D J BIRMINGHAM MO
WAYNE STATE UNIV
DETROIT MI

LEONARD BIRNDORF MD

18317 JOHN R ST

DETROIT MI 48203

G W BISSELL MD
VA HOSPITAL

ALLEN PARK MI 48101

NORBERT M BITTRICH HD
16001 9 MILE RD

SOUTHFIELD MI 48075

EARL D BLACK MD
20340 HARPER

HARPER WOODS MI 48236

ROBERT W BLACK HD
408 OAV WHITNEY BLDG
DETROIT MI 48226

ALEXANDER BLAIN 111 MD

2201 E JEFFERSON

DETROIT MI 48207

JAMES H BLAIN JR MD

935 GRAND MARAIS

DETROIT MI 48230

MAX BLAINE MD

13700 WOODWARD

OETROIT MI 48203

WM F BLAIR MD

12500 E 12 MILE RD

WARREN MI 48093

48202

48202

L

33062

48224

48101

48124

48207

RUSSELL S BLANCHARD MD

3724 JACKSON ST

OMAHA NEBRASKA 68105

DOUGLAS H BLANKS MO
12811 NORTHLINE
SOUTHGATE MI 48195

RONALD W BLATT MD
32226 TALL TIMBER DR
FARMINGTON MI 48024

JANUARY, 1972/Michigan Medicine 61

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

ALFREO BLEIER MO

A

A WAITE BOHNE MD

LEO J BOWERS MD

1583 CANYON EST DR

HENRY FORD HOSP

11200 E MCNICHOLS RD

PALM SPRINGS CA

92262

OETROIT MI

48202

DETROIT MI

48234

DAVID H BLINKHORN MD

JOHN R BOLAND MD

R

JAMES R BOWLBY MD

8445 JEFFERSON

BOX 50

36000 FIVE MILE RD

DETROIT MI

48214

GRAND MARAIS MI

49839

LIVONIA MI

48154

D L BLOCK MO MED DIR

MURRAY BOLES MD

ALBERT BOYAJIAN MD

FORD MOTOR CO

26381 DUNDALK LANE

17916 FARMINGTON

THE AMERICAN RD

FARMINGTON MI

48024

LIVONIA MI

48154

DEARBORN MI

48121

DONALD S BOLSTAD MD

CHARLES R BOYCE MD

HENRY FORD HOSP

3790 WOODWARD AVE

MELVIN A BLOCK MO

DETROIT MI

48202

DETROIT MI

48201

2799 M GRAND BLVD

DETROIT MI

48202

SIDNEY BOLTER M D

ALBERT L BOYD MD

6760 WOODBANK

4407 ROEMER

JAMES B BLODGETT MD

L

BIRMINGHAM MI

48010

DEARBORN MI

48126

3535 M 13 MILE RD *406

ROYAL OAK MI

48072

NORMAN BOLTON MD

CAROLE B BOYD MD

19321 GREENFIELD

1400 CHRYSLER EXPWY

MM H BLODGETT MD

DETROIT MI

48235

DETROIT MI

46207

74 M ADAMS AVE

DETROIT MI

48226

RUSSELL P BOLTON JR

MD

EUGENE H BOYLE MO

18530 GRAND RIVER

572 THORN TREE RD

MARSHALL J BLONDY MD

DETROIT MI

48223

GROSSE PTE WOODS MI

48236

19201 M SEVEN MILE RD

DETROIT MI

48219

OTTO F W BONETA MD

A

RUTH B BRACKETT MD

19697 CARRIE

18136 MACK

ALBERT BLOOM MD

DETROIT MI

48234

DETROIT MI

48224

6484 CHENE ST

DETROIT MI

48211

JAIME BONILLA MD

HORACE F BRADFIELD MO

25447 PLYMOUTH RD

3008 E GRAND BLVD

ARTHUR R BLOOM MD

L

DETROIT MI

48239

DETROIT MI

48202

16500 N PARK DR #1406

SOUTHFIELD MI

48075

ABRAHAM M BOOKSTEIN

MD L

R JOHN BRADFIELD MD

1725 PINECREST DR

18134 MACK AVE

VICTOR BLOOM MD

FERNOALE MI

48220

DETROIT MI

48224

951 E LAFAYETTE

DETROIT MI

48207

GEO F BOONE MD

GEORGE T BRADLEY MD

81 WOODLAND SHORES

3800 WOODWARD AVE

ROBT J BLOOR MD

GROSSE PTE SHORES HI

48236

DETROIT MI

48201

MM BEAUMONT HOSPITAL

ROYAL OAK MI

48072

EARNEST BOOTH MD

WH N BRALEY MO

L

WOMANS HOSPITAL

12897 WOODWARD

ROSEMARIE BLOSEN MD

DETROIT MI

48201

DETROIT MI

48203

20070 E RIVER RO

GROSSE ILE MI

48138

ROBERT G BORCHAK MD

BEN J BRAND MO

17800 E EIGHT MILE

1201 DAVID WHITNEY BLG

GILBERT B BLUHM MD

DETROIT MI

48236

DETROIT MI

48226

HENRY FORD HOSP

OETROIT MI

48202

IGOR I BORDEN MD

ADOLFO J BRANE MD

15361 PLYMOUTH RD

LAFAYETTE CLINIC

GEORGE L BLUM MD

DETROIT MI

48227

DETROIT Ml

48207

15901 M 9 MILE RD

SOUTHFIELD MI

48075

LEO 0 BORES MD

LIONEL BRAUN MD

L

962 FISHER BLOG

18520 W 7 MILE RD

FRANK S BLUMENTHAL MD

DETROIT MI

48202

DETROIT MI

48219

261 MACK BLVD

DETROIT MI

48201

MAURICE C BORIN HD

A

ROBERT A 8RAUN MD

29322 LANCASTER DR*203

18610 HARTWELL AVE

ABRAHAM BLUMER MD

SOUTHFIELD MI

48075

DETROIT MI

48235

22341 M EIGHT MILE RD

DETROIT MI

48219

MELVIN BORNSTEIN MD

FRANK N BREDAU JR MO

17600 NORTHLAND PK CT

24781 FIVE MILE RD

ANTONIO BOBA MD

SOUTHFIELD MI

48075

DETROIT MI

48239

1400 CHRYSLER EXPMY

DETROIT MI

48207

SIDNEY BORNSTEIN MD

VIOLA G BREKKE MD

28056 TAVESTOCK

369 GLENDALE ST

JOHN L BOCCACCIO MO

SOUTHFIELD MI

48075

HIGHLAND PARK MI

48203

332 EASTLAND CENTER

PROFESSIONAL BLOG

JOSE M BORREGO MO

JOHN P BREMER MD

1342 WHITTIER

17700 MACK

DETROIT MI

48225

GROSSE PTE MI

48236

DETROIT MI

48224

JAMES J BOCCIA MO

EDMUND T BOTT MD

WM M BREMER MO

3450 S OCEAN *422

1629 FORD

15641 E WARREN

PALM BEACH FL

33480

WYANDOTTE MI

48192

DETROIT MI

48224

ARTHUR W BODDIE MD

ISADORE BOTVINICK MD

GERALD M BRENEMAN MD

2737 CHENE ST

13701 W 7 MILE RD

28300 FOREST BROOK DR

DETROIT MI

48207

DETROIT MI

48235

FARMINGTON MI

48024

ROBT E BOGUE MD

RUDRICK E BOUCHER MD

A

MICHAEL J BRENNAN MD

15901 W 9 MILE RD *604

WAYNE STATE UN I V

1168 THREE MILE OR

SOUTHFIELD MI

48075

DETROIT MI

48207

GROSSE PTE MI

48236

LADISLAUS BOGUSZ MD

R

THOS A BOUTROUS MD

MORRIS S BRENT MD

R

29215 MARANYA RD

15801 W MC NICHOLS

1330 STRATHCONA OR

HOMESTEAD FL

33030

DETROIT MI

48235

DETROIT MI

48203

l STEPHEN BOHN MD

DONALD W BOWER MD

ROBERT L BRENT MD

3800 WOODWARD AVE

3725 FORT

954 FISHER BLDG

DETROIT MI

48201

LINCOLN PARK MI

48146

DETROIT MI

48202

BOVD K BRESNAHAN HD
25070 W EIGHT MILE RD
SOUTHFIELD MI 48075

NORMAN W BREY MO

1900 DAV BRODERICK TWR

DETROIT MI 48226

MURRAY BRICKMAN MD
24777 GREENFIELD
SOUTHFIELD MI 48075

MM J BRIGGS MD

1900 DAV BRODERICK TMR

DETROIT MI 48226

JACOB E BRISKI MD

1058 BLAIRMOOR

GROSSE PTE MOODS MI 48236

JOS C BRISSON MD R

23112 MESTBURY

ST CLAIR SHORES MI 48080

JOHN E BRISSON MO
17533 FORT ST

RIVERVIEM MI 48192

SYLVAN A BROADMAN MD
25705 MIDDLEBELT
FARMINGTON MI 48024

DONALD R BROCK MD
36475 FIVE MILE RD
LIVONIA MI 48154

HARVEY S BRODERSON MD R

5411 14TH ST M

BRADENTON FL 33505

MILL I AM BROMME MO L

17170 E JEFFERSON AVE
GROSSE PTE MI 48230

ALDRICH M BROOKS JR MD
2400 EMALD CIRCLE
DETROIT MI 48238

EUGENE M BROOKS MD
609 NORTHLAND MED BLDG
SOUTHFIELD MI 48075

NATHAN BROOKS MD
7401 3RD ST

DETROIT MI 48202

CHAS 0 BROSIUS MD
16981 FARMINGTON RD
LIVONIA MI 48154

MM L BROSIUS MD L

1823 FAIR OAK COURT
ROCHESTER MI 48063

ANDREM G BROMN MD
20905 GREENFIELD
SOUTHFIELD MI 48075

AUDREY 0 BROMN MD L

1795 CEDAR HILL DR
BIRMINGHAM MI 48010

CARLTON F BROMN MD
24636 MALDEN RD M
SOUTHFIELD MI 48075

CHAS H BROMN MD
2387 FORT ST

MYANDOTTE MI 48192

ELI M BROMN MD
13123 LA SALLE
HUNTINGTON MOODS MI 48070

GORDON T BROMN MD L

13000 HAYES AVE

DETROIT MI 48205

JAMES C BROMN MD

3800 MOODMARO AVE

DETROIT MI 48201

JOHN R BROMN MD

1145 DAV MHITNEY BLDG

DETROIT MI 48226

62 JANUARY, 1972/Michigan Medicine

48221

5

48226

08

48201

A

48183

48010

L

33460

48210

48138

48203

48126

48192

48192

48202

48080

48075

48207

L

48202

49286

48206

48127

48236

48202

48202

48224

MEMBERS

Wayne County

HOWARD B BURNSI0E HO

33 OAKLAND PARK

PLEASANT RIDGE MI 48069

DAVID BURNSTINE MD

18400 SCHAEFER

DETROIT MI 48235

PERRY P BURNSTINE MD L

2329 W GRAND BLVD
DETROIT MI 48208

ROSWELL G BURROUGHS MD
18161 W 12 MILE RD
LATHRUP VILLAGE MI 48075

HOWARD A BURROWS MD L

10423 W WARREN AVE
DEARBORN MI 48126

HARRY S BURSTEIN MD

2950 W GRAND BLVD

DETROIT MI 48202

I MARVIN BURSTEIN M D
2950 W GRAND BLVD
DETROIT Ml 48202

REGIS L CALLAGHAN MD

22146 FORD RD

DEARBORN MI 48128

YANI V CALMIDIS MD

24800 CROMWELL

FRANKLIN MI 48025

EDGAR A CALVELO MD

1615 CARLTON BLVD

JACKSON MI 49203

JOHN G CALWELL MD
714 NEW CENTER BLDG
DETROIT MI 48202

ARTHUR H CAMERON MD L

155 VINEWOOD

WYANDOTTE MI 48192

DUNCAN A CAMERON MD
2021 MONROE

DEARBORN MI 48124

HARVEY E CAMPBELL MD

3 ROBINDALE CT

DEARBORN MI 48124

JAMES E CARAWAY MD R

R1 BOX 503

FRANKLIN NC 28734

LOUIS CARBONE MD
487 LAKELAND

GROSSE PTE MI 48230

TOMAS CARBONELL MD

353 DEVONSHIRE

DEARBORN MI 48124

JOHN 0 CAREY MD
HENRY FORD HOSP
DETROIT Ml 48202

JOHN C CARLISLE MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

HAROLD W CARLSON MD L

18070 W ILDEMERE AVE
DETROIT MI 48221

KENNETH W CARMAN MD
30928 FORD RD

GARDEN CITY MI 48135

IRVING F BURTON NO
26912 YORK RD

HUNTINGTON WOODS MI 48070

GLENDON J BUSH MD
18901 W MC NICHOLS
DETROIT MI 48219

JAMES E BUTLER MD
2177 W GRAND BLVD
DETROIT MI 48208

JOHN 0 BUTLER MD

2173 W GRAND BLVD

DETROIT MI 48208

L F CAMPBELL MD
2843 MIDDLEBELT
PONTIAC MI 48053

MALCOLM D CAMPBELL MD L
1520 N GULLEY RD
DEARBORN MI 48128

ROBT E CAMPBELL MD

20901 MOROSS RD

DETROIT MI 48236

RUTH B CAMPBELL MD
3800 WOODWARD AVE #314
DETROIT MI 48201

JOS CARP MO
8717 VAN DYKE

DETROIT MI 48213

C J CARPENTER MD L

P 0 BOX 249

WAYNE MI 48184

WM s CARPENTER MD
1750 HAMMOND CT
BLOOMFIELD MI 48013

CARLOS CARRASOUILLA MD

VETERANS HOSPITAL

ALLEN PARK MI 48101

LAWRENCE H BUTLER MD L

14521 EAST 7 MILE RD
DETROIT MI 48205

RICHARD G BUTLER MD
1922 MONROE

DEARBORN MI 48124

THELMA M CAMPBELL MD
2355 MONROE BLVD
DEARBORN MI 48124

ENRIQUE CAMPS MD
1838 RUSSELL

DEARBORN MI 48128

LEE CARRICK MD
18050 MACK AVE
GROSSE PTE MI 48236

ELMER H CARROLL MD L

16734 GREENVIEW

DETROIT MI 48219

VOLNEY N BUTLER MD L

28 W ADAMS AVE

DETROIT MI 48226

EDWARD J BUTTRUM MD

14755 FENKELL ST

DETROIT MI 48227

E CANCINO SAMSON MD

18700 MEYERS RD

DETROIT MI 48235

HERBERT C CANTOR MD
26831 N WOODWARD
HUNTINGTON WOODS MI 48070

JEROME G CARROLL MO
29588 FIVE MILE RD
LIVONIA MI 48154

LONA B CARROLL MD L

938 DAVID WHITNEY BLDG
DETROIT MI 48226

GLEN L BYERS MD A

DETROIT GENERAL HOSP
DETROIT MI 48226

MEYER 0 CANTOR MD
4850 CHARING CROSS
BLOOMFIELD HILLS MI 48013

HERMAN J CARSON MD
19149 SEVEN MILE RD
OETROIT MI 48219

BYRON K BYRON MD

817 VIRGINIA PARK

DETROIT MI 48202

LAWRENCE A CANTOW MD
19291 WARRINGTON DR
DETROIT MI 48221

HENRY R CARSTENS MD L

628 S FOX HILLS DR 103
BLOOMFIELD HILLS MI 48013

HECTOR H CABRAL MD
24860 RIVER HEIGHTS
SOUTHFIELD MI 48075

MARY E CANTRELL MD

HENRY FORD HOSP

DETROIT MI 48202

ANNE C CARTER MD A

HENRY FORD HOSPITAL
DETROIT MI 48202

ENRIQUE CABRERA MD
30900 FORD RD

GARDEN CITY MI 48135

ELMER E CAPELLAR I MD
810 MUTUAL BLDG
28 W ADAMS AVE

JAMES A U CARTER MD
19271 STRATHCONA DR
DETROIT MI 48203

JOS L CAHALAN MD
15830 FORT ST

SOUTHGATE MI 48195

BERNARD J CAHN MD A

DUKE UN I V HOSP

DURHAM N C 27706

WALDO L CAIN MD

3800 WOODWARD AVE #804

DETROIT MI 48201

GEO L CALDWELL MD L

19005 FAIRFIELD

OETROIT MI 48221

JOHN R CALDWELL MD

2799 W GRAND BLVD

DETROIT MI 48202

DETROIT MI 48226

DAVID B CAPOBRES MD

3001 E 7 MILE RD

DETROIT MI 48234

JOS M CAPUTO MD

2021 MONROE BLVD

DEARBORN MI 48124

NANCY T CAPUTO MD

17712 MACK AVE

GROSSE PTE MI 48236

EUGENE T CAPUZZI MO

19061 LACROSSE

LATHRUP VILLAGE MI 48075

LELAND F CARTER MD L

114 HANOY RD

GROSSE PTE MI 48236

MIGUEL A CASAS MD

9613 E OUTER DR

DETROIT MI 48213

PHILIP N CASCADE MD

SINAI HOSPITAL

DETROIT MI 48235

HILDA B CASE MD

22670 MADISON DR

ST CLAIR SHORES MI 48081

EMANUEL R CASENAS MD
29226 ORCHARD LAKE RD
FARMINGTON MI 48024

JANUARY, 1972/Michigan Medicine 63

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

MORTON B CASH MO

33155 ANNAPOLIS

WAYNE MI 48184

RALPH CASH MO
15705 W TEN MILE RO
SOUTHFIELD MI 48075

TOM J CASPERSON MD A

IRWIN ARMY HOSP

FT RILEY KANSAS 66442

HARRY E CASSEL M D
6742 PARK AVE

ALLEN PARK MI 48101

VICENTE T CASTILLO MO
3901 BEAUS l EN

DETROIT MI 48201

MAURICE E CASTLE MD

20211 GREENFIELD

DETROIT MI 48235

JOSEPH V CATALANO MD
20905 GREENFIELD
SOUTHFIELD MI 48075

GREGORIO R CATURAY MD
NO DETROIT GEN HOSP
3105 CARPENTER

DETROIT MI 48212

ANDREW F CAUGHEY JR MO

15256 LEVAN RD

LIVONIA MI 48154

FRED E CAUMARTIN MD

17184 WILDEMERE

DETROIT MI 48221

ANIBAL CAZAL MD

911 DAVID WHITNEY BLDG

DETROIT MI 48226

FRANK A CELLAR JR MD
26789 WOODWARD AVE
HUNTINGTON WOODS HI 48070

ALBERT J CERAVOLO MO
468 CADIEUX RO

DETROIT MI 48230

ANTHONY R CERESKO MD
1060 W FORT

DETROIT MI 48226

EUGENE J CETNAR MD
4322 BISHOP

DETROIT MI 48224

MANSUK CHAE MO
W OUTER DR HOSPITAL
LINCOLN PARK MI 48146

NED I CHALAT MD
929 FISHER BLDG
DETROIT MI 48202

HENRY G CHALL MO L

2941 W MC NICHOLS RD
DETROIT MI 48221

NORA CHANG MD
CHILDRENS HOSPITAL
DETROIT MI 48202

SIDNEY E CHAPIN MD

125 N MILITARY

DEARBORN MI 48124

AARON L CHAPMAN MO L

406 W FRISCO RD
PENSACOLA FL 32507

E FORREST CHAPMAN MD
36825 B1BBINS

ROMULUS MI 48174

PAUL T CHAPMAN MD

1151 TAYLOR AVE

DETROIT MI 48202

ROLAND H CHAPMAN MD
3790 WOODWARD AVE
DETROIT MI 48201

HENRY A CHAPNICK MD
29636 MIODLEBELT #1064
FARMINGTON MI 48024

BARBARA M CHAPPER MD
861 MONROE

DEARBORN MI 48124

MARTIN L CHARLES MD

1050 FISHER BLDG

DETROIT MI 48202

ARNOLD D CHARNLEY MD

1678 MERRIMAN RD

WAYNE MI 48184

SIDNEY CHARNAS MO
15901 W NINE MILE RD
SOUTHFIELD MI 48075

CLYDE H CHASE MD R

2922 DAWES ST SE

GRANO RAPIDS MI 49508

JACOB L CHASON MO

1401 RIVARD ST

DETROIT MI 48207

LUIS A CHAVEZ MD

690 MULLETT ST

DETROIT MI 48226

WILL I AM M CHAVIS MD

13800 LIVERNOIS

DETROIT MI 48238

FRANK E CHECK MO

76 W ADAMS AVE

DETROIT MI 48226

ALLEN S Y CHEN MD
11933 BELLEVILLE RD
BELLEVILLE MI 48111

CALVIN H CHEN MD
STATE HOSP

NORTHVILLE MI 48167

YOU CHEN CHEN MD
CHILOREN S HOSPITAL
DETROIT MI 48202

SHEK C CHEN MD

1326 ST ANTOINE

DETROIT MI 48226

VINCENT V CHEN MD
1800 TUXEDO

DETROIT MI 48206

B J CHERENZIA MO
7437 WELLBOURNC CT
BIRMINGHAM MI 48010

ALICE CHESTER M D

25085 COOL I DGE HWY

OAK PARK MI 48237

WM P CHESTER MD
3800 WOODWARD RM 802
DETROIT MI 48201

GEO M CHILDS MD L

1059 FISHER BLDG
DETROIT MI 48202

ADOLFO M CHIPOCO MD
950 E STATE FAIR RD
DETROIT MI 48203

YOON HA CHO MD
1400 CHRYSLER EXPWY
DETROIT MI 48207

BERNARD CHODORKOFF MD
19435 SHREWSBURY
DETROIT MI 48221

ABDUL S CHOUDHRY MO
17533 FORT ST

RIVERVIEW MI 48192

MARION C CHOWN HD
2025 FORD

WYANDOTTE MI 48192

R C CHRISTENSEN MD

20861 MACK AVE

GROSSE PTE WOODS MI 48236

JAMES G CHRISTOPHER MD A

20295 DOUGLAS CT
BIRMINGHAM MI 48010

LAURENCE A CHROUCH MD L

PLEASANT HILL TN 38578

ALOYSIUS S CHURCH MD A

19570 BRETTON DR

DETROIT MI 48223

MARIO S CIOFFARI MD
21819 W 9 MILE RD
SOUTHFIELD MI 48075

MUIR CLAPPER MD

1401 RIVARO ST

DETROIT MI 48207

ARTHUR M CLARK MD
22371 NEWMAN

DEARBORN MI 48124

CHARLES E CLARK 111 MD A
WAYNE STATE UN I V
SCHOOL OF MEDICINE

DETROIT MI 48207

MAX D CLARK MD

2799 W GRAND BLVD

DETROIT MI 48202

WM P CLARK MD
1808 BALDWIN

ANN ARBOR MI 48104

NORMAN E CLARKE MO L

21950 GREENFIELD

DETROIT MI 48237

NORMAN E CLARKE JR MO

21950 GREENFIELD

DETROIT MI 48237

ROBT B CLARKE MD

76 W ADAMS AVE

DETROIT MI 48226

RAYMOND R CLEMENS MD
23843 JOY

DEARBORN MI 48127

VOLNA CLERMONT MD
5050 JOY RD

DETROIT Ml 48204

JOHN E CLIFFORD MD
18348 MACK

DETROIT MI 48236

ANDREW R W CLIMIE MD

HARPER HOSPITAL

DETROIT MI 48201

JOHN P CLUNE MD

414 DAVID WHITNEY BLDG

DETROIT MI 48226

E OSBORNE COATES JR MD

HENRY FORD HOSP

DETROIT MI 48202

JOHN H COBANE MD L

151 MERRIWEATHER

DETROIT MI 48236

TULL 10 L COCCIA MD

20211 GREENFIELD

DETROIT MI 48235

EDGAR G COCHRANE MD L

503 MED ARTS BLDG
DETROIT MI 48203

OAVID M COHEN MD A

US NAVAL HOSPITAL
BEAUFORD S C 29902

HERBERT H COHEN MD
23077 AOVANCE BLDG
SOUTHFIELD MI 48075

S LEONARD COHN MD
28505 SOUTHFIELD RD

LATHRUP VILLAGE MI 48075

DON A COHOE MO L

18916 WOODWARD AVE
DETROIT MI 48203

WYMAN C C COLE MD L

1116 LEISURE LN #3
WALNUT CREEK CA 94529

WYMAN C C COLE JR MD

23843 JOY ROAD

DEARBORN HGTS MI 48127

WM G COLEMAN MD L

P 0 BOX 4766

DETROIT MI 48219

THOMAS B COLES JR MD

GRACE HOSPITAL

DETROIT MI 48235

JAMES E COLLINS MD
13103 W CHICAGO BLVD
DETROIT MI 48228

JAMES W COLLINS MD

13800 LIVERNOIS

DETROIT MI 48238

JAY L COLLINS MD

HENRY FORD HOSP

DETROIT MI 48202

LESL IE T COLVIN MD R

15015 GLASTONBURY RD
DETROIT MI 48223

RAYMOND G COLYER MD R

284 PILGRIM

BIRMINGHAM MI 48009

JULIUS V COMBS MD
2424 PURITAN

DETROIT MI 48238

LAWRENCE A COMSTOCK MD
3700 WEST RD

TRENTON MI 48183

EMMA J CONKLIN MD
WAYNE CO GEN HOSP
ELOISE MI 48132

LOWRY C M CONLEY MD L

99 TUXEDO AVE

DETROIT MI 48203

RICHARD C CONNELLY MD L
1360 THREE MILE DR
GROSSE PTE MI 48236

PAUL J CONNOLLY MD

3800 WOODWARD AVE

DETROIT MI 48201

PHYLLIS M CONNOR MD
6500 LODGE EXPWY
GOLD KEY INN

DETROIT MI 48202

JOHN J CONNORS MD L

25657 SOUTHF I ELO RD
SOUTHFIELD MI 48075

BASIL CONSIOINE JR MD

HARPER HOSPITAL

DETROIT MI 48201

CARLA A COOK MD
HENRY FORD HOSP
OETROIT MI 48202

64 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

JAMES A COOK MD

ROY E CRAIG MD

MARK DALE MD

1815 NORTHLINE

74 FONTANA LANE

3702 E 8 MILE RO

WYANDOTTE MI

48192

GROSSE PTE SHORES MI

48236

DETROIT MI

48234

JAMES C COOK MD

PHILIP G CRAMER MD

G DAL SANTO MD

3825 BRUSH ST

WAYNE CO HLTH DEPT

1401 RIVARD ST

DETROIT MI

48201

ELOISE MI

48132

DETROIT MI

48207

FRANK COOKINHAM MD

EUGENE H CRAWLEY MD

EUGENE T DALY MD

999 S HIGHLAND

1160 KENSINGTON RD

24781 FENKELL

DEARBORN MI

48124

GROSSE PTE PARK MI

48230

DETROIT MI

48223

WARREN B COOKSEY MD

L

E E J CROCKETT MD

SEGUNDO C DANAO MD

3535 W 13 MILE RD

1327 NICOLET

36616 PLYMOUTH RD

ROYAL OAK MI

48072

DETROIT MI

48207

LIVONIA MI

48150

JAMES B COOPER MD

LEO J CROLL MD

JAMES C DANFORTH JR

MD

18150 MACK AVE

12703 W 7 MILE RD

20175 MACK AVE

GROSSE PTE MI

48236

DETROIT MI

48235

GROSSE PTE WOODS MI

48236

RALPH R COOPER MD

MAURICE CROLL MD

ROBT D DANFORTH MD

1515 DAV WHITNEY BLDG

12703 W SEVEN MILE RD

20175 MACK AVE

DETROIT MI

48226

DETROIT MI

48235

GROSSE PTE WOODS MI

48236

RICHARD F COOPER MD

HAROLD E CROSS MD

JOHN J DAN I EL SK I MD

18100 SHADBROOK DR

68 N DEEPLAND RD

35478 PARKDALE

NORTHVILLE MI

48167

GROSSE PTE MI

48236

LIVONIA MI

48150

THOMAS M COOPER HD

ROBERT J CROSSEN MD

DAVID A DANLEY MD

8445 E JEFFERSON AVE

20867 MACK AVE

MT CARMEL MERCY HOSP

DETROIT MI

48214

GROSSE PTE WOODS MI

48236

OETROIT MI

48235

CATHERINE CORBEILLE

MD L

JAMES E CROUSHORE MD

L

BRUCE L DANTO MD

700 SEWARD

561 NE GOLDEN HARBOUR

466 FISHER BLDG

DETROIT MI

48202

BOCA RATON FL

33432

DETROIT MI

48202

DAVID P CORBETT MD

CARLITO V CRUZ MD

GEORGE W DANZ MD

HARPER HOSPITAL

20867 MACK AVE

1539 FORD

DETROIT MI

48201

GROSSE PTE WOODS MI

48236

WYANDOTTE MI

48192

GILBERT E CORRIGAN MD

VICTOR M CRUZ MD

PATRICK H DAOUST MD

400 E LAFAYETTE

15901 W 9 MILE RO #303

15520 GARFIELD

DETROIT MI

48226

SOUTHFIELD MI

48075

ALLEN PARK MI

48101

JOSEPH A CORTEZ MD

MARIA V C SERHALMI MD

JOHN J DARIN MO

A

19350 W MC NICHOLS

1302 BEACON SF I ELD

DETROIT GENERAL HOSP

DETROIT MI

48219

DETROIT MI

48230

DETROIT MI

48226

STEPHEN D COSTELLO MD

ROBT 8 CUBBERLEY MD

CHAS E DARLING MD

9435 ISLAND DR

1800 TUXEDO ST

673 FISHER BLDG

GROSSE ILE MI

48138

DETROIT MI

48206

DETROIT MI

48202

JOHN F COTANT MD

FRANK CULL I S MD

HARRY 0 DAVIDSON MD

L

15901 W 9 MILE RD #420

261 MACK BLVD

2799 W GRAND BLVD

SOUTHFIELD MI

48075

DETROIT MI

48201

DETROIT MI

48202

MARIO COTE MD

ROBERT P CURHAN MD

WINDSOR S DAVIES MD

13700 WOODWARD #800

18709 MEYERS RD

28 W ADAMS AVE

DETROIT MI

48203

DETROIT MI

48235

DETROIT MI

48226

MOISES G COTO MD

FRANK E CURTIS MD

L

JEROME D DAVIS MD

26314 HARRIET DR

273 KENWOOD CT

29927 W SIX MILE

DEARBORN HEIGHTS MI

48127

DETROIT MI

48236

LIVONIA MI

48152

CHAS J COURVILLE MD

WM P CURTISS MD

WM N DAVIS MD

703 NORTHLAND MED BLD

22631 MACK AVE

125 N MILITARY

SOUTHFIELD MI

48075

ST CLAIR SHORES MI

48080

DEARBORN MI

48124

CHARLES M COWAN MD

FREDERICK R CUSHING MD

W A DAWSON MD

R

1400 CHRYSLER EXPWY

22101 MOROSS RD

188 LAKE SILVER DR NW

DETROIT MI

48207

DETROIT MI

48236

WINTER HAVEN FL

33880

LEON B COWEN MD

L

PAUL L CUSICK MD

A JACKSON DAY MO

10225 N BALBOA DR

15901 W 9 MILE RD #400

3800 WOOOWARD AVE #406

SUN CITY AZ

85351

SOUTHFIELD MI

48075

DETROIT MI

48201

ROBT L COWEN MD

L

GERALD A CYROWSKI MD

FRANCIS T DAY MD

962 FISHER BLDG

15901 W 9 MILE RD

18540 MACK

DETROIT MI

48202

SOUTHFIELD MI

48075

DETROIT MI

48236

DOUGLAS E COX MD

F M DAIGNAULT MD

JAY C DAY MD

2355 MONROE

20905 GREENFIELD

1016 PROF PLAZA

OEARBORN MI

48124

SOUTHFIELD MI

48075

DETROIT MI

48201

FRANK COX JR M D

HAROLD J DAITCH MD

JORGE H DAY MD

N

HENRY FORD HOSP

22341 W EIGHT MILE RD

1787 NEWCASTLE

DETROIT MI

48202

DETROIT MI

48219

GROSSE PTE WOODS MI

48236

JAMES E COYLE MD

MARTIN H DAITCH MD

RUTH S DAY MD

17770 MACK AVE

15244 MIDDLEBELT RD

3790 WOODWARD AVE

GROSSE PTE MI

48224

LIVONIA MI

48154

DETROIT MI

48201

ROY D CRAIG MD

ESTHER H DALE MD

L

VEHBI DAY I OGLU MD

3790 WOODWARD AVE

4811 JOHN R ST

27560 CHERRY HILL

DETROIT MI

48201

DETROIT MI

48201

GARDEN CITY MI

48135

ELIODORO OE AENLLE MO
29022 MERRICK

WARREN MI 48092

GEORGE A DEAN MD
18900 W TEN MILE RD
SOUTHFIELD MI 48075

ROGER W DE BUSK MD

4160 JOHN R ST

DETROIT MI 48201

ROBT J DEERING MD

1359 CHAMPAIGN

LINCOLN PARK MI 48146

ALBERT F DE GROAT MD L

31296 PICKWICK SOUTH
BIRMINGHAM MI 48009

GLORIA K DE GUZMAN MD

754 FISHER BLDG

DETROIT MI 48202

DANIEL DEITCH MD
KIRWOOD GENERAL HOSP
DETROIT MI 48238

EDWIN DE JONGH MO
GEN MOTORS BUILDING
DETROIT MI 48202

STELLA M OELAINI MD

3011 W GRAND BLVD

DETROIT MI 48202

BETTY J DE LAWRENCE MD
21576 MICHIGAN AVE
DEARBORN MI 48124

THOMAS DE LAWRENCE MD
21576 MICHIGAN AVE
DEARBORN MI 48124

THOS E DEL GIORNO MD A

MECOSTA MI 49332

P A DELGI UD ICE MD

GRACE HOSPITAL

DETROIT MI 48201

C C DEL-ROSARIO MD

22231 W OUTER DR

OEARBORN MI 48124

FRANCISCO DEL VALLE MD
3729 FORT ST

LINCOLN PARK MI 48146

MARIO DEL VALLE MD
5826 ANDOVER

TROY MI 48084

ALPHONSE R DERESZ MO

4204 E OUTER DR

DETROIT MI 48234

PAUL E DERLETH MD
563 W OAKRIDGE AVE
FERNDALE MI 48220

C F DERRICK MD

3677 FORT STREET

LINCOLN PARK MI 48146

GEO C DE SMYTER MD

15527 E WARREN

DETROIT MI 48224

YVON J DES ROBERTS MD

18430 MACK AVE

DETROIT MI 48236

OWEN J DEUBY MD
15121 W SEVEN MILE RD
DETROIT MI 48235

OOUGLAS A OEVENS MD
DETROIT GENERAL HOSP
DETROIT MI 48226

HERBERT W DEVINE MD

22101 MOROSS RD

DETROIT MI 48236

JANUARY, 1972/Michigan Medicine 65

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

LILIAN M DIAKOW MD

S DJURASKOVIC MD

A

EDW A DOUGHERTY JR MD

1539 N LINE RD

WAYNE STATE UNIV

18241 W MC NICHOLS RD

WYANDOTTE MI

48192

DETROIT MI

48207

DETROIT MI

48219

GEORGE DIAZ MD

A

CLIFFORD L DOANE MD

CLAIR L DOUGLAS MD

L

LAFAYETTE CLINIC

15041 E 7 MILE RD

1201 RICHMOND ST #807

DETROIT MI

48207

DETROIT MI

48205

LONDON ONT CANADA

G J DIAZDELCASTILLO

MD A

JOHN C DODDS MD

L

ROBT C DOUGLASS MD

WAYNE STATE UNIV

18520 W 7 MILE RD

23023 ORCHARD LAKE RD

DETROIT MI

48207

DETROIT MI

48219

FARMINGTON MI

48024

ROBERT C DICKENMAN

MD

CHAS F DODENHOFF MD

BEN J W DOVITZ MD

DETROIT MEMORIAL HOSP

18031 KELLY RD

16820 GREENFIELD AVE

DETROIT MI

48226

DETROIT MI

48224

DETROIT MI

48235

BASIL R DICKSON MD

L

FOREST D DODRILL MD

IRA G DOWNER MD

L

337 W GRAND BLVD

W0008ERRY DR

8445 E JEFFERSON AVE

DETROIT MI

48216

BLOOMFIELD HILLS MI

48013

DETROIT MI

48214

EFRAIN 0 DICKSON MD

WENDELL R DOERING MD

GEO 0 OOWNES MD

4021 HARDSWOOD DR

18211 W 12 MILE RD

15062 HOUSTON

ORCHARD LAKE HI

48033

LATHRUP VILLAGE MI

48075

DETROIT MI

48205

ELIAS L DICKSON JR

MD

EDWARD A DOLAN MD

ELLET H DRAKE MD

17320 LIVERNOIS

1960 S HAMMOND LAKE

DR

HENRY FORD HOSP

DETROIT MI

48221

PONTIAC MI

48053

DETROIT MI

48202

LEON A DICKSON MD

STANLEY F OOLEGA MD

RUTH L DRAPIZA MD

18200 WYOMING

15640 E WARREN AVE

13400 FORT ST

DETROIT MI

48221

DETROIT MI

48224

SOUTHGATE MI

48195

MARY D DICKSON MD

SIDNEY DOLGOFF MD

EDWARD F DRAVES MD

A

18424 MACK AVE

15600 MICHIGAN AVE

19647 JOY RD

GROSSE PTE FARMS MI

48236

DEARBORN MI

48126

DETROIT MI

48228

NELSON W DIEBEL MD

SIMON DOLIN MD

JOEL DREYER MD

660 CADIEUX RD

28500 BELL RD

15800 W MCNICHOLS RD

DETROIT MI

48230

SOUTHFIELD MI

48075

DETROIT MI

48235

FRED C OIEKMAN HO

HENRY M OOMZALSKI MD

BEN DROBLAS MD

31815 SOUTHFIELD RD

15252 GRATIOT AVE

8233 W CHICAGO

BIRMINGHAM MI

48009

DETROIT MI

48205

DETROIT MI

48204

MARGARET R DIETZE MO

ROLF W DONATH MD

Z J F DROZDOWSKA MD

861 MONROE

719 NEW CENTER BLDG

240 CHESTERFIELD RD

DEARBORN MI

48124

DETROIT MI

48202

BLOOMFIELD HILLS MI

48013

LEONARD L 01 LELLA

MD

EUGENE T DONOVAN MO

BRUCE H DRUKKER MD

12811 NORTHLINE RD

13349 MICHIGAN AVE

HENRY FORD HOSPITAL

SOUTHGATE MI

48195

DEARBORN MI

48126

DETROIT MI

48202

HUGH L DILL MD

L

RICHARD S DONOVAN MD

JOHN K DRUMM MO

365 MARY ST

18211 W 12 MILE RD

1420 ST ANTOINE ST

GROSSE PTE FARMS MI

48236

LATHRUP VILLAGE MI

48075

DETROIT MI

48226

J LEWIS DILL MD

L

ALFREDO J 00 PICO MD

DOROTHY D SENA MD

1070 S W TAMARIND WAY

P 0 BOX 308

33000 PALMER RD

BOCA RATON FL

33432

GARDEN CITY MI

48135

WAYNE MI

48184

PANFILO C DI LORETO

MD

JOHN H DORAN MD

MARTIN S DUBPERNELL MD L

285 VINCENNES PL

23871 W MCNICHOLS

4019 GILBERT ST

DETROIT MI

48236

DETROIT MI

48219

DETROIT MI

48210

GENNARO J DI MASO M

0

JACK DORMAN MO

ROBT 0 DUBPERNELL MD

20963 KELLY

21701 W 11 MILE RD

18595 GRAND RIVER

EAST DETROIT MI

48021

SOUTHFIELD MI

48075

DETROIT MI

48223

GEO E DIMOND MD

M G OOROSTKAR MD

JOHN J OUDEK JR MD

18401 BRETTON DR

45101 HARMONY

19244 GRAND RIVER

DETROIT MI

48223

BELLEVILLE MI

48111

DETROIT MI

48223

JUAN C DIMUSTO MD

EDWARD C DORSEY MD

JOHN J DUDEK MD

1554 TUXEDO

86 KERBY RD

19244 GRAND RIVER

DETROIT MI

48206

GROSSE PTE FARMS MI

48236

DETROIT MI

48223

RANI ERO DIP IERO MD

JOHN M DORSEY MD

L

PAUL R DUMKE MD

1800 TUXEDO

756 MACKENZIE HALL WSU

2799 W GRAND BLVD

DETROIT MI

48206

DETROIT MI

48202

DETROIT MI

48202

DONALD M DITMARS JR

MD

BHOGILAL C OOSHI MD

JAMES R DUNCAN MD

HENRY FORD HOSPITAL

10448 LINCOLN

5050 JOY RD

DETROIT MI

48202

TAYLOR MI

48180

DETROIT MI

48204

EDWIN F DITTMER MD

WILLIAM L DOSS MD

HENRY A DUNLAP MD

18342 MACK AVENUE

10145 E JEFFERSON

7815 JEFFERSON AVE E

DETROIT MI

48236

DETROIT MI

48214

DETROIT MI

48214

FREDK W DIXON MD

CHESTER A DOTY MD

L

CORNELIUS E DUNN MD

L

245 S MARTHA

12210 ST ANNES DR

327 VILLA LANE

DEARBORN MI

48124

SUN CITY ARIZ

85351

ST CLAIR SHORES MI

48080

ANGEL G DIZON MD

HOWARD P DOUB MD

L

JOHN S DUNN MD

A

18424 W MCNICHOLS RD

2799 W GRAND BLVD

4063 18TH ST N W

DETROIT HI

48219

DETROIT MI

48202

ROCHESTER MINN

55901

GERALD E DUPLER MD
24234 MICHIGAN AVE
DEAR80RN MI 48124

FRANK S DUPONT MO
DETROIT MEMORIAL HOSP
DETROIT MI

EVERETT W DURHAM MD
18101 0AKW000 BLVD
DEARBORN MI

ROBT DURHAM MD
HENRY FORD HOSP
DETROIT MI

DWIGHT J DUTCHER MD
711 S OXFORD
DETROIT MI

FRANK A OUWE MD
25321 FIVE MILE RD
DETROIT MI

PAUL J DWAIHY MD
14530 E WARREN
DETROIT MI

FRANCIS W DWYER MD
15901 W 9 MILE RD #314
SOUTHFIELD MI 48075

ROSEMARY M DYKEMA MD
18424 MACK AVE
DETROIT MI

JOHN F DZIUBA MD
18901 W WARREN AVE
DETROIT MI

PAUL DZUL MD
17800 E 8 MILE RD
DETROIT MI

CHAS C EADES MD
NO 60 TREASURE ISLAND

LAGUNA BEACH CA 92651

ROBT L EASTERLY MD
1404 FORD AVENUE
WYANDOTTE MI 48192

RAYMOND J ECHT MD
VA HOSPITAL

ALLEN PARK MI 48101

ARTHUR W ECKHOUS MD

1015 KALES BLDG

DETROIT MI 48226

DONALD E ECONOMY MD
18 W LANE CT

DEARBORN MI 48124

SAML J EDER MD L

19800 W 12 MILE RD
SOUTHFIELD MI 48075

IRVING I EDGAR MD
1036 DAV WHITNEY BLDG
DETROIT MI 48226

WM N EDMONDS MD L

18525 MERRIMAN RD
LIVONIA MI 48152

ROBT B EDMONDSON MD

18501 MACK AVE

DETROIT MI 48236

C RUPERT L EDWARDS MD
3800 WOODWARD AVE *318
DETROIT MI 48201

JAMES G EDWARDS MD
17751 E WARREN AVE
DETROIT MI 48224

CHARLES F EGAN MD
WYANDOTTE GEN HOSP
WYANOOTTE MI 48192

A B El SENBREY MD
1026 FISHER BLDG
DETROIT MI 48202

48236

48228

48236

R

48226

48124

L

48202

48236

48239

A

48215

A

66 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

B E I SENSTE I N MD
*59 FISHER BLOG
DETROIT MI

EDWARD F ELDREDGE MD
185*0 MACK AVE
GROSSE PTE MI

JEAN C EL I E MD

938 OAV WHITNEY BLDG

DETROIT MI

JOS P ELLIOTT JR MD
HENRY FORD HOSP
DETROIT MI

FRANK R ELLIS MD
BOO S LAFAYETTE
OEARBORN MI

LEONARD E ELLISON MD
3800 WOODWARD AVE
DETROIT MI

MEYER J ELMAN MD
108 W HANCOCK
DETROIT MI

ABRAHAM L ELSON MD
28200 SOUTHFIELD
LATHRUP VILLAGE MI

ROBT J ELVIDGE MD
2900 W GRAND BLVD
DETROIT MI

JOHN EMANUELSEN MD
1*930 GRANOVILLE
DETROIT MI

HERMAN C EMMERT MD
*927 N 3*TH
ARLINGTON VA

GERHARD C ENDLER MD
1*13 BLAIRMOOR CT
GROSSE PTE WOODS MI

HENRI L ENFROY MD
7*21 W 7 MILE RD
DETROIT MI

EARL H ENGEL MD
33 EMMONS COURT
WYANDOTTE MI

FREDK W ENGSTROM MD
2021 MONROE
DEARBORN MI

RUBY M ENGSTROM MD
1777 CULVER AVE
DEARBORN MI

LAUREL S ENO MO
212 EASTLAND PR BLDG
DETROIT MI

DWIGHT C ENSIGN MD
HENRY FORD HOSP
DETROIT MI

WILLIAM R EPPLER MD
20160 MACK AVE
DETROIT MI

BURTON S EPSTEIN MO
18215 GREENFIELD
DETROIT MI

ELOON W ERICKSON MD
25750 W OUTER DR
LINCOLN PARK MI

MILES A ERICKSON MD
12285 TELEGRAPH
TAYLOR MI

JOS M ERMAN MD
19530 STRATFORD RD
DETROIT MI

SAIT D ERMETE MD
162* MERRIMAN
WESTLAND MI

REGINALD H ERNST MD

SHERMAN P FAUNCE MD

5050 JOY RD

182* SEMINOLE ST

*8202

DETROIT MI

*820*

DETROIT MI

*821*

JOS W ESCHBACH MD

L

JOHN F FEA MD

935 S MILITARY ST

MT CARMEL MERCY HOSP

*8236

DEARBORN MI

*812*

DETROIT MI

*8235

ELVIRA ESPIRITU MD

MAUREEN S FEDESON MD

2200 E GRAND BLVD

MT CARMEL MERCY HOSP

*8226

DETROIT MI

*8211

DETROIT MI

*8235

ROGELIO F ESPIRITU MD

THEODORE M FEDESON MD

*059 W DAVISON

MT CARMEL MERCY HOSP

*8202

DETROIT MI

*8238

DETROIT MI

*8235

FRANK J EURS MD

OAVIO FELD MD

20*85 MACK AVE

15101 W MC NICHOLS RD

*812*

GROSSE PTE WOODS MI

*8236

DETROIT MI

*8235

GEORGE C EVANS MD

LEE E FELDKAMP MD

*059 W DAVISON

360 N MAIN

*8201

DETROIT MI

*8238

PLYMOUTH MI

*8170

GOMER P EVANS JR MD

IRWIN FELDMAN MO

1553 WOODWARD AVE

37380 GLENWOOD

*8201

DETROIT MI

*8226

WAYNE MI

*818*

JOS M EVANS MD

NATHAN I AL L FELDMAN MD A

16*31 HARPER

96* CERES RD

*8075

DETROIT MI

*822*

PALM SPRINGS CA

92262

L

TOMMY N EVANS MD

PAUL H FELDMAN MD

18630 FAIRWAY DR

16800 GREENFIELD

*8202

DETROIT MI

*8221

DETROIT MI

*8235

CHAS H EWING MD

L

MARTIN Z FELDSTEIN MO

L

17120 E WARREN

16500 NO PARK DR **20

*8223

DETROIT MI

*822*

SOUTHFIELD MI

*8075

L

WM R EYLER MD

WM A FELLNER MD

2799 W GRAND BLVD

3 202 GEN MOTORS BLDG

22207

OETROIT MI

*8202

DETROIT MI

*8202

ALFRED E EYRES MD

WILLIAM R FELLOWS MD

17800 E 8 MILE

3815 PELHAM

*8236

DETROIT MI

*8236

DEARBORN MI

*812*

HAROLD L FACHNIE MD

HAROLD B FENECH MD

L

17*01 GREENFIELD RD

3800 WOODWARD AVE

*8221

DETROIT MI

*8235

DETROIT MI

*8201

L

SEBASTIAN J FAELLO MD

WM G FENNER MD

168*0 E WARREN AVE

12*5* E OUTER DR

*8192

DETROIT MI

*822*

DETROIT MI

*822*

IRVING D FAGIN MO

JOHN F FENNESSEY MD

1825* LIVERNOIS AVE

512 RIVARD

*812*

DETROIT MI

*8221

GROSSE PTE MI

*8236

RAMFIS B FAHIM MD

MERYL M FENTON MD

1*63* E 7 MILE RD

15901 W 9 MILE RD

*812*

DETROIT MI

*8205

SOUTHFIELD MI

*8075

A C FAJARDO MD

RUSSELL F FENTON MD

L

OAKWOOD HOSP

18*69 HILLCREST BLVD

*8236

DEARBORN MI

*812*

BIRMINGHAM MI

*8009

L

MORDECA I L FALICK MD

STUART V FENTON MD

189 TOWNSEND

23300 GREENFIELD

*8202

BIRMINGHAM MI

*8011

OAK PARK MI

*8237

IRA E FALK MD

VANCE FENTRESS MD

23300 PROVIDENCE DR

308 PROFESSIONAL PLAZA

*8236

SOUTHFIELD MI

*8075

DETROIT MI

*8201

LAWRENCE S FALL I S MD

L

PHILIP J FERINGA MD

2799 W GRAND BLVD

208*0 VERNIER

*8235

DETROIT MI

*8202

HARPER WOODS MI

*8236

THEODORE S FANORICH

MD R

RICHARD J FERRARA MD

200 MIRAMAR AVE

200*5 MACK AVE

*81*6

MONTECITO CA

93103

GROSSE PTE WOODS MI

*8236

LUIS R FANEGO MD

VIRGINIA M FERRARA MD

**96 LARME

18*22 WOODWARD

*8180

ALLEN PARK MI

*8101

DETROIT MI

*8203

L

AARON A FARBMAN MD

FELICIANO FERRER MD

1*515 KERCHEVAL

2763* FIVE MILE

*8221

DETROIT MI

*6215

LIVONIA MI

*815*

ANGEL M FARINA MD

GEORGE N FERRIS M D

2020 MIDDLEBELT

20001 GREENFIELD

*8185

GARDEN CITY MI

*8135

DETROIT MI

*8235

MARION S FERSZT MD

15369 GRANOVILLE

DETROIT MI *8223

LEO S FIGIEL MO

1500 BALMORAL RD

DETROIT MI *8203

STEVEN J FIGIEL MD

*160 JOHN R ST

DETROIT MI *8201

LAWRENCE E FILKIN MD
156*5 NORTHVILLE
FOREST OR APT 193

PLYMOUTH MI *8170

LEON FILL MD

2310 CASS EXEC SUITE

DETROIT MI *8201

F SINCLAIR FINCH MD
89* N RENAUD
DETROIT MI

JEROME H FINCK MD
258*1 PLYMOUTH
DETROIT MI

EDWARD FINE MD
15901 W 9 MILE RD
SOUTHFIELD MI

GERALD FINE MD
HENRY FORD HOSP
DETROIT MI

SAML FINK MD
10161 BURTON
OAK PARK MI

I S FINKELSTEIN MD
20905 GREENFIELD *102

SOUTHFIELD MI *8075

M B FINKELSTEIN MD

1825* LIVERNOIS

DETROIT MI *8221

PAUL G FIRNSCHILD M D

8 SHADY HOLLOW

DEARBORN MI *812*

ARTHUR J FISCHER MD

15370 LEVAN RD

LIVONIA MI *815*

FREDK J FISCHER MD L

65* FISHER BLDG
DETROIT MI *8202

HERBERT L FISHBEIN MD
987 E JEFFERSON AVE
DETROIT MI *8207

GEO S FISHER MO

1709 DAV WHITNEY BLDG

OETROIT MI *8226

JAMES M FISHER MD

176 MERRIWEATHER

GROSSE PTE MI *8236

STUART FISHER MD A

OETROIT GENERAL HOSP
DETROIT MI *8226

C H FITZGERALD MD DIR
23* STATE ST
WAYNE CO MENTAL
HEALTH CLINIC

DETROIT MI *8226

F W FITZPATRICK MD

17187 SCHAEFER

DETROIT MI *8235

NORMAN W FLAHERTY MD
2*315 FAIRMONT DR
DEARBORN MI *812*

THOMAS M FLAKE MD
13800 LIVERNOIS AVE
DETROIT MI *8238

*8236

*8239

*8075

*8202

*8237

JANUARY, 1972/Michigan Medicine 67

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

L E FLE I SCHMANN MD

NILS A FRANZEN MD

L

HUGH M FULLER MD

CHILDRENS HOSPITAL

15360 OAKFIELD AVE

404 DAVID WHITNEY BLDG

DETROIT MI

48202

DETROIT MI

48227

DETROIT MI

48226

WM R FLORA MD

GEO C FREDERICKSON MD

WM J FULTON MD

R

17800 E EIGHT MILE RD

7430 SECOND

BENNETT PTE RD

DETROIT MI

48236

DETROIT MI

48202

QUEENSTOWN MD

21658

BETTY S FLORES MO

HARRY W FREE MD

CARL A GAGLIARDI MD

1449 DAV WHITNEY BLDG

17550 W 12 MILE RD

3516 FORT ST

DETROIT MI

48226

SOUTHFIELD MI

48075

LINCOLN PARK MI

48146

WILLIAM S FLOYD MD

DONALD K FREEMAN MD

RAY 0 GAINES MO

28505 SOUTHFIELD RD

881 CHALMERS ST

WAYNE CO GEN HOSP

LATHRUP VILLAGE MI

48075

DETROIT MI

48215

ELOISE MI

48132

MARIE N FLY MD

MICHAEL W FREEMAN MD

L

ROBERT J GALACZ MD

OAKWOOD HOSPITAL

1810 WELLESLEY DR

19291 WOODSTON RD

DEARBORN MI

48124

DETROIT MI

48203

DETROIT MI

48203

ROBT G FOGT MD

RICHARD F FREEMAN MD

H C GALANTOWICZ MD

L

316 NEFF ftOAD

310 VISGER

7433 MICH AVE

GROSSE POINTE MI

48230

RIVER ROUGE MI

48218

DETROIT MI

48210

HUGH S FOLEY MD

L

WILMER FREEMAN MD

THOS H GALANTOWICZ

MD

22707 ALEXANDRINE

940 EAST 7 MILE RD

23601 FORD RD

DEARBORN MI

48124

OETROIT MI

48203

OEARBORN MI

48128

JOHN A FOOTE MO

SAMUEL ERE I D MD

LASLO GALDONY I M D

L

1336 SOUTHFIELD RD

17537 PARKSIDE

2311 DAV BRODERICK

TWR

LINCOLN PARK MI

48146

DETROIT MI

48221

DETROIT MI

48226

FRANK S FORDELL MD

R

MORTON L FREIER MD

DARREL B GALERNEAU

MD L

22159 W OUTER DR

26440 SOUTHFIELD RD

964 OAKWOOD DR APT

152

DEARBORN MI

48124

LATHRUP VILLAGE MI

48037

ROCHESTER MI

48063

GORDON R FORRER MD

ANDREW A FREIER MD

HENRY GALL M D

905 PENNIMAN

18597 W TEN MILE

10531 FARMINGTON RD

PLYMOUTH MI

48170

SOUTHFIELD MI

48075

LIVONIA MI

48150

ROBERT P FOSNAUGH M

D

EUGENE L FREITAS MD

JAMES P GALLAGHER MD

23185 TIMBERLINE

ST JOHNS HOSPITAL

14801 SOUTHFIELD

SOUTHFIELD MI

48075

DETROIT MI

48236

ALLEN PARK MI

48101

E BRUCE FOSTER MD

ALEX S FRIEDLAENDER MD

VINCENT J GALLANT MD

20905 GREENFIELD RD

15901 W NINE MILE RD

1414 WELLESLEY DR

SOUTHFIELD MI

48075

SOUTHFIELD Ml

48075

DETROIT MI

48203

OWEN C FOSTER MD

L

SIDNEY FRIEDLAENDER MD

RICHARD P GALLUCCI

MD

167 WORDSWORTH ST

15901 W NINE MILE RD

23100 CHERRY HILL

FERNOALE MI

48220

SOUTHFIELD MI

48075

DEARBORN MI

48124

WALLACE M FOSTER MD

JOSEPH FRIEDLANOER MD A

JOHN P GALVIN MD

13700 WOODWARD AVE

19959 VERNIER RD

HIGHLAND PARK MI

48203

HARPER WOODS MI

48236

CHARLES W FOUNTAIN MD

DAVID FRIEOMAN MD

S N GANGULY MD

2012 MONROE BLVD

1333 STRATHCONA

HUTZEL HOSPITAL

DEARBORN MI

48124

DETROIT MI

48203

DETROIT MI

48201

MELVIN E FOWLER MD

L

HYMAN FRIEDMAN MD

THOS GANOS MD

247 E WARREN ST

6742 PARK AVE

6742 PARK AVE

DETROIT MI

48201

ALLEN PARK MI

48101

ALLEN PARK MI

48101

THOMAS A FOX JR MD

ISIOOR H FRIEDMAN MD

L

ROBERT I GANS MD

HENRY FORD HOSP

10 PETERBORO

26615 GREENFIELD

DETROIT MI

48202

DETROIT MI

48201

SOUTHFIELD MI

48075

PAUL L ERA I BERG MD

SEYMOUR FRIEDMAN MO

JOHN H GANSCHOW MD

16240 N PARK OR

7636 ALLEN RD

25034 CHAMPLAIGN

SOUTHFIELD MI

48075

ALLEN PARK MI

48101

SOUTHFIELD MI

48076

BOY FRAME MD

WM G FRIEND MD

REM I G 10 GARCIA MD

543 LAKEPOINTE

3800 WOOOWARD AVE #508

HENRY FORD HOSP

GROSSE PTE PARK MI

48230

DETROIT MI

48201

DETROIT MI

48202

CHAS J FRANCE MD

HAROLD M FROST MD

LAWRENCE W GARDNER

MD

17800 E EIGHT MILE RO

HENRY FORD HOSP

18782 GLENWOOD

ESTLND PROF BLDG #436

DETROIT MI

48202

LATHRUP VILLAGE MI

48076

HARPER WOODS MI

48225

RICHARD G FROST MD

MAX L GARDNER MD

410 HILLCREST AVE

19557 MACK AVE

MARION J FRANJAC MD

R

GROSSE PTE FARMS MI

48236

GROSSE PTE MI

48236

3 AUBURN DRIVE

LAKE WORTH FL

33460

JAMES D FRYFOGLE MD

LOUIS B GARIEPY MD

15901 W 9 MILE RD #715

6116 WING LAKE RD

MAURICE A FRANKEL MO

SOUTHFIELD MI

48075

BIRMINGHAM MI

48010

17000 W EIGHT MILE

SOUTHFIELD MI

48075

SHIRO FUJITA MD

LOUIS J GARIEPY MD

L

HENRY FORD HOSPITAL

16401 GRAND RIVER

JOHN E FRANKLIN MD

DETROIT MI

48202

DETROIT MI

48227

4075 INK RD

INKSTER MI

48141

WILLIAM R FULGENZI MD

H HARVEY GASS MD

1210 KALES BLOG

529 FISHER BLOG

DETROIT MI

48226

OETROIT MI

48202

HERBERT B GASTON MO
7501 W MORROW CIRCLE
OEARBORN MI 48126

MIGUEL G GATMAITAN MD A

GRACE HOSPITAL

OETROIT MI 48201

ALEX GAYNOR MO

1755 E 7 MILE RO

OETROIT MI 48203

HAROLD W GEHRING MD
3535 W 13 MILE NO 507
ROYAL OAK MI 48072

AUGUST E GEHRKE MD R

850 TRAIL WOOD PATH
BIRMINGHAM MI 48010

WM A GEITZ MD
BOX 1133
BOCA RATON FL

R

33432

PHILIP D GELBACH MD
22600 KING RICHARD CT
BIRMINGHAM MI 48010

M J GEOGHEGAN MD
3815 PELHAM

DEARBORN MI 48124

ALMA R GEORGE MD

10730 W 7 MILE RD

DETROIT MI 48221

JOHN A GERALT MD

11420 MACK AVE

DETROIT MI 48214

ROBT A GERISCH MD
1217 DAV WHITNEY BLDG
DETROIT MI 48226

ELMOND J GERONDALE MD L
3001 W GRAND BLVD
DETROIT MI 48202

HASSAN GHANDCHI MD

16975 FARMINGTON

LIVONIA MI 48154

BURJOR D GHANDHI MD

19309 GREENFIELD

DETROIT MI 48235

DUNBAR P GIBSON MD
BOX 1256

DETROIT MI 48231

PETER GIBSON MD
CHILDRENS HOSPITAL
DETROIT MI 48202

WM GIBSON MD

3790 WOODWARD AVE

DETROIT MI 48202

FRED W GIESE M D

18526 SCHOOLCRAFT

DETROIT MI 48223

CONRAD L GILES MD

407 NORTHLAND MED BLOG

SOUTHFIELD MI 48075

STEPHEN M GILLESPIE MD
23100 CHERRY HILL
OEARBORN MI 48124

JAMES C GILLIAM JR MD
3502 BRUSH ST

OETROIT MI 48202

WATSON A GILPIN MD

1539 LOCKRIOGE

BLOOMFIELD HILLS MI 48013

JAMES L GILREATH MD
1800 TUXEDO

DETROIT MI 48206

JOHN GILROY MD

HARPER HOSPITAL

DETROIT MI 48201

68 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

HAROLD I GINSBERG MD

ABE S GOLDSTEIN MD

GEORGE R GRANGER MD

18181 W 12 MILE RD

19445 GLOUCESTER DR

17800 E 8 MILE RD

LATHRUP VILLAGE MI

48075

DETROIT MI

48203

HARPER WOODS MI

48236

BIRUTE GIRNIUS MD

MAURICE 0 GOLLMAN MD

ABRAHAM H GRANT MD

15439 HARPER

17000 W EIGHT MILE RD

16300 W 9 MILE RD #121

DETROIT MI

48224

SOUTHFIELD MI

48075

SOUTHFIELD MI

48075

CHAS GITLIN MD

L

ROMUALD H GOMLEY MD

HEMAN E GRANT MD

L

21510 HARPER AVE

BOX 224

ST CLAIR SHORES MI

48080

BABSON PARK FL

33827

PERRY C GITTINS MD

L

SALVADOR GONZALEZ MD

HENRI L GRATTON MD

L

2075 W LINCOLN RO

28 W ADAMS ST

12054 PREST

BIRMINGHAM MI

48009

DETROIT MI

48226

DETROIT MI

48227

DONOVAN H GIVENS JR MD

MAXWELL M GOODMAN MD

JAMES H GRAVES MD

3800 WOODWARD

22265 GARRISON

63 KERCHEVAL

DETROIT MI

48201

WEST DEARBORN MI

48124

GROSSE PTE FARMS MI

48236

WALDEMAR E GIZYNSKI MD

PAUL A GOODMAN MO

HOWARD 0 GRAY M D

15420 FARMINGTON

SINAI HOSP

3800 WOODWARD AVE

LIVONIA MI

48154

DETROIT MI

48235

DETROIT MI

48201

GORDON K GLASGOW MD

R

VIRGIL P GOODMAN MD

EDWARD W GREEN MD

395 MOROSS RD

1708 VERNIER RD

CHILDRENS HOSPITAL

GROSSE PTE FARMS MI

48236

GROSSE PTE WOODS MI

48236

5224 ST ANTOINE

WALTER S GLAZER MD

A

WARREN W GOODWIN MD

DETROIT MI

48202

5555 GULFSTREAM

20101 JAMES COUZENS

SARASOTA FL

33570

DETROIT MI

48235

ELLIS R GREEN MO
11393 INKSTER RD

L

RAYMOND B GLEMENT MD

L

WILLIAM P GOODWIN MD

LIVONIA MI

48150

16126 WOODRING CT

1616 BOSTON W

LIVONIA MI

48154

DETROIT MI

48206

HENRY L GREEN MD
17214 JEANETTE

BEN F GLOWACKI MD

L

MARVIN GORDON MD

SOUTHFIELD MI

48075

840 JONATHAN

DETROIT MEMORIAL HOSP

BLOOMFIELD HILLS MI

48013

DETROIT MI

48226

LEWIS GREEN MD
29588 FIVE MILE RD

EDWARD T GLOWACKI MD

MARTIN J GORELICK MD

LIVONIA MI

48154

54 WEBBER PLACE

23901 MICHIGAN AVE

GROSSE PTE SHORES MI

48236

DEARBORN MI

48124

MILTON M GREEN MD
17000 W 8 MILE RD

RAYMOND M GLOWACKI MD

STEPHEN V GORYL MD

SOUTHFIELD MI

48075

2421 MONROE

12141 CHARLEVOIX

DEARBORN MI

48124

EAST DETROIT MI

48215

NELSON W GREEN MD
31815 SOUTHFIELD RD

JULIEN GO JR MD

SAME B GOSS MD

BIRMINGHAM MI

48009

27537 PARKVIEW

26200 GREENFIELD

WARREN MI

48092

OAK PARK MI

48237

THOMAS GREEN JR MD
5050 JOY RD

ALEGRO J GODLEY MD

EDMOND J GOSTINE MD

DETROIT MI

48204

3790 WOODWARD

9750 CHALMERS

DETROIT MI

48201

DETROIT MI

48213

JACK R GREENBERG MD
15821 W SEVEN MILE

RD

ELMER A GOERKE MD

JAMES E GOTHAM MD

DETROIT MI

48235

36663 GODDARD RD

3825 BRUSH ST

ROMULUS MI

48174

DETROIT MI

48201

JULIUS J GREENBERG
22940 SHERVINGTON

MD

ANGUS G GOETZ MD

L

ABRAHAM G GOTMAN MD

SOUTHFIELD MI

48075

3800 WOODWARD AVE *406

987 E JEFFERSON AVE

DETROIT MI

48201

DETROIT MI

48207

MORRIS Z GREENBERG
9105 VAN DYKE

MD

MEHMET K GOKNAR MD

JACQUES S GOTTLIEB MD

DETROIT MI

48213

NORTHVILLE STATE HOSP

951 E LAFAYETTE

NORTHVILLE MI

48167

DETROIT MI

48207

STANLEY GREENBERG M
20905 GREENFIELD

D

ARTHUR GOLDBERG MD

SALAH E A GOUDA MD

SOUTHFIELD MI

48075

20461 JOHN R ST

28633 HOOVER RO

DETROIT MI

48203

WARREN MI

48093

JOHN B GREENE MD
2179 W GRAND BLVD

ALFRED GOLDEN MD

RAYMOND S GOUX MD

L

DETROIT MI

48208

26764 YORK RO

17566 MUIRLAND AVE

HUNTINGTON WOODS MI

48070

DETROIT MI

48221

THOMAS J GREENE MD
1054 FISHER BLDG

ALFRED GOLDFADEN MD

JOS M GRACE MD

L

DETROIT MI

48202

9122 W FORT ST

31140 HUNTLEY SQUARE

DETROIT MI

48209

BIRMINGHAM MI

48009

WM T GREENLEE MD
15053 MADDELEIN

L

AUBREY GOLDMAN MD

JOS A GRADY MD

DETROIT MI

48205

18400 SCHAEFER

946 THREE MILE OR

DETROIT MI

48235

DETROIT MI

48230

FRANK S GREENSLIT MD

2021 MONROE

PERRY GOLDMAN MD

JOHN G GRAHAM JR MD

DEARBORN MI

48124

18050 FAIRWAY DR

491 LINCOLN RO

DETROIT MI

48221

GROSSE PTE MI

48236

CLARENCE W GREER MD
4096 LESLIE

A

ROBERT T GOLDMAN MD

THEODORE N GRAHAM MD

DETROIT MI

48238

WAYNE COUNTY HOSPITAL

2424 PURITAN

ELOISE MI

48132

DETROIT MI

48238

GERTRUDE B GREGORY
P 0 BOX 3622

MD

MILTON H GOLDRATH MD

FRANCIS L GRANGER MD

FORD TRACTOR PLANT

17000 W 8 MILE RD

14160 GRATIOT AVE

SOUTHFIELD MI

48075

DETROIT MI

48205

HIGHLAND PARK MI

48203

LOUIS J GREGORY MO

47 WEBBER PLACE

DETROIT MI 48236

FREOK C GREILING MO

710 NOTRE DAME

DETROIT MI 48230

JOHN H GRIFFIN MD

22101 MOROSS RD

DETROIT MI 48236

ROBERT J GRIFFIN MD

17401 MACK AVE

DETROIT MI 48224

SYDNEY J GRIFFITHS MD
15400 PLYMOUTH RD
DETROIT MI 48227

THOMAS J GRIFKA MD
1400 CHRYSLER EXPWY
DETROIT MI 48207

GREGORY J GRIMALDI MD A

905 HARCOURT

DETROIT MI 48230

ALEXANDER GRINSTEIN MD

18466 WILDEMERE

DETROIT MI 48221

S GRIVA-LIZLOVS MD

6033 MIDDLEBELT

GARDEN CITY MI 48135

JOHN GRIZ MD

3815 PELHAM RD

DEARBORN MI 48124

OTTO GROB MD A

900 CALLE DELOSAMIGOS
SANTA BARBARA CA 93105

CARLOS GRODSINSKY MD

HENRY FORD HOSP

DETROIT MI 48202

JOSE GUERRERO MD L

4285 GLENDALE

DETROIT HI 48238

DAVID S GUDES MD
1080 FISHER BLDG
DETROIT MI 48202

OMAR GUEVARA MD
30900 FORD RD
GARDEN CITY MI

48135

JULIAN M GUIDOT MD

18714 GRAND RIVER

DETROIT MI 48223

ABILIO S GUIMARAES MD L
440 SOUTH DENWOOD
DEARBORN MI 48124

GEO E GUINAN MD
5012 HOWE RD
WAYNE MI

L

48184

MOUNIR F GUINOI MD

1080 FISHER BLDG

DETROIT MI 48202

EDWIN R GUISE JR MD
HENRY FORD HOSPITAL
DETROIT MI 48202

SAMI F GUINDI MD
1080 FISHER BLDG
DETROIT MI 48202

ARTHUR E GULICK MD
4160 JOHN R

DETROIT MI 48201

ELISHA S GURDJIAN MD L

1553 WOODWARD AVE
DETROIT MI 48226

EUGENIA E GURSKIS MD

504 KALES BLDG

DETROIT MI 48226

JANUARY, 1972/Michigan Medicine 69

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

V A GUTIERREZ MD

ROBT H HAMBURG MD

JESSE T HARPER MD

L

P 0 BOX 587

1515 DAV WHITNEY BLDG

1110 DAV WHITNEY BLDG

BLOOMFIELD HILLS MI

48013

DETROIT MI

48226

DETROIT MI

48226

BENJAMIN R GUTOW MD

AL8ERT C HAMBURGER MD L

EDW B HARRINGTON MD

12415 E 12 MILE RD

865 S PEMBERTON RD

15212 MICHIGAN AVE

WARREN MI

48093

BLOOMFIELD HILLS MI

48013

DEARBORN MI

48126

JOS F GUYON MD

STUART W HAMBURGER MD

F L HARRINGTON M D

WYANOOTTE HOSP

18400 SCHAEFER HWY

15901 W 9 MILE RD

REHAB CENTER

DETROIT MI

48235

SOUTHFIELD MI

48075

2331 VAN ALSTYNE BLVD

WYANOOTTE MI

48192

EDWIN J HAMMER MD

HARCOURT G HARRIS MD

16616 MACK AVE

13800 LIVERNOIS

OANIEL R GUYOT MD

DETROIT MI

48224

OETROIT MI

48206

3825 BRUSH

DETROIT MI

48201

ROY W HAMMER MD

HAROLD H HARRIS MD

R

11455 E MCNICHOLS

1221 DREW C-l

JACK S GUYTON MD

DETROIT MI

48234

CLEARWATER FL

33315

2799 W GRAND BLVD

DETROIT MI

48202

ARTHUR E HAMMOND MO

L

IVOR D HARRIS MD

1553 WOODWARO AVE

1245 DAVID WHITNEY BLD

ELAINE M HACKER MD

DETROIT MI

48226

DETROIT MI

48226

763 FISHER BLDG

DETROIT MI

48202

JAMES L HAMMOND MO

L

MICHAEL A HARRI S MD

1006 MORSE ST

FORD MOTOR COMPANY

BENJAMIN F HADDAD M

D

OCEANSIDE CA

92054

DEARBORN MI

48121

1010 MICH MUTUAL BLDG

DETROIT MI

48226

RONALD G HAMMOND MD

WILL 1 AM A HARRI TY MD

15830 FORT ST

302 EASTLAND PROF BLDG

ELIAS D HADOAO MO

SOUTHGATE MI

48195

DETROIT MI

48236

14636 E SEVEN MILE

DETROIT MI

48205

JACK E HANDEL MD

CHARLES E HART M D

DETROIT MEMORIAL HOSP

23845 VAN DYKE

DONALD HAOESMAN MD

DETROIT MI

48226

CENTERLINE Ml

48015

985 E JEFFERSON

DETROIT MI

48207

JOHN W HANSEN MD

R

ZWI H HART MD

715 W MICHIGAN *703

800 N GULLEY RD

B S HADJIMIHALOGLU MD

JACKSON MI

49201

DEARBORN MI

48128

2429 E MILWAUKEE

DETROIT MI

48211

KARL HANYI M D

HENRY H HARTKOP MD

7645 THORNWOOD

20055 MACK AVE

H H HAGERMOSER MD

PLYMOUTH MI

48170

DETROIT MI

48236

412 EASTLAND CTR BLDG

DETROIT MI

48236

CLARENCE M HARDY MD

ROBT J HARTQUI ST MD

3745 MONROE

1495 FORT ST

8 H HA I DOST I AN MD

DEARBORN MI

48124

WYANDOTTE MI

48192

18456 GRAND RIVER

DETROIT MI

48223

GERALDINE M HARDY MD

A

JOHN M HARTZELL MD

19707 MACK AVE

7815 E JEFFERSON

ELLEN R HAINES MD

GROSSE PTE WOODS MI

48236

DETROIT MI

48214

525 SEYBURN

DETROIT MI

48214

WARREN G HARDY MD

CLYDE K HASLEY MD

L

801 DAV WHITNEY BLDG

2320 N LASALLE GARDENS

LEONARD MAKING MD

DETROIT MI

48226

DETROIT MI

48206

14014 E 7 MILE RD

DETROIT MI

48205

WM W HARDY JR MO

ABDUL A HASSAN MD

A

HENRY FORD HOSPITAL

10049 PELHAM RD

G PETER HALEKAS MD

DETROIT MI

48202

ALLEN PARK MI

48101

21727 MACK AVE

ST CLAIR SHORES MI

48080

ELY W HARELIK MD

L

GERARD R HASSETT MD

27385 GREENF I ELO

ST MARYS HOSPITAL

WILLIAM A HALEY MD

SOUTHFIELD MI

48075

LIVONIA MI

48151

781 E GRAND BLVD

DETROIT MI

48207

CAMILLE K E HARIZE MD

WALTER W HASSIG MD

14807 W MCNICHOLS RD

20914 KELLY

ARCH H HALL MD

DETROIT MI

48235

EAST DETROIT MI

48021

3790 WOODWARD

DETROIT MI

48201

ROMAN W HARKAWAY MD

ORVILLE J HASTINGS MD L

19120 VAN DYKE

15744 HARPER AVE

C ROBERT HALL MD

A

DETROIT MI

48234

DETROIT MI

48224

23581 SENECA

OAK PARK MI

48237

GARTH H HARLEY MO

VLADIMIR A HASZCZYC MD

2853 CUESTA WAY

3329 YEMANS

RALPH E HALL MD

L

CARMEL CA

93921

HAMTRAMCK MI

48212

DRUMMOND ISLAND

DRUMMOND MI

49726

LOUIS M HARLEY MD

HUBERT R HATHAWAY MD

A

4100 W MC NICHOLS RD

154 ENGLEWOOD RD

RICHARD H HALL MD

DETROIT MI

48221

SPRINGFIELD OH

45504

28700 EIGHT MILE RD

FARMINGTON MI

48024

WINFRED B HARM MD

L

I JEROME HAUSER MD

16150 OXLEY APT 101

7411 THIRD AVE

WINTHROP D HALL MD

SOUTHFIELD MI

48075

DETROIT MI

48202

5237 OAKMAN BLVD

DEARBORN MI

48126

EDWIN L HARMON MD

L

JOHN E HAUSER MD

745 BEDFORD RD

405 NORTHLAND MED BLDG

LEONARD J HALLEN MD

GROSSE PTE PARK MI

48230

SOUTHFIELD MI

48075

1335 NICOLET PL

DETROIT MI

48207

R W F HARNETT MD

MAURICE J HAUSER MD

A

529 FISHER BLOG

7411 THIRD AVE

RONALD C HAMAKER MO

A

DETROIT MI

48202

OETROIT MI

48202

712 E PROSPECT

MARSHALL MI

49068

JAMES H HARPER MD

RAOUF R HAWASH MD

KIRWOOD GENERAL HOSP

19647 JOY RD

DETROIT MI

48238

DETROIT MI

48228

OAVID B HAWTOF MO
15901 W 9 MILE RD
SOUTHFIELD MI 48075

MOLLY TAN HAYDEN MO

SINAI HOSPITAL

DETROIT MI 48235

ROYAL C HAYDEN JR MD

22000 GREENFIELD

OAK PARK MI 48237

ALLEN L HAYES MD
17431 GREENFIELD
DETROIT MI 48235

LOUIS F HAYES MD

441 E JEFFERSON

DETROIT MI 48226

ROY S HAZEN MD

15121 W 7 MILE RD

DETROIT MI 48235

LEONARD P HEATH MD

1553 WOODWARD AVE

DETROIT MI 48226

LYLE E HEAVNER MD

903 CRESCENT LN

GROSSE PTE WOODS MI 48236

THEOPHILUS H HEENAN MD
1553 WOODWARD AVE
DETROIT MI 48226

ROBERT P HEIDELBERG MD
13701 W SEVEN MILE RD
OETROIT MI 48235

LOUIS E HE I DEMAN MD
4545 WAGON WHEEL DR
BIRMINGHAM MI 48010

EDWARD R HE I L MD
24111 SOUTHFIELD
SOUTHFIELD MI 48075

MARILYN HEINS MD
747 LAKELAND

GROSSE PTE MI 48236

RICHARD F HELDT MD

1951 MONROE BLVD

DEARBORN MI 48124

THOS J HELDT MD L

17 POPLAR PARK

PLEASANT RIDGE MI 48069

MANUEL H HENDELMAN MD
17141 HAYES

DETROIT MI 48205

ALLISON B HENDERSON MD

9041 DEXTER BLVD

DETROIT MI 48206

ARTHUR B HENDERSON MD L

946 BEACONSF IELD RD
GROSSE PTE PARK MI 48230

CHAS W HENDERSON MD
20905 GREENFIELD RD
SOUTHFIELD MI 48075

FREDERIC C HENDERSON

20861 MACK AVE

GROSSE PTE WOODS MI 48236

H R HENDERSON MD
3800 WOODWARD AVE 208
DETROIT MI 48201

HUGH W HENDERSON MD

18601 MACK AVE

DETROIT MI 48236

LESLIE T HENDERSON MD L
832 N RENAUD

GROSSE PTE WOODS MI 48236

ALAN K HENDRA MD
15540 HARPER

DETROIT MI 48224

70 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

HUGH C HENDRIE MD

FREDK G HICKS MD

HARRY Y HOFFMAN MD

951 E LAFAYETTE

1000 WESTWOOD

15085 E SEVEN MILE RD

DETROIT MI

48207

BIRMINGHAM MI

48009

DETROIT MI

48205

FRED N HENIG HD

ROBERT H HIGH MD

HENRY A HOFFMAN MD

A

7605 W SEVEN MILE RD

HENRY FORD HOSP

10015 E OUTER DR

DETROIT MI

48221

DETROIT MI

48202

DETROIT MI

48224

RAYMOND HENKIN MD

J GILBERTO HIGUERA MD

HILTON C HOFFMAN MO

17228 SHERVILLA

13700 WOODWARD AVE

18555 E WARREN

SOUTHFIELD MI

48075

DETROIT MI

48203

DETROIT MI

48236

WM A HENKIN MD

EDWARD J HILL JR MD

AZAT HOGIKYAN MD

18215 GREENFIELD

949 DAV WHITNEY BLDG

16901 W MCNICHOLS RD

DETROIT MI

48235

DETROIT MI

48226

DETROIT MI

48235

ALAN T HENNESSEY MD

GEORGE C HILL MD

JEAN M HOLDREDGE MD

OAKWOOD HOSP

3800 WOODWARD AVE

3011 W GRAND BLVD

DEARBORN MI

48121

DETROIT MI

48201

DETROIT MI

48202

LAURENCE E HENRICH MD L

RAYMOND D HILL MD

F WAYNE HOLLINGER MD

105 HAGGERTY RD

22190 GARRISON

5-267 GEN MOTORS BLDG

PLYMOUTH MI

48170

W DEARBORN MI

48124

DETROIT MI

48202

R08ERT C HENRY MD

WELFORD T HILL MD

HENRY B HOLLIS MD

725 WATERS EDGE DR

8300 MACK AVE

6809 SIRENA

ANN ARBOR MI

48105

DETROIT MI

48214

DETROIT Ml

48210

HAROLD B HERBST MD

GLENN I HILLER MD

JANET L HOLLOWAY MO

7282 RIVERSTONE RD

15901 W 9 MILE RD #610

7430 SECOND

BIRMINGHAM MI

48010

SOUTHFIELD MI

48075

DETROIT MI

48202

MARIA M HERENDA MD

JOHN W HILLYER MD

M L HOLLOWELL MD

101 E ALEXANDRINE

3700 WEST ROAD

10720 W 7 MILE RD

DETROIT MI

48201

TRENTON MI

48183

DETROIT MI

48221

KLAUS HERGT MD

WM E HILTON MD

L

GEO F HOLMES MD

14551 SOUTHFIELD

5951 YORKSHIRE RD

14729 CHAMPAIGN

ALLEN PARK MI

48101

DETROIT MI

48224

ALLEN PARK MI

48101

HUGO R HERNANDEZ MD

A

LEO J HIRSCH MD

CHAS J HOLT JR MD

NORTHVILLE STATE HOSP

1190 E 12 MILE RD

1210 S OXFORD

NORTHVILLE MI

48167

MADISON HEIGHTS MI

48071

GROSSE PTE MI

48236

EDUARDO M HERRERO MD

LORE HIRSCH MD

HENRY T HOLT MD

21913 CANTERBURY

212 S MELBORN

5050 CASS ST

GROSSE 1LE MI

48138

DEARBORN MI

48124

DETROIT MI

48202

EDUARDO U HERRERO MD

A H HIRSCHFELD MO

W S HOLT JR MD

21845 CANTERBURY

625 PURDY

MT CARMEL HOSP

GROSSE ILE MI

48138

BIRMINGHAM MI

48009

DETROIT MI

48235

ROSE E HERROLD M D

L

CECELIA HISSONG MD

EUGENE A HOME I STER MD

1277 E GRAND BLVD

4407 ROEMER

12925 PENNSYLVANIA AVE

DETROIT MI

48211

DEARBORN MI

48126

WYANDOTTE Ml

48192

ROY F HERSCHELMANN MD

A

EUGENE HO MD

JOSEPH C HONET MO

3343 GRATIOT AVE

WYANDOTTE GEN HOSP

SINAI HOSPITAL

DETROIT MI

48207

WYANDOTTE MI

48192

DETROIT MI

48235

ERNEST A HERSHEY JR MD

DONALD V HOBBS MD

FRED L HONHART MD

L

641 DAVID WHITNEY BLDG

17550 W 12 MILE RD

1405 BERKSHIRE ROAD

OETROIT MI

48226

SOUTHFIELD MI

48075

GROSSE PTE MI

48230

JACK H HERTZLER MD

MORTON M HOCHMAN MD

ANDREW J HOPKINS MD

3011 W GRAND BLVD

16633 PLYMOUTH RD

4407 ROEMER

DETROIT MI

48202

DETROIT MI

48227

DEARBORN Ml

48126

JOHN T HERWICK MD

A ALBERTO HODAR I MD

GEORGE C HOPKINS MD

2799 W GRAND BLVD

CRITTENTON HOSPITAL

20464 WEBBER DR

DETROIT HI

48202

DETROIT MI

48206

HARPER WOODS MI

48225

MURRAY W HESS MD

JASON HODGES MD

SCOVELL M HOPKINS MD

30650 BRUCE

26401 HARPER

910 DAV BRODERICK TWR

FRANKLIN MI

48025

ST CLAIR SHORES MI

48081

DETROIT MI

48226

PHILIP C HESSBURG MD

CHAS P HODGKINSON MD

GEORGE H HOPSON MD

20160 MACK AVE

17546 MEADWOOD AVE

20101 JAMES COUZENS

GROSSE PTE WOODS MI

48236

LATHRUP VILLAGE MI

48075

DETROIT MI

48235

LOUIS F HEYMAN MD

THOS HOFFER MD

EARL J HORKINS MD

19201 W SEVEN MILE RD

5825 ALLEN RD

32316 GRAND RIVER

DETROIT MI

48219

ALLEN PARK MI

48101

FARMINGTON MI

48024

C S HEYNER MD

BEN G HOFFMAN MD

ROBT C HORN JR MD

15901 W 9 MILE RD #400

19545 SHREWSBURY

2799 W GRAND BLVD

SOUTHFIELD MI

48075

DETROIT MI

48221

DETROIT HI

48202

FREOK J HEYNER MD

EDWARD A HOFFMAN MD

ROBERT J H0RN8ECK MD

15901 W 9 MILE RD #400

7615 W VERNOR HWY

31500 SCHOOLCRAFT RD

SOUTHFIELD MI

48075

DETROIT Ml

48209

LIVONIA MI

48150

STANLEY A HEYNER MD

EDWIN S HOFFMAN MD

R

HUGO 0 HORNY MD

3424 OAKMAN BLVD

8106 E JEFFERSON AVE

1365 CASS AVE

DETROIT MI

48204

DETROIT MI

48214

DETROIT MI

48226

OREST E HORODYSKY MO
18055 GREENFIELD
DETROIT MI 48235

EUGENE D HORRELL MD
3800 WOODWARD

OETROIT MI 48201

RICHARD P HORSCH MD
32900 FIVE MILE RD
LIVONIA MI 48154

REECE H HORTON MD
606 NORTHLAND MED CTR
SOUTHFIELD MI 48075

JAMES J HORVATH MD

1553 WOODWARD AVE

DETROIT Ml 48226

LORIS M HOTCHKISS MD

33220 W 7 MILE

LIVONIA MI 48152

PHILIP J HOWARD MD L

HENRY FORD HOSP

OETROIT MI 48202

WILLIAM K HOWARD MD
1800 TUXEDO

DETROIT MI 48206

BERT F HOWELL MD
344 MOROSS RD

GROSSE PTE FARMS MI 48236

HOMER A HOWES MD
1515 DAV WHITNEY BLDG
DETROIT MI 48226

HOWARD T HOWLETT MD

868 FISHER BLOG

DETROIT MI 48202

PEDRO G HOYOS MD

55 N DEEPLANDS

GROSSE PTE SHORES MI 48236

LOUIS HROMAOKO MD L

7375 PARKSTONE LANE
BIRMINGHAM MI 48010

JOHN P HUBBARD JR MD L

1171 S E SECOND
DEERFIELO BEACH FL 33441

PHILIP J HUBER MD
1724 BASSETT

ROYAL OAK MI 48067

J STEWART HUDSON MD L

114 LOTHROP

OETROIT MI 48236

WM A HUDSON MD L

HUDSONAKERS

JASPER AR 72641

E RAE HUDSPETH MD

763 FISHER BLDG

DETROIT MI 48202

WILFRED A HUEGLI MD
16840 E WARREN AYE
DETROIT MI 48224

CALVIN H HUGHES MD
19959 VERNIER

HARPER WOODS MI 48236

JOHN A HUGHES MO
31940 NOTTINGWOOD
FARMINGTON MI 48024

H HORNE HUGGINS MD
8355 GRATIOT

DETROIT MI 48213

ARTHUR L HUGHETT MD
19959 VERNIER

HARPER WOODS MI 48236

ARCHIE G HULICK MD
1600 TUXEDO

DETROIT MI 48206

JANUARY, 1972/Michigan Medicine 71

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

LEROY W HULL MD

L

NAPOLEON C IMPERIO MD

J R JACONETTE MD

6364 COWELL RD

22231 W OUTER DR

MT CARMEL MERCY HOSP

48235

BRIGHTON MI

48116

DEARBORN MI

48124

DETROIT MI

H ROSS HUME JR MD

SAMUEL INDENBAUM MD

GROVE A JAEGER MD

3800 WOODWARO AVE #406

18400 SCHAEFER HWY

11711 MINDEN

48205

DETROIT MI

48201

DETROIT MI

48235

DETROIT MI

JAMES J HUMES MD

NARCISO 0 INEZ MD

CLARENCE N JAEKEL

MD

L

ST JOHN HOSPITAL

3800 WOODWARD AVE

433 LEXINGTON

DETROIT MI

48236

DETROIT MI

48201

GROSSE PTE MI

48236

THADDEUS S HUMINSKI

MD

M YUNG YUL INE MD

DONALD J JAFFAR MD

19244 VAN DYKE AVE

1800 TUXEDO

15901 W 9 MILE RD

#514

DETROIT MI

48234

DETROIT MI

48206

SOUTHFIELD MI

48075

ARTHUR R HUMMEL MD

HARRY 0 INGBERG MD

HAROLD W JAFFE M

D

1020 3 MILE DR

261 BRADY

1073 FISHER BLDG

GROSSE PTE MI

48236

DETROIT MI

48201

DETROIT MI

48202

THEOOORE H HUNT MD

CHARLES N INNISS MD

JACOB JAFFE MD

A

19431 VAN DYKE AVE

3750 WOODWARO AVE

11740 WILSHIRE

OETROIT MI

48234

DETROIT MI

48201

LOS ANGELES CA

90025

VERNE G HUNT MD

L

EARLE A IRVIN MD

R

LOUIS JAFFE MD

1553 WOODWARO AVE

FORD MOTOR CO AMERICA

18662 MUIRLAND

DETROIT MI

48226

DEARBORN MI

48121

OETROIT MI

48221

DONALD G HUNTER MO

WM A IRWIN MD

WM E JAHSMAN MD

R

3245 E JEFFERSON

16001 9 MILE RD

501 MANDALAY AVE

G18

DETROIT MI

48207

SOUTHFIELD MI

48075

CLEARWATER BEACH

FL

33515

ROBERT B HUNTER MD

HAROLD E ISAACSON MD

RICHARO WM JAKACKI MD

HENRY FORD HOSP

15361 PLYMOUTH RD

36157 SHERWOOD

DETROIT MI

48202

DETROIT MI

48227

LIVONIA MI

48154

CHAS W HUSBAND MO

L

JO D ISAACSON MD

THOS J JAMIESON MD

L

14500 W MCNICHOLS

26008 PEMBROKE

2058 FERRIS

DETROIT MI

48235

HUNTINGTON WOODS MI

48070

LINCOLN PARK MI

48146

RAYMOND C HUSBAND MD

F F ISHAC MO

ROBERT S JAMPEL MD

14500 W MC NICHOLS

38241 SOUTHFARM

690 MULLETT ST

DETROIT MI

48235

NORTHVILLE MI

48167

OETROIT MI

48226

M COLTON HUTCHINS MD

BARNEY B ISRAEL MD

L

NATALIA J JANICKI

MD

3011 W GRAND BL VD

663 FISHER BLDG

ELOISE HOSP

DETROIT MI

48202

DETROIT MI

48202

ELOISE MI

48132

JARVIS M HYATT MD

H DAVID ITKIN MD

HAROLD F JARVIS MD

22265 GARRISON

257500 W OUTER DR

360 MOROSS

DEARBORN MI

48124

LINCOLN PARK MI

48146

DETROIT MI

48236

FREDK W HYDE JR MO

HERBERT T IWATA MD

LAWRENCE J JASION

MD

A

GRACE HOSPITAL

19616 BRANDYWINE

11945 PAYTON

DETROIT MI

48201

RIVERVIEW MI

48192

DETROIT MI

48224

JOHN R HYLAND MD

BERNICE IZNER MD

RICHARD V JAYNES

MD

17200 MACK

16500 NO PARK DR #1414

6033 MIDDLEBELT

DETROIT MI

48224

SOUTHFIELD MI

48075

GARDEN CITY MI

48135

ALIQEMAL HYSNI MD

DAVID JACKNOW MD

BEN J JEFFRIES MD

8011 W VERNOR

60 W HANCOCK

19959 VERNIER RD

DETROIT MI

48209

OETROIT MI

48201

HARPER WOODS MI

48236

PETER H I ACOBELL MD

FRANKLIN R JACKSON MO

WM JEND JR MD

19300 VAN DYKE

10730 W 7 MILE RD

1365 CASS AVE

DETROIT MI

48234

DETROIT MI

48221

DETROIT MI

48226

M I ACOBELL I S MD

NANCY E JACKSON MD

BARBARA J JENKINS

MD

22159 W OUTER DRIVE

33750 FREEDOM RD

19250 CANTERBURY

DEARBORN MI

48124

FARMINGTON MI

48024

DETROIT MI

48221

GARNET T ICE MD

WINSTON B JACKSON MD

ELWOOO A JENKINS

MD

8401 WOODWARD AVE

12720 W SEVEN MILE RD

610 DAV WHITNEY 8LDG

DETROIT MI

48202

DETROIT MI

48235

DETROIT MI

48226

ELI J IGNA MD

OAVID M JACOBS MD

CHAS G JENNINGS MD

584 LAKELAND

10601 W 7 MILE RD

1585 ALINE DR

GROSSE PTE MI

48230

DETROIT MI

48221

DETROIT MI

48236

LUIS J IGLESIAS MD

HOWARD JACOBS MD

VIGGO W JENSEN MD

3535 W 13 MILE RD

18241 GREENFIELD

17850 MAUMEE

ROYAL OAK MI

48072

DETROIT MI

48235

OETROIT MI

48230

ANTONIO IGNAGNI MD

LYLE F JACOBSON MD

WILL I AM H JEVONS

MD

21470 SLOAN DR

5224 ST ANTOINE

8425 TWELVE MILE

RD

DETROIT MI

48236

DETROIT MI

48202

WARREN MI

48093

KAMIL IMAMOGLU MD

A

SAML D JACOBSON MD

F C JEWELL MD

1400 CHRYSLER EXPWY

WAYNE CO GENL HOSP

21510 HARPER AVE

DETROIT MI

48207

ELOISE MI

48132

ST CLAIR SHORES MI

48080

ARTURO D IMPERIAL MD

WAYNE N JACOBUS MD

770 FISHER BLDG

20055 MACK AVE

DETROIT MI

48202

GROSSE PTE MI

48236

PATRICK F JEWELL MD
EASTLAND CENTER
PROF BLOG *232

HARPER WOOOS HI

48225

JOHN S JEWELL MD
2021 MONROE SUITE 203
DEARBORN MI 48124

MARVIN R JEWELL MD
CHILDRENS HOSPITAL
DETROIT MI 48202

MARION W JOCZ MD R

1501 N RIVER RD #102
ST CLAIR MI 48079

EMERY 0 JODAR MD L

P 0 BOX 667

HUGHSON CA 95326

LOYAL W JOOAR MD
18412 MACK

GROSSE PTE MI 48236

ARAN S JOHNSON MD

642 BL A IRMOOR CT

GROSSE PTE WOODS MI 48236

ARTHUR J JOHNSON MD
3800 WOODWARD *514
DETROIT MI 48201

GAGE JOHNSON MD

2785 S FORT ST

DETROIT MI 48217

THOS D JOHNSON HD
18530 GRAND RIVER
DETROIT MI 48223

VERNE E JOHNSON MD

2119 MONROE AVE

DEARBORN MI 48124

VERNON P JOHNSON MD L

21327 HARPER AVE

ST CLAIR SHORES Ml 48080

WALLACE E JOHNSON MD
HENRY FORD HOSPITAL
DETROIT MI 48202

WILBUR E JOHNSON M D
14654 GRATIOT

DETROIT MI 48205

WM H M JOHNSON MD L

7157 63 MICHIGAN

DETROIT MI 48210

EVERETT V JOHNSTON MD L
4726 N W 49TH CT
FT LAUDERDALE FL 33313

GLEN A JOHNSTON MD
369 GLENDALE

DETROIT MI 48203

HERBERT C JOHNSTON MD
3001 MILLER RD
FORD MOTOR CO
ROUGE PLANT

DEARBORN MI 48121

JOS A JOHNSTON MO L

HENRY FORD HOSP

DETROIT MI 48202

WM E JOHNSTON MD L

9000 E JEFFERSON #25-9
DETROIT MI 48214

BEN J I JOHNSTONE MD L

31 OAKLAND PARK

PLEASANT RIDGE MI 48069

EUCLIDE V JOINVILLE MD L

28 W ADAMS AVE

DETROIT MI 48226

CECIL R JONAS MO
8942 DEXTER

DETROIT MI 48206

72 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

ARNOLD M JONES MO

RUDOLF W KALLENBACH

MD

JOS A KASPER MD

L

3706 STURTEVANT

388 INKSTER RD

1011 CADIEUX RD

DETROIT MI

48206

INKSTER MI

48141

GROSSE PTE PARK MI

48230

DON P JONES MD

HERBERT I KALLET MD

L

ALBERT J KASPOR MD

90 SUNNINGDALE DR

651 FISHER BLDG

20901 MOROSS RD

GROSSE PTE SHORES MI

48236

DETROIT MI

48202

DETROIT MI

48236

G RICHARD JONES MD

MAERIT B KALLET MD

ARNOLD KASS MD

18412 MACK AVE

1800 TUXEDO

1316 DAVID STOTT BLDG

DETROIT MI

48236

DETROIT MI

48206

DETROIT MI

48226

RICHARD J JONES MD

DAVID KALLMAN MD

L

LAWRENCE KATZ MD

MT CARMEL MERCY HOSP

2351 W GRAND BLVD

987 E JEFFERSON

DETROIT MI

48235

DETROIT MI

48208

DETROIT MI

48207

ROY D JONES MD

L

LEO KALLMAN MD

L

MARTIN KATZ MD

104 BIRCH CT

2351 W GRAND BLVD

12794 VERONICA DR

FOREST HILLS

DETROIT MI

48208

SOUTHGATE MI

48195

HOLIDAY FL

33589

REUBEN R KALLMAN MD

STUART KATZ MD

2631 WOODWARD AVE

22341 W EIGHT MILE

WM J JONES MD

DETROIT MI

48201

DETROIT MI

48219

8209 ALLEN RD

ALLEN PARK MI

48101

ANGELOS A KAMBOURIS

MD

IRVING S KATZMAN MD

L

18255 W MCNICHOLS RD

848 FISHER BLDG

THAD H JOOS MD

DETROIT MI

48219

DETROIT MI

48202

20361 MACK AVE

GROSSE PTE WOODS MI

48236

RICHARD S KAMIL MD

JACK H KAUFMAN MD

14438 W MCNICHOLS

17421 GREENFIELD

PRESCOTT JORDAN JR MD

DETROIT MI

48235

DETROIT MI

48235

5224 ST ANTOINE

DETROIT MI

48202

JOHN W KAMINSKI MD

LOUIS W KAUFMAN MD

3001 MILLER RD

23077 GREENFIELD

RAMON R JOSEPH MD

OEARBORN MI

48120

SOUTHFIELD MI

48075

WAYNE CO GEN HOSP

ELOISE MI

48132

ROBERT F KANDEL MD

WILLIAM H KAUFMAN MD

HENRY FORD HOSP

6525 PARK AVE

DAYA P JOSHI MD

OETROIT MI

48202

ALLEN PARK MI

48101

987 E JEFFERSON AVE

DETROIT MI

48207

ARCHIBALD V KANE MD

JAMES KAWCHAK M D

BOX 1108 NORTHLAND CTR

FORD MOTOR CO

STANLEY J JOYCE MD

L

SOUTHFIELD MI

48075

DEARBORN MI

48121

478 ST CLAIR

GROSSE PTE MI

48230

SELMA KANSA M D

LUCIAN KAWECKI MD

19431 VAN 0 YKE

10734 HART AVE

MYRON H JOYRICH MD

DETROIT MI

48234

HUNTINGTON WOODS MI

48070

SINAI HOSPITAL

DETROIT MI

48235

HERMAN KANTER MD

L

CONRAD A KAWEL JR MD

16222 OXLEY RD APT 103

10955 FARMINGTON RD

JOSEPH F JULIAR MD

SOUTHFIELD MI

48075

LIVONIA MI

48150

20501 OLDHAM RD #206

SOUTHFIELD MI

48075

SHELDON M KANTOR MD

CENGIZ KAY I MD

17550 W 12 MILE RD

NORTHVI LLE STATE HOSP

BEN J JULIAR MD

SOUTHFIELD MI

48075

NORTHV I LLE MI

48167

17305 MUIRLANO AVE

DETROIT MI

48221

ADRIAN KANTROWITZ MO

MORRIS KAZDAN MD

SINAI HOSPITAL

4619 ALLEN ROAD

JOHN B JUNCKER MD

DETROIT MI

48235

ALLEN PARK MI

48101

OAKWOOD HOSPITAL

DEARBORN MI

48124

DON I KAPETANSKY MD

EDGAR B KEEMER JR MD

16400 N PARK DR #116

1111 DAV WHITNEY BLDG

R V JUNGWIRTH MD

SOUTHFIELD MI

48075

DETROIT MI

48226

19350 W MCNICHOLS RD

DETROIT MI

48219

NATHAN J KAPETANSKY

MD

HENRY J KEHOE MD

L

16400 N PARK DR

7047 E ORANGE BLOSM

LN

JAMES E KACKLEY MD

SOUTHFIELD MI

48075

SCOTTSDALE AR l Z

85253

18495 MACK

DETROIT MI

48236

WALTER A KAPLITA MD

RACHEL H C B KEITH MD

60 FONTANA LANE

3800 WOODWARD AVE

AHMAD KAF1 MD

GROSSE PTE SHORES MI

48236

DETROIT MI

48201

20101 JMS COUZENS HWY

DETROIT MI

48235

K H KAPPHAHN MD

FRANK J KELLEY MD

HENRY FORD HOSP

853 FISHER BLDG

THOMAS R KAIN MD

DETROIT MI

48202

DETROIT MI

48202

3245 E JEFFERSON AVE

DETROIT MI

48207

PHILIP C KARAMATAS MD

A P KELLY JR MD

10822 W WARREN

HENRY FORD HOSP

HENRY D KAINE MD

DEARBORN MI

48126

DETROIT MI

48202

3011 W GRAND BLVD

DETROIT MI

48202

SAUL KARCH MD

JOHN J KELLY MD

18080 MUIRLAND

14729 CHAMPAIGN

PETER J KALABAT MD

DETROIT MI

48221

ALLEN PARK MI

48101

ST JOSEPH MERCY HOSP

DETROIT MI

48211

JAMES J KARO MD

L J KELLY MO

HENRY FORD HOSPITAL

14015 GRATIOT

BERNARD S KALAYJIAN

MD R

DETROIT MI

48202

DETROIT MI

48205

30676 HARLINCIN CT

FRANKLIN MI

48025

ARTHUR A KASELEMAS MD

VICTOR A KELMENSON MD

22341 W 8 MILE RD

475 FISHER BLDG

NATHAN KALI CHMAN MD

DETROIT MI

48219

DETROIT MI

48202

23300 GREENFIELD #123

OAK PARK Ml

48237

A S KASIBORSKI MD

MALCOLM J KELSON MD

2300 OAK STREET

1045 HARVARD

WYANDOTTE MI

48192

DETROIT MI

48230

JAMES M KENNARY MO

4900 CADIEUX R0

DETROIT MI 48224

JAMES M KENNARY JR MD

4900 CADIEUX RD

DETROIT MI 48224

DONALD J KENNEDY MD

410 NORTH SHORE DR

ST CLAIR SHORES MI 48080

G HOWARD KENT MD
8300 MACK AVE

DETROIT MI 48207

JAMES E KERMATH MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

MELVIN 0 KERNICK MD L

13700 WOODWARD AVE
HIGHLAND PARK MI 48203

GEORGE R KERWIN MD
22149 CHATSFORD CIR
SOUTHFIELD MI 48075

KARL J KESSEL MD

21421 KELLY RD

EAST DETROIT MI 48021

CHAS KESSLER MD

18241 GREENF IELO

DETROIT MI 48235

JOHN W KEYES MD
HENRY FORD HOSP
DETROIT MI 48202

EL I E R KHOURY MD
8300 MACK AVE

DETROIT MI 48214

RONALD B KIHN MD

125 CHEWTON RD

BIRMINGHAM MI 48010

DEMETRO IS KIKAS MD
1800 TUXEDO

DETROIT MI 48206

CHAS G KILLINS MD
8100 E JEFFERSON

DETROIT MI 48214

SOON KUYN KIM MD
P 0 BOX 172

ELOISE MI 48132

YOUNG SONG KIM MD
3800 WOODWARD AVE
DETRUIT MI 48201

K K KIMBERL IN JR M D
11110 MORANG DRIVE
DETROIT MI 48224

EDWARD D KING MD L

270 RIVARD

GROSSE PTE MI 48230

MELBOURNE J KING MD

5435 W VERNOR HWY

DETROIT MI 48209

ROY C KINGSWOOD MD L

EXCELLO CORP BOX 386
DETROIT MI 48232

JOHN R KIRKPATRICK MD

WAYNE STATE UNIV

DETROIT MI 48201

JOHN L KITZMILLER MD
15901 W 9 MILE RD
SOUTHFIELD MI 48075

ROGER G KLAIBER MD

1541 EDSEL DRIVE

TRENTON MI 48183

HERMAN KLEIN MD

5030 WALLBROOK

BIRMINGHAM MI 48010

JANUARY, 1972/Michigan Medicine 73

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

HOWARD A KLEIN MO
1846 OAV WHITNEY BLDG
DETROIT MI 48226

SANDER P KLEIN MD
14825 W MC NICHOLS RD
DETROIT MI 48235

SHMARYA KLEINMAN MD L

1800 TUXEDO

DETROIT MI 48206

KARL S KLICKA MD

33101 ANNAPOLIS

WAYNE MI 48184

DAVID KLIGER MD L

7756 SOUTHFIELD

DETROIT MI 48228

M M KLIMCHUK MD
620 EASTLAND CENTER
PROFESSIONAL BLDG

HARPER WOODS MI 48225

EDW J KLIMKOWSKI MO

23871 MCNICHOLS

DETROIT MI 48227

GEORGE A KLING MD

HARPER HOSPITAL

DETROIT MI 48201

MURRAY G KLING MD

22341 W EIGHT MILE

DETROIT MI 48219

GEORG H E KLUTKE MD
2841 MONROE

DEARBORN MI 48124

CASSANDRA M KLYMAN MD
20905 GREENFIELD
SOUTHFIELD MI 48075

EARL J KNAGGS MD
2387 FORT ST

WYANDOTTE MI 48192

FLOYO B KNAPP MD R

202 MAPLE GROVE AVE
PRUDENVILLE MI 48651

GARY H KNAPP MD
23611 GOODARO

TAYLOR MI 48180

WM L KNAPP MD
27740 DEVONSHIRE DR
SOUTHFIELD MI 48075

ROBT S KNIGHTON MD

2799 W GRAND BLVO

DETROIT MI 48202

EDMUND J KNOBLOCH MD L

5933 CHENE ST

DETROIT MI 48211

STUART A KNOTT MD
100 OAK ST

WYANDOTTE MI 48192

ROSS M KNOX MD L

3180 FORT ST

LINCOLN PARK MI 48146

SIDNEY D KOBERNICK MD

6767 W OUTER DR

DETROIT MI 48235

JOSEF M KOBILJAK MD
14876 WARWICK

ALLEN PARK MI 48101

STEFAN H KOBILJAK MD

3516 FORT STREET

LINCOLN PARK MI 48146

EUGENE J KOCHKODAN MD
2799 W GRAND BLVD
DETROIT MI 48202

RAYMOND H KOEBEL MO L

409 N SHORE DR

ST CLAIR SHORES MI 48080

SHAHIN 8 KOEGLER MD
DETROIT GENERAL HOSP
DETROIT MI 48226

BENJAMIN F KOEPKE MD

35550 MICHIGAN AVE

WAYNE MI 48184

EDWARD J K0ER8ER MD L

42 BRIARCLIFF PL

OETROIT MI 48236

NATAL 10 KOGAN MD
3379 PIQUETTE

DETROIT MI 48211

CONSTANTINE S KOGUT MD
18181 W 12 MILE RD
LATHRUP VILLAGE MI 48075

MARY J KOKOSKY MD
HENRY FORD HOSPITAL
OETROIT MI 48202

RAYMOND J KOKOWICZ MD

19440 VAN DYKE

DETROIT MI 48234

ISADORE I KOLMAN MD
1800 TUXEDO

DETROIT MI 48206

HARVEY J KOMORN MD
17000 W EIGHT MILE RD
SOUTHFIELD MI 48075

JOHN D KONDOMERKOS MD

33020 PALMER ROAD

WAYNE MI 48184

LEIGHTON N L KONG MD
GRACE HOSP

DETROIT MI 48201

EOW T KONNO MD

1400 CHRYSLER FREEWAY

DETROIT MI 48207

JOE M KOPMEYER JR MD
702 PARKMAN

BLOOMFIELD HILLS MI 48013

VALENTINE L KORAN MD
1306 KALES BLOG

DETROIT MI 48226

LOUIS KOREN MD

650 DAV WHITNEY BLOG

DETROIT MI 48226

THOMAS E KORNACKI MD A

3461 CAMBRIDGE

DETROIT MI 48235

LYLE W KORUM MD

18585 E WARREN ST

OETROIT MI 48236

H K KOSCHNI TZKE MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

ADAM W KOSSAYDA MD
15324 MICHIGAN AVE
DEARBORN MI 48126

DENNIS D KOVAN MD L

23077 GREENFIELD
SOUTHFIELD MI 48075

JOHN J KOWALESKI MD
3755 FORT ST

LINCOLN PARK MI 48146

ANTHONY E KOZLINSKI MD
2195 E GRAND BLVD
DETROIT MI 48211

K L KRABBENHOFT MD
3825 BRUSH ST

DETROIT MI 48201

RAYMOND B KRAFT MD R

700 S OCEAN BLVD

BOCA RATON FL 33432

RUTH M KRAFT M D
19164 DEVONSHIRE RD
BIRMINGHAM MI 48009

BERNARO KRAKAUER MD
17716 W SEVEN MILE RD
DETROIT MI 48235

EDWARD W KRASS MO
11088 GRATIOT AVE
DETROIT MI 48213

JOHN J KRAUS MD

16840 E WARREN AVE

DETROIT Ml 48224

CHARLES J KRAWEC MD
MT CARMEL MERCY HOSP
DETROIT MI 48235

GEO E KREINBRING MD
14295 E 7 MILE RD
DETROIT MI 48205

JOHN C KRETZSCHMAR MD

660 E GRAND BLVD

DETROIT MI 48207

DAVID A KREVSKY MD
8449 PARK

ALLEN PARK MI 48101

HAROLD KREVSKY MD

8449 PARK AVENUE

ALLEN PARK MI 48101

SEYMOUR KREVSKY MD

732 FISHER BLDG

DETROIT MI 48202

HERBERT KRICKSTEIN MD

22101 MOROSS RD

DETROIT MI 48236

EARL G KRIEG MU A

134 N WATER ST

MARINE CITY MI 48039

HARLEY L KRIEGER MD R

11390 STRATHMOUR

DETROIT MI 48227

KARL T KRISTEN MD
MT CARMEL MERCY HOSP
DETROIT MI 48235

MAURICE J KRITCHMAN MD L
23237 PROVIDENCE DR
APARTMENT 301

SOUTHFIELD MI 48075

LAWRENCE A KROHA MD
19787 MACK

GROSSE PTE MI 48236

LAWRENCE H KROHN MD
24340 W MCNICHOLS RD
DETROIT MI 48219

H HARVEY V KROLL MD

21327 HARPER AVE

ST CLAIR SHORES MI 48080

RONALD L KROME MD
1326 ST ANTOINE ST
DETROIT MI 48226

JAMES A KRUG MD

32238 SCHOOLCRAFT

LIVONIA MI 48150

LAWRENCE KRUGEL MD

19481 LIVERNOIS

DETROIT MI 48221

EDWARD A KRULL MD

482 RIVARD BLVO

GROSSE PTE MI 48230

FRANCIS X KRYNICKI MD L

2717 GOLF VI EW DR

TROY MI 48084

FRANCIS S KUCM1ERZ MD
18934 VAN DYKE AVE
DETROIT MI 48234

NED N KUEHN MD
20203 WELLESLEY BLVD
BIRMINGHAM MI 48010

JAMES M KUHLMAN MD

3800 WOOOWARO AVE

DETROIT MI 48201

ALBERT A KUHN MD
635 W SEVEN MILE RD
DETROIT MI 48203

HENRY H KUHN MD
635 W SEVEN MILE RO
OETROIT MI 48203

RICHARD F KUHN MD
1700 JUNCTION AVE
DETROIT MI 48209

WALTER F KUJAWSKI MD
17800 E EIGHT MILE RD

DETROIT MI 48236

SUSHIL KUMAR MD

690 MULLETT ST

DETROIT MI 48226

HAROLD J KULLMAN MD A

930 BEECHMONT

DEARBORN MI 48124

LIONEL V KURAN MD
15212 MICHIGAN AVE
DEARBORN MI 48126

JOS A KURCZ MD

7433 MICHIGAN AVE

DETROIT MI 48210

IRVIN J KURTZ MD

25210 GRAND RIVER

DETROIT MI 48240

RAYMOND S KURTZMAN MD
DETROIT MEMORIAL HOSP
OETROIT MI 48226

JOHN D KUTSCHE MD
3794 FORT ST

TRENTON MI 48183

BEN J KVIETYS MD
27235 JOY RD

DEARBORN MI 48127

S A KWASIBORSKI MD
2300 OAK ST

WYANDOTTE MI 48192

WM V KYLE JR MO

8780 GRAND RIVER

DETROIT MI 48204

JAMES M LABERGE MD
100 OAK

WYANDOTTE MI 48192

LEONARD W LACHOVER MD
15233 LESLIE

OAK PARK MI 48237

LAWRENCE S LACKEY MD
310 VISGER

RIVER ROUGE MI 48218

GEORGE E LACROI X MD

695 VAUGHAM RD

BLOOMFIELD HILLS MI 48013

DAVID C LADERACH MD
3001 MILLER RD
FORD MOTOR CO

DEARBORN MI 48121

74 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

ALFRED D LA FERTE MD
667 NEFF ROAD
GROSSE PTE MI

M M LAHAM MD
2929 FORT ST
WYANDOTTE MI

MICHAEL J LAHOOD MD
20001 GREENFIELD
DETROIT MI

RAYMOND J LAIGE MD
PO BOX 1259
DETROIT MI

LOUIS J LAJOIE MD
601 PIQUETTE
DETROIT MI

GEORGE C LAKATOS MD
33020 PALMER
WAYNE MI

ROBT C LAKE MD
8445 E JEFFERSON
DETROIT MI

ALAN C LAKIN MD
17431 GREENFIELD
DETROIT MI

MERVYN H LAKIN MD
18900 W TEN MILE RD
SOUTHFIELD MI

CHAS B LAKOFF MD
8233 W CHICAGO BLVD
DETROIT MI

MANULAL LALA MD
GRACE HOSPITAL
DETROIT MI

CONRAD R LAM MD
HENRY FORD HOSPITAL
DETROIT MI

FRANK A LAMBERSON MD
1666 PENNSYLVANIA
WINTER PARK FL

JAMES V LAMMY MD
20867 MACK
DETROIT MI

RICHARD L LAMONT MD
3815 PELHAM RD
DEARBORN MI

GAETAN LAMONTAGNE MD
13479 NORTHLINE
SOUTHGATE MI

HAROLD H LAMPMAN MD
3011 W GRAND BLVD
DETROIT MI

JAMES W LANDERS MD
1507 SUNNINGDALE
GROSSE PTE WOODS MI

MAURICE B LANDERS MD
275 W GRAND BLVD
DETROIT MI

ERNST F LANG MD
3790 WOODWARD
DETROIT MI

WM A LANGE MD
3790 WOODWARD AVE
DETROIT MI

JOHN D LANGSTON MD
1420 ST ANTOINE ST
DETROIT MI

GEO M LAN ING MD

EUGENE H LANSING MD
33116 PALMER RD
WESTLAND MI

L

48230

MANDELL LANSKY MD
16339 E WARREN
DETROIT MI

48224

WENDELL L LEACH MD
10811 E WARREN
DETROIT MI

48214

48192

ALFRED M LARGE MD
19515 MACK AVE
GROSSE PTE WOODS MI

48236

ROBT C LEACOCK MO
440 UNIVERSITY PL
GROSSE PTE MI

L

48236

48235

DONALD J LARGO M D
16717 WARWICK
OETROIT MI

48219

LUTHER R LEADER MD
3535 W 13 MILE RD
ROYAL OAK MI

L

48072

A

48231

DUANE R LARKIN MD
28435 PLYMOUTH
LIVONIA MI

48150

L ROSS LEAVER MD
9508 CRESCENT BEACH
PIGEON MI

R

DR

48755

48202

RICHARD I LARNED MD
15208 BRINGARD
DETROIT MI

48205

A T LEBAMOFF MD
14801 SOUTHFIELD RD
ALLEN PARK MI

48101

48184

EDWARD G LARSEN MD
2421 FORT ST
TRENTON MI

48183

PHILIP LEBLANC MD
DETROIT GENERAL HOSP
DETROIT MI

48226

48214

ROBT D LARSEN MD

3800 WOODWARD AVE *614

DETROIT MI 48201

MONROE S LECHNER MD
P 0 BOX 1919
DETROIT MI

48231

48235

RONALD R LARSON MD
18101 OAKWOOD BLVD
DEARBORN MI

48122

A F LECKLIDER MD
848 BERKSHIRE RD
GROSSE PTE MI

R

48230

48075

BROR H LARS SON MD
81 E KIRBY AVE
DETROIT MI

L

48202

FRANK LEE MD
501 MEADOWLANE DR
DEARBORN MI

48124

L

48204

ANDREW G LASICHAK MD
76 W ADAMS AVE
DETROIT MI

48226

HARRY E LEE MD
13616 GRATIOT AVE
DETROIT MI

L

48205

A

48201

JAMES W LASLEY MD
2058 BOOTMAKER LANE
BLOOMFIELD HILLS MI

48013

HI SUNG LEE MD
WAYNE CO GEN HOSP
ELOISE MI

48132

48202

FREDK R LATIMER MD
28 W ADAMS
DETROIT MI

48226

PYONG T A I LEE MD
15901 W 9 MILE RD
SOUTHFIELD MI

48075

A

32789

KARL K LATTEIER MD
6145 BLUE BEECH RD
ROCHESTER MI

48063

YOUNG MO LEE MD
25210 GRAND RIVER
OETROIT MI

48240

L

48236

EDWARD H LAUPPE MD
1553 WOODWARD AVE
DETROIT MI

L

48226

LOUIS S LEIPSITZ MD
3566 CASS AVE
DETROIT MI

48201

48124

ALBERT L LAURA MD
9105 HARRISON
LIVONIA MI

48150

FORREST C L E I TER MD
P 0 BOX 527
ROCHESTER IND

46975

48195

EUGENE LAURISIN MD L

3019 W 13 MILE APT 413
ROYAL OAK MI 48073

LOUIS S LELAND MD
867 GROSSE PTE COURT
GROSSE PTE MI

48230

L

48202

CARL B LAUTER MD
550 E CANFIELD
DETROIT MI

A

48201

SOLOMON LELAND MD
6563 GRAND RIVER
OETROIT MI

48208

48236

ERIC W LAUTER MD
1800 TUXEDO
DETROIT MI

48206

CLARK F LEMLEY MD
3011 W GRAND BLVD
DETROIT MI

L

48202

48216

FRANK K LAWAND MD
4510 W WARREN
DETROIT MI

48210

BRUCE K LEMON MD
20905 GREENFIELD
SOUTHFIELD MI

48075

48201

LOUIS F LAWRENCE MD
15901 W 9 MILE RD
SOUTHFIELD MI

48075

JAMES J LENTINE MD
15831 MACK AVE
DETROIT MI

48224

48201

NOEL S LAWSON MD
22101 MOROSS RD
DETROIT MI

48236

WILLARD R LENZ MO
418 MORAN RD
DETROIT MI

48236

48226

MORTON R LAZAR MD
20905 GREENFIELD
SOUTHFIELD MI

48075

CECIL W LEPARD MD
1553 WOODWARD AVE
DETROIT MI

48226

L

DAVID LEACH MD
430 FISHER BLDG
DETROIT MI

R

48202

FRED 0 LEPLEY MO
19799 MACK AVE
GROSSE PTE WOODS MI

L

48236

ROBT B LEACH MD
3535 W 13 MILE RD

FREDERICK J LEPLEY MD
19803 MACK

48184 ROYAL OAK MI 48072 GROSSE PTE MI 48236

S AML I LERMAN MD

18330 PARKSIDE

DETROIT MI 48221

A MARTIN LERNER MD
432 E HANCOCK

DETROIT MI 48201

JOHN M LESESNE MD

17770 MACK AVE

DETROIT MI 48224

ARNOLD L LESHMAN MO
18181 W 12 MILE RD
LATHRUP VILLAGE MI 48076

FATELLA L LESSANI MD
ST MARYS HOSPITAL
LIVONIA MI

MELVIN A LESTER MD
26831 WOODWARD AVE
HUNTINGTON WDS MI

JOS S LESZYNSKI MD
8120 E JEFFERSON
DETROIT MI

TRAIAN LEUCUTIA MD
SHERATON CAD HOTEL
DETROIT MI

DAVIO I LEVADI MD
15635 TWELVE MILE RD
SOUTHFIELD MI 48075

FLOYD B LEVAGOOD MD
23100 CHERRY HILL RD
DEARBOPN MI 48124

ARTHUR B LEVANT MD

15715 E WARREN

DETROIT MI 48224

MALCOLM L LEVENSON MD
24500 CUSTIS

SOUTHFIELD MI 48075

IRA LEVENTER MD
20211 ANN ARBOR TRAIL
DEARBORN MI

WALTER G LEVICK MO
19959 VERNIER
HARPER WOODS MI

DAVID M LEVIN MD
5628 NORTH 12TH ST
PHOENIX AZ

HERBERT G LEVIN MD
16500 NORTH PARK *101
SOUTHFIELD MI

M MITCHEL LEVIN MD
20905 GREENFIELD
SOUTHFIELD Ml

S AML J LEVIN MD
3011 W GRAND BLVD
DETROIT MI

EDWARD E LEVINE MD
12891 SHERWOOD
HUNTINGTON WOODS MI

IRVING LEVITT MD
870 UNITED NATNS PLAZA

NEW YORK N Y 10017

NATHAN LEVITT MD L

1007 KALES BLDG

DETROIT MI 48226

DAVIO B LEVY MD
29594 FIVE MILE RD
LIVONIA MI 48154

STANLEY H LEVY MD
10601 SEVEN MILE RD
DETROIT MI 48221

BENJAMIN M LEWIS MD
1401 RIVARD

DETROIT MI 48207

48075

L

48075

L

48202

48070

48127

48236

A

85014

48154

48070

L

48214

L

48226

JANUARY, 1972/Michigan Medicine 75

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

HARVEY Y LEWIS MO
18181 W 12 MILE RD
LATHRUP VILLAGE MI 48075

J HUGH LEWIS MD L

1543 FORD AVE

WYANDOTTE MI 48192

LEE A LEWIS MO

2730 E JEFFERSON AVE

DETROIT MI 48207

WILFRID J LEWIS MD L

10 PETERBORO ST

DETROIT MI 48201

DANIEL K LI MD
13118 FORT ST

SOUTHGATE MI 48195

ROBT V LIBBRECHT MD
6540 PARK AVE

ALLEN PARK MI 48101

MAX L LICHTER MD
2900 OAKWOOD BLVO
MELVINDALE MI 48127

ARTHUR G LIDOICOAT MO L
20125 FENKELL

DETROIT MI 48223

KIM K LIE MO

3800 WOODWARD #1206

DETRUIT MI 48201

BARNARD L L I EBERMAN MD R

668 EL CENTRO LGBT KEY
SARASOTA FL 33577

JAMES J LIGHTBODY MD L

7815 E JEFFERSON

DETROIT MI 48214

ARNOLD E LIGHTBOURN MD
3800 WOODWARD AVE
DETROIT MI 48201

GEO A LIGHTBOURN MD
3800 WOODWARD AVE #808
DETROIT MI 48201

RUDOLPH W LIGNELL MD
401 NORTHLAND MEO BLDG
SOUTHFIELD MI 48075

JOSEPH A L 1 1 0 I MD
17000 W 8 MILE RO
SOUTHFIELD MI 48075

ROBERT P LILLY MO
15240 MERRIMAN RD
LIVONIA MI 48154

JESS LIM MO

15101 SOUTHFIELD

ALLEN PARK MI 48101

WILLIAM LIM MD
NORTHV I LLE STATE HOSP
NORTHVILLE MI 48167

DAVIO W LINDNER MD
3800 WOODWARD 822
DETROIT MI 48201

LEONARD S LINKNER MD
12944 LA SALLE LANE
HUNTINGTON WOODS MI 48070

HERMAN J LINN MD

1420 ST ANTOINE

DETROIT MI 48226

STANLEY L LIPINSKI MO
7540 MICHIGAN AVE
DETROIT MI 48210

EZRA LIPKIN MD L

14150 VICTORIA

OAK PARK MI 48237

CARL E LIPNIK MD

31610 PLYMOUTH RD

LIVONIA MI 48150

MORRIS J LIPNIK MD
17000 W EIGHT MILE
SOUTHFIELD MI 48075

FLOYD H LIPPA MD

3815 PELHAM RD

DEARBORN MI 48124

DAVID I LIPSCHUTZ MD
17000 W 8 MILE RD
SOUTHFIELD MI 48075

LOUIS S LIPSCHUTZ MD A

2243 GOLF V I EW DR #205
TROY MI 48084

CHANNING T LIPSON MD
20101 JAMES COUZENS
OETROIT MI 48235

MADELEINE L LIPSON MO
1800 TUXEDO

DETROIT MI 48206

RAYMOND F LIPTON MD

10 PETERBORO ST

DETROIT MI 48201

JAMES W LITTLE MD
3637 FRANKLIN RO
BLOOMFIELD HILLS MI 48013

JACK A LITWIN MD

22341 W 8 MILE RD

DETROIT MI 48219

D J LITZENBERGER MD
2429 OAKWOOD

MELVINDALE MI 48127

BENITO C LIU MD
60 W HANCOCK

DETROIT MI 48201

W C LIVINGSTON MD
12901 W 7 MILE RD
DETROIT MI 48235

CLARENCE S LIV1NG00D

345 UNIVERSITY

GROSSE PTE MI 48236

JAMES R LLOYD MD
1515 DAV WHITNEY BLDG
DETROIT MI 48226

EDWARD C LOCKHART MD
7569 TIREMAN

DETROIT MI 48204

JAMES E LOFSTROM MD R

2220 CALLE P FIERRE

PALM SPRINGS CA 92262

ANNIE 6 LOGRIPPO MD A

36 R IDGE ROAD

PLEASANT RIDGE MI 48069

CARL W LOHMANN MD
933 DAV WHITNEY BLDG
DETROIT MI 48226

BERTQN L LONDON MD
18510 MEYERS

DETROIT MI 48235

JAVIER H LONDONO MD A

171 HARRISON

BOSTON MA 02111

SALVATORE LONGO MD
468 CADIEUX

OETROIT MI 48230

JOHN L LOOMIS MD
236 VISGER RD

RIVER ROUGE MI 48218

GERALD N LOOMUS MD

4100 W MCNICHOLS

DETROIT MI 48221

REUBEN LOPATIN MO
2421 MONROE BLVO C
DEARBORN MI 48124

RODOLFO LOPEZ MD
1429 DAV WHITNEY BLDG
DETROIT MI 48226

C B P LORANGER MD L

20825 MACK

DETROIT MI 48236

JOS H LORBER MO

873 LAKEWOOD AVE

DETROIT MI 48215

EDWIN H LORENTZEN MD L

11702 GRAND RIVER AVE
DETROIT MI 48204

RODOLFO B LORENZO MD
1151 TAYLOR

DETROIT MI 48202

WM S LDVAS MD

500 THE ESPLANADE #304

VENICE FLA 33595

OONALD M LOVE MD
32665 UTICA

FRASER MI 48026

JAMES M LOVE MD
P 0 BOX 157

QUINNESEC MI 49876

AOOLF W LOWE MD
3338 W DAVISON AVE
DETROIT MI 48238

PAUL L LOWINGER MD
2170 IROQUOIS

OETROIT MI 48214

ELLIOT D LU8Y MO
4467 STONY RIVER DR
BIRMINGHAM MI 48010

CHARLES E LUCAS MD
DETROIT GENERAL HOSP
DETROIT MI 48226

ROBERT J LUCAS MD

771 FISHER BLDG

DETROIT MI 48202

ALFRED H F LUI MD
WAYNE CO GEN HOSPITAL
ELOISE MI 48132

PAUL INO R LUNA MD
10151 MICHIGAN AVE
DEARBORN MI 48126

JOHN G LUMPKIN JR MD
3800 WOODWARD AVE #418
DETROIT MI 48201

TENNIE M LUNCEFORD MD
EASTLAND PROF BLDG#452
DETROIT MI 48225

EARL F LUTZ MD R

2920 N E 55TH ST
FT LAUDERDALE FL 33308

SHERWIN J LUTZ MD
15121 W MCNICHOLS
DETROIT MI 48235

DENIS A LUZ MD

BON SECOURS HOSPITAL

GROSSE PTE MI 48236

JOHN H LUZADRE MD

18430 MACK AVE

DETROIT MI 48236

DAVID H LYNN MO R

LYNN HOSPITAL

LINCOLN PARK MI 48146

HARVEY D LYNN MD

3815 PELHAM RD

DEARBORN MI 48124

ROBT P LYTLE MU

402 NORTHLAND MEO BLDG

SOUTHFIELD MI 48075

HAYWARD C MABEN JR MO

554 FISHER BLDG

DETROIT MI 48202

JOHN D MABLEY MD L

404 DAVIO WHITNEY BLDG
DETROIT MI 48226

ORRIN P MAC DOUGALL MD A

18914 PINEHURST

DETROIT MI 48204

HOWARD W MACFARLANE MD L
1553 WOODWARD AVE
DETROIT MI 48226

HAROLD C MACK MD L

3800 WOOOWARD #512
OETROIT MI 48201

ROBERT E MACK MD

WOMANS HOSPITAL

DETROIT MI 48201

IAN D MACKAY MD

3800 WOODWARD AVE

DETROIT MI 48201

EARLE D MAC KENZIE MD L
81 E KIRBY ST

OETROIT MI 48202

WM G MACKERSIE MD L

23237 PROVIDENCE DR
SOUTHFIELD MI 48075

CHARLES W MAC LEOD MD
16345 W MC NICHOLS
DETROIT MI 48235

FRANCIS B MACMILLAN MD L
1553 WOODWARD AVE
DETROIT MI 48226

K C MAC PHERSON MD L

8100 E JEFFERSON

DETROIT MI 48214

MALCOLM 0 MAC QOEEN MD L

660 WOODWARD AVE

DETROIT MI 48226

RAMON A MADRID MD
10151 MICHIGAN AVE
DEARBORN MI 48126

RALPH C MAGNELL MD
20100 W MCNICHOLS RD
DETROIT MI 48219

CLARENCE E MAGUIRE MD
1553 WOODWARD AVE
DETROIT MI 48226

BIRESH C MAHANTI MO
2300 OAK ST

WYANDOTTE MI 48192

MURRAY S MAHLIN MD
16820 GREENFIELD AVE
DETROIT MI 48235

HUGH M MAHONEY MD
1553 WOOOWARD AVE
DETROIT MI 48226

FREDK P MAIBAUER MD

2934 BIDDLE AVE

WYANDOTTE MI 48192

ROSSER L MAINWARING MD
18101 OAKWOOD BLVD
DEARBORN MI 48123

EDWARD D MAIRE MO L

15224 E JEFFERSON
DETROIT MI 48230

HARRY MAISEL MO A

WAYNE STATE UNIV
STUDENT AFFAIRS
1401 RIVARO

DETROIT MI 48207

76 JANUARY, 1972/Michigan Medicine

48226

48239

48146

48207

48226

48135

I

48024

48101

L

48202

48227

48071

t

48235

L

33312

48201

48240

48235

i

48219

A

48207

48226

48236

48203

48202

48201

ID

48124

Wayne County

ANDREAS MARCOTTY HD
28035 SOUTHFIELD RD
LATHRUP VILLAGE MI 48075

EDWIN L MARCUS MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

VINCENT J MARECKI MD

10326 W WARREN

DEARBORN MI 48126

RAYMOND R MARGHER 1 0 MD
3800 WOODWARD AVE
DETROIT MI 48201

MARVIN 0 MARGQLIS MD

18205 PARKSIDE

DETROIT MI 48221

SAUL Z MARGULES MD
22301 GREATER MACK
ST CLAIR SHORES MI 48080

CARLETON J MARINUS MD L

1037 DAV WHITNEY BLDG
DETROIT MI 48226

FEOERICO MARIONA MD
1554 TUXEDO

DETROIT MI 48206

JEROME MARK MD

513 OAVID WHITNEY BLDG

DETROIT MI 48226

ALEXANDER P MARKEY MO
15212 MICHIGAN AVE
DEARBORN MI 48126

FRANK R MARKEY MD
15212 MICHIGAN AVE
DEARBORN MI 48126

E S MARTINOVSKY MD
NORTHVILLE STATE HOSP
NORTHVILLE MI 48167

EDGAR E MARTMER MD R

6935 CURTIS DR

COLOMA MI 49038

THOS B MARWIL MD
21751 W 11 MILE RD
SOUTHFIELD MI 48075

ROBERT C MARVIN MD
22362 MORLEY

DEARBORN MI 48124

T A MASCARIN MD

18101 E WARREN

DETROIT MI 48224

DONALD D MASSE MD

3040 E 7 MILE RD

DETROIT MI 48234

BURTON V MATTHEWS MD
13724 W FORT ST
SOUTHGATE MI 48195

PAUL E MATTMAN MD
1500 SEMINOLE

DETROIT MI 48214

THEO M MATTSON MD

901 W GRANO BLVD

DETROIT MI 48208

EUGENE W MAUCH MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

HARRY G MAUTHE MD
16859 POLLYANA DR
LIVONIA MI 48154

RACHEL MC CLELLAND MD
P 0 BOX 71 NE STATION
LIVONIA MI 48152

JAMES J MC CLENDON MD L

8401 WOODWARD

DETROIT MI 48202

WM R MC CLURE MD L

BOX 1498

BOYNTON BEACH FL 33435

C E MCCOLE MD

HENRY FORD HOSP

DETROIT MI 48202

CHAS W MC COLL MD
2025 FORD AVENUE
WYANDOTTE MI 48192

CLARKE M MC COLL MD L

31262 HUNTLEY SQ EAST
BIRMINGHAM MI 48009

JOHN H MCCOLLOUGH MD
3800 WOODWARD AVE
DETROIT MI 48201

E BERT MC COLLUM MD
20867 MACK

DETROIT MI 48236

CAREY P MC CORD MD L

SCH OF PUBLIC HEALTH

ANN ARBOR Ml 48104

COLIN C MC CORMICK MD A
24352 ROCKFORD AVE
DEARBORN MI 48124

FRANK B MCCUE MD
7106 PARK AVE

ALLEN PARK MI 48101

BEN MARKS MD

232 W GRANO RIVER AVE

DETROIT MI 48226

BERT W MARKS MD
8250 LINCOLN DR
HUNTINGTON WOODS MI 48070

CARLOS MAX MD

18984 LIVERNOIS

DETROIT MI 48221

FREDK M MAYNARD MD
6828 PARK AVE

ALLEN PARK MI 48101

L E MC CULLOUGH MD
1711 DAV WHITNEY BLDG
DETROIT MI 48226

ANGUS L MC DONALD MD L

81 MEADOW LANE

GROSSE PTE MI 48236

ALTON R MARSH MD

L

P 0 BOX 4
GOOD HART MI

49737

JAMES R MARSHALL MD

L

14827 E JEFFERSON AVE
DETROIT MI

48215

J R MARSHALL JR MD
20160 MACK AVE
DETROIT MI

48236

WILLIAM 0 MAYS MD

19737 CHEYENNE

DETROIT MI 48235

F N MAYWOOD MD

20840 VERNIER RD

HARPER WOODS MI 48236

GORDON S MC ALPINE MD L
1250 C TRAIL WOOD PATH
BIRMINGHAM MI 48010

JOHN R MC DONALD MD
HARPER HOSP

DETROIT MI 48201

WM G MC DONALD MD
15600 MICHIGAN AVE
DEARBORN MI 48126

WM G MC EVITT MD
1140 W BOSTON BLVD
DETROIT MI 48202

J B MARTIN JR MD
449 E ELIZABETH ST
DETROIT MI 48201

LYNOLE R MARTIN MD

'2000 SECOND BLVD

DETROIT MI 48226

THOS J MC BRYAN MD
21420 HARPER

ST CLAIR SHORES MI 48080

LYMAN M MC BRYDE MD L

RICHARDS LANDING
ST JOSEPH ISLAND

T MANFORD MCGEE MD

22000 GREENFIELD

OAK PARK MI 48237

KENNETH 0 MCGINNIS MD

6071 W OUTER DR

DETROIT MI 48235

PETER A MARTIN MD

857 FISHER BLDG

DETROIT MI 48202

WALTER MARTIN MD

13800 LIVERNOIS

DETROIT MI 48238

WILBUR C MARTIN MD

10401 W CHICAGO

DETROIT MI 48204

ANTHONY MARTINEZ MD

8226 HAMPTON RD

GROSSE ILE MI 48138

ALVARO MARTINEZ MD M

ROUTE 1 BOX 57

KEY LARGO FL 33037

PEDRO 0 MARTINEZ MD L

1439 BAGLEY AVE

DETROIT MI 48216

ONTARIO CANADA

JAMES H MC CAD I E MD
13700 WOODWARD AVE
HIGHLAND PARK MI 48203

MARION G MCCALL JR MD
8401 WOODWARD

DETROIT MI 48202

VIRGINIA MCCANDLESS MD
270 S MELBORN

DEARBORN MI 48124

R S MC CAUGHEY MD
3535 W 13 MILE RD
ROYAL OAK MI 48072

N D MC GLAUGHLIN MD

2312 BIDDLE AVE

WYANDOTTE MI 48192

JOS M MC GOUGH MD
18211 W TWELVE MILE
LATHRUP VILLAGE MI 48075

JOHN F MC GUIRE MD
3815 PELHAM

DEARBORN MI 48124

JOHN T MC HENRY MD

DEPT OF NEUROLOGY

HARPER HOSP

3825 BRUSH AVE

DETROIT MI 48201

ROB T J MC CLELLAN MD
16345 W MCNICHOLS
DETROIT MI 48235

C W MC INTOSH MD
8339 MACK AVE

DETROIT MI 48214

JANUARY, 1972/Michigan Medicine 77

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

R08T D MC INTOSH MD

21390 E RIVER R0

GROSSE ILE MI 48138

WM 8 MC INTYRE MD

20901 MOROSS RD

DETROIT MI 48236

G THOS MC KEAN MD
1553 WOODWARD AVE
DETROIT MI 48226

GEO E MC KEEVER MD

5237 OAKMAN BLVD

DEARBORN MI 48126

JAMES MCKENNA MD

573 FISHER BLDG

DETROIT MI 48202

CHAS J MC KENNA MD R

1295 SUNNINGOALE

GROSSE POINTE MI 48236

ROBT E MCKNIGHT MD
15901 W 9 MILE RD
SOUTHFIELD MI 48075

HARRIET I E MC LANE MD L

1367 NICOLET PLACE
DETROIT MI 48207

JAMES T MCLAUGHLIN MD
WYANDOTTE GEN HOSP
WYANOOTTE MI 48192

JASPER E MCLAURIN MD
5050 JOY RD

OETROIT MI 48204

BRITA R MC LEAN MD
1365 CASS

DETROIT MI 48226

DON W MC LEAN MD L

1066 FISHER BLDG

OETROIT HI 48202

OONALD C MC LEAN M D

459 FISHER BLDG

DETROIT MI 48202

I WM MCLEAN JR MD
PARKE DAVIS l CO
JOSEPH CAMPAU a RIVER

DETROIT MI 48232

THOMAS V MCMANAMON MD
23470 MEADOW PARK
DETROIT MI 48239

JOSEPH M MC NAMARA MO
9430 S MAIN

PLYMOUTH MI 48170

ROGER F MC NEILL MD
63 KERCHEVAL

GROSSE PTE MI 48236

L J MCNICHOL MD
18424 W MCNICHOLS RD
DETROIT MI 48219

RODERICK T MC PHEE MD
14628 E 7 MILE RD
DETROIT MI 48205

MARK R MC QUIGGAN MD L

700 SEWARD APT 715
DETROIT MI 48202

THELMA H MCQUIGGAN MO

125 N MILITARY

DETROIT MI 48124

JOSEPH F MEARA MO

DETROIT MEM HOSP

DETROIT MI 48226

GIL H MEDIODI A MD

22912 CANTERBURY

ST CLAIR SHORES MI 48080

STUART F MEEK MD

19431 VAN DYKE

DETROIT MI 48234

R J MEHDIA8ADI MD A

WAYNE STATE UNIVERSITY
OETROIT MI 48207

L W MELANDER JR MD
1229 DAVID WHITNEY BDG
DETROIT MI 48226

HYMAN S MELLEN MD

16800 GREENFIELD

DETROIT MI 48235

RAYMOND C MELLINGER MD
959 PEMBERTON

GROSSE PTE MI 48236

MAXIM P MELNIK MD
3011 W GRAND BLVO
DETROIT MI 48202

NESTOR MELNYCZUK MD

19600 W WARREN

DETROIT MI 48228

RICHARD MENC2ER MD

29081 DEQUINDRE

MADISON HEIGHTS MI 48071

HERBERT MENDELSON MD
24508 LAFAYETTE CIRCLE
SOUTHFIELD MI 48075

LAWRENCE MENDELSOHN MD
10601 W SEVEN MILE RD
OETROIT MI 48221

R J MENDELSSOHN MD
8100 E JEFFERSON AVE
DETROIT MI 48214

EDGAR V MEND I AN S MD R

9486 BE ACONSF I ELD
DETROIT MI 48224

SAMUEL MENDOZA MD
14515 FORD RD

OEARBORN MI 48126

NORMAN J MENTON M D
15300 W MCNICHOLS
DETROIT MI 48235

RODOLFO S MERCADER MO
30900 FORD RD

GARDEN CITY MI 48135

CHAS C MERKEL MD L

85 KERCHEVAL AVE

GROSSE PTE FARMS MI 48236

KARL MERKLE M D
530 N TELEGRAPH
DEARBORN MI 48128

C R MERRILL JR MD
1951 MONROE

DEARBORN MI 48124

EARL G MERRITT MO L

3800 WOODWARD AVE
DETROIT MI 48201

JOHN S METES MD
62 WEBBER PL

GROSSE PTE SHORES MI 48236

KENNETH R MEYER MD
OAKWOOD HOSP

DEARBORN MI 48124

MARJORIE P MEYERS M D
3790 WOODWARD

DETROIT MI 48201

MAURICE P MEYERS MD
23195 RIVERSIDE DR
SOUTHF I ELO MI 48075

CLEON M MICHAEL MD
32300 SCHOOLCRAFT
LIVONIA MI 48150

MICHAEL J MICHAEL MD
15901 W 9 MILE RD #400
SOUTHFIELD MI 48075

ELWIN W MIDGLEY MD
60 W HANCOCK

DETROIT MI 48201

DAVID MIGDOLL MD

15361 PLYMOUTH RD

DETROIT MI 48227

BENJAMIN MIHAY M D
2021 MONROE

OEARBORN MI 48124

W 8 MIKESELL JR MD
23611 GODDARD

TAYLOR MI 48180

GEORGE MIKHAIL MD

HENRY FORD HOSP

DETROIT MI 48202

LEWIS H MILBURN MD

3800 WOODWARD AVE

DETROIT MI 48201

VYTAUTAS MILERIS MO
2730 E JEFFERSON AVE
DETROIT MI 48207

HUGH H MILEY MD
WAYNE COUNTY GEN HOSP
ELOISE MI 48132

GLENN E MILLARD MD

958 FISHER BLDG

DETROIT MI 48202

ANTONINA MILLER MD

16989 FARMINGTON

LIVONIA MI 48154

DANL H MILLER MD
23100 CHERRY HILL
DEARBORN MI 48124

ELMER 8 MILLER MO
7 JOHN GLENN PLACE
HIGHLAND PARK MI 48203

JACOB J MILLER MD
20131 JAMES COUZENS
DETROIT MI 48235

J MARTIN MILLER MD

2799 W GRAND 8LV0

DETROIT MI 48202

KARL L MILLER MD

1553 WOODWARD AVE

DETROIT MI 48226

MYRON H MILLER MD L

27330 SOUTHFIELD RD
LATHRUP VILLAGE MI 48075

OSCAR W MILLER MD
FLEETWOOD PLT FBD GMC
DETROIT MI 48209

THOS H MILLER MD L

3031 IROQUOIS AVE
DETROIT MI 48214

WM E MILLER MD L

361 MERTON RO

DETROIT MI 48203

WILLIAM J MILLER M D

5649 INKSTER RD
GARDEN CITY MI

48135

CLINTON C MILLS
13938 SARASOTA
DETROIT MI

HO

L

48239

GEO R MILLS MD
8209 ALLEN ROAD
ALLEN PARK MI

48101

SAMUEL 8 MILTON
234 VISGER
RIVER ROUGE MI

MD

48218

BYONG G MIN MO
198 S GRATIOT

MT CLEMENS MI 48043

EDWARD I MINTZ MD R

MORRIS J MINTZ MD
23077 GREENFIELD #261
SOUTHFIELD MI 48075

MORTEZA MINUI MD
1576 KIRKWAY DR
BLOOMFIELD HILLS MI 48013

JOHN MINYE MD
6014 WEST FORT ST

DETROIT MI 48209

SOPHIE MISHELEVICH MD L
4651 E NINE MILE RD
WARREN MI 48091

MARTYNA MISKINIS MD

393 W GRAND BLVD

DETROIT MI 48216

D K MISRA MD

828 FISHER BLDG

DETROIT MI 48202

SUOARSAN MISRA MD
1400 CHRYSLER EXPWY
DETROIT MI 48207

EDWARD MISSAVAGE JR MD
WAYNE CO GENL HOSP
ELOISE MI 48132

A W MITCHELL M D
12000 VISGER

DETROIT MI 48217

C LESLIE MITCHELL MD R

1772 LA JOLLA RANCHO RD
LA JOLLA CA 92037

DARNELL P MITCHELL MD
8401 WOODWARD AVE
DETROIT MI 48202

OSCAR C MITCHELL MD
3400 W WARREN

DETROIT MI 48208

ROY A MITCHELL MD

1992 ARDMORE RO

TRENTON MI 48183

ROBT C MOEHLIG MD L

964 FISHER BLDG

DETROIT MI 48202

KAMRAN S MOGHISSI MD
3800 WOODWARD AVE

502 PROFESSIONAL PLAZA
DETROIT MI 48201

GEO MOGILL MD

26321 WOODWARD

HUNTINGTON WOODS MI 48070

JAHANGIR MOHTADI MD
302 W MAIN ST

NORTHVILLE MI 48167

VASIL P MOISIDES MD L

28 W ADAMS AVE

DETROIT MI 48226

MILA A MOJARES MD
DETROIT GENERAL HOSP
DETROIT MI 48226

HOWARD MOL I TZ MD A

OPHTHALMOLOGY DEPT
DETROIT GENERAL HOSP

OETROIT MI 48226

CLARENCE D MOLL MD L

2368 HARRISON DR

OUNEDIN FL 33528

78 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

STEPHEN K MOLNAR MD
4525 S TELEGRAPH RD
DEARBORN MI 48125

BOXIDAR MOMCILOVICH MD
2241 HURON RIVER DR
ROCKWOOD MI 48173

E MONGE-ST LAURENT MD
23607 FARMINGTON RD
FARMINGTON MI 48024

ROBT C MONSON MD
17520 CHESTER

DETROIT MI 48224

JOS R MONTANTE MD
3040 MIDDLEBELT RD
ORCHARD LAKE MI 48033

MILTON MONTENEGRO MO

16633 GOLFVIEW

LIVONIA MI 48154

WM C MONTGOMERY MD

6071 W OUTER DR

DETROIT MI 48235

RAYMOND W MONTO MD

HENRY FORD HOSP

DETROIT MI 48202

GERALD A MOORE MD
801 DAV WHITNEY BLDG
DETROIT MI 48226

JOHN W MOORE JR MD

8251 W 8 MILE RD

DETROIT MI 48221

THOMAS F MOORE MD A

2921 BAMLET ROAD

ROYAL OAK MI 48073

WESLEY P MOORE MD
HENRY FORD HOSPITAL
DETROIT MI 48202

WARREN R MOORE MD
17800 E 8 MILE RD
DETROIT MI 48236

COLEMAN MOPPER MD
14633 E SEVEN MILE RD
DETROIT MI 48205

MIRIAM V MORALES MD

5495 W 12TH LANE

HIALEAH FLORIDA 33012

FRANK J MORAN MD
16311 MIDDLEBELT
LIVONIA MI 48154

DONALD N MORGAN MD
326 EASTLAND CENTER
PROFESSIONAL BLDG

HARPER WOODS MI 48225

GEO J MOR I ARTY MO
3011 W GRAND BLVD
DETROIT MI 48202

YOSHIKAZU MOR I TA MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

ARTHUR R MORLEY MD

9645 ISLAND DR

GROSSE ILE MI 48138

HAROLD V MORLEY MD

970 FISHER BLOG

OETROIT MI 48202

GEORGE M MORLEY MD
20211 ANN ARBOR TRAIL
DEARBORN HEIGHTS MI 48127

JAMES A MORLEY MD L

4200 WHITE BIRCH DR
ORCHARD LAKE MI 48033

THOMAS S MORLEY MD

PAUL H MUSKE MD

4160 JOHN R ST

13244 W WARREN

DETROIT MI

48201

DEARBORN MI

48126

SHEFFICK J MOROUN MD

KADRI K MUTLU MD

675 PARKER

35337 W WARREN

OETROIT MI

48214

WESTLAND MI

48185

MARVA J MORRIS MD

JAROSLAW MUZ MD

A

12632 DEXTER

GRACE HOSPITAL

DETROIT MI

48238

DETROIT MI

48201

GEORGE W MORRISON MD

L

DANL W MYERS MD

2033 PARK

2243 GOLFVIEW DR #106

DETROIT MI

48226

TROY MICHIGAN

48084

WILLIAM H MORSE MD

STEVEN A MYERS MD

26711 SOUTHFIELD

951 E LAFAYETTE

LATHRUP VILLAGE MI

48075

DETROIT MI

48207

DAVID G MORTON MD

D P NACHAZEL JR MD

19445 PLYMOUTH

3800 WOODWARD AVE

DETROIT MI

48228

DETROIT MI

48201

FREDK L MOSELEY MD

RUSSELL NAHIGIAN MD

2561 S SCHAEFER

17371 ANNCHESTER AVE

DETROIT MI

48217

DETROIT MI

48219

PETER F MOSER MD

ANTOINE NAHOUM MD

26082 E HURON RIVER DR

1030 KENSINGTON

FLAT ROCK MI

48134

DETRUIT MI

48230

JOHN W MOSES MD

K C R NAIR MD

MT CARMEL MERCY HOSP

41001 W SEVEN MILE RD

6071 OUTER DR WEST

NORTHV I LLE MI

48167

DETROIT MI

48235

SUNGHEE NAM MD
KIRWOOD HOSPITAL

NATHAN H MOSS M D

L

DETROIT MI

48238

2847 TRUMBULL
DETROIT MI

48216

DEMETRIO N NASOL MD
20503 UEQUINDER

NORMAN D MOSS MD

DETROIT MI

48234

29519 MEADOWLANE DR
SOUTHFIELD MI

48075

EDWARD B NASH MD
2235 INKSTER ROAD

SELMA S MOSS MD
20905 GREENFIELD

INKSTER MI

48141

SOUTHFIELD MI

48075

ALBERT G NAULT JR MD
18101 E WARREN

CARLIN P MOTT MD
2395 W GRAND BLVO

L

DETROIT MI

48224

DETROIT MI

48208

JOSEPH H NAUD MO
18241 GREENFIELD RD

JOHN W MOYNIHAN MD

DETROIT MI

48235

2841 MONROE BLVD
DEARBORN MI

48124

DOM I NADOR G NAVALTA
3529 W JEFFERSON

MD

HERSCHEL E MOZEN MD
17550 W 12 MILE RD

ECORSE MI

48229

SOUTHFIELD MI

48075

CORNELIUS A NAVORI MD

3516 FORT STREET

JOHN MUCASEY M D
22341 W 8 MILE RD

LINCULN PARK MI

48146

DETROIT MI

48219

ARTHUR H NAYLOR MD
2220 N TIPSICO LK RD

L

HECTOR L MULERO MD

MILFORD Ml

48042

15101 SOUTHFIELD RD
ALLEN PARK MI

48101

S G NAZARENO MD
18144 MULBERRY

JOS R MULLEN MD

RIVERVIEW MI

48192

19003 ECORSE RD
ALLEN PARK MI

48101

WALTER G NEEB MD
16840 E WARREN ST

HENRY T MUNSON MO
7815 E JEFFERSON

DETROIT MI

48224

DETROIT MI

48214

JOHN M NEHRA MD

17800 E 8 MILE RD #412

GORDON M MURRAY MD

GROSSE POINTE MI

48236

9901 WHITTIER
DETROIT MI

48224

EOWIN J NEILL MD
5026 BEDFORD

IAN H L MURRAY MD
18161 W 12 MILE RD

DETROIT MI

48224

LATHRUP VILLAGE MI

48075

DARWIN M NELSON MD
63 RIDGE RD

PATRICK MURRAY MD

DETROIT MI

48236

261 MACK AVE
DETROIT MI

48201

HARRY M NELSON MD
1800 LULA LAKE RD

L

ROBT J MURRAY MD

LOOKOUT MOUNTAIN TN

37350

3700 WEST RD
TRENTON MI

48183

NORMAN A NELSON MD
WAYNE CO GEN HOSP
ELOISE MI

48132

VICTOR E NELSON MD

3025 CROOKS RD

ROYAL OAK MI 48073

WARREN S NESBIT MD
24382 ROSS CT

DETROIT MI 48239

PAUL N NEUFELD MD
17000 W EIGHT MILE RD
SOUTHFIELD MI 48075

ERNEST NEWMAN MD R

17371 EVERGREEN ST
DETROIT MI 48219

GEO F NEWMAN MD

2012 MONROE BLVD

DEARBORN MI 48124

MAX K NEWMAN MD
21701 W 11 MILE RD
SOUTHFIELD MI 48075

KENNETH NEWTON MD

11841 SUSAN AVE

WARREN MI 48093

WALLACE NICHOLS JR MD
2387 ASHBY

TRENTON MI 48183

WARREN 0 NICKEL MD

21935 WILDWOOD

DEARBORN MI 48128

ALBERT W NICKELS MD

3535 W 13 MILE RD

ROYAL OAK MI 48072

AAGE E NIELSEN MD
3790 WOODWARD

DETROIT MI 48201

DONALD R NIELSEN MO
26339 WOODWARD AVE
HUNTINGTON WOODS MI 48070

NORMAN D NIGRO MD
3800 WOODWARD #508

DETROIT MI 48201

M H NILFOROUSHAN MO
16975 FARMINGTON RD
LIVONIA MI 48154

JOHN B NILL MD L

710 BERKSHIRE

GROSSE PTE PARK MI 48230
LUIS A NINO MD

25638 CHAPELWEIGH OR

FARMINGTON MI 48024

WM C NOBLE MD

4045 W JEFFERSON

ECORSE MI 48229

BERNARD E NOLAN MD

5460 SCHAEFER RD

DEARBORN MI 48126

DAVID C NOLAN MD
1151 TAYLOR RM 119C
DETROIT MI 48202

WILFRED S H NOLTING MD
15850 E WARREN AVE
DETROIT MI 48224

DAVID C NORTHCROSS MD
2929 W BOSTON BLVD
DETROIT MI 48206

ARTHUR B NORTON MD L

18615 MUIRLAND

DETROIT MI 48221

MARTIN L NORTON MD
17125 MT VERNON BLVD
SOUTHFIELD MI 48075

WM C NOSHAY MD

2799 W GRAND BLVD

DETROIT MI 48202

JANUARY, 1972/Michigan Medicine 79

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

K S NOWAKOWSKI MD

GARY R 0 NEIL MD

HELEN A PAPAIOANOU

MD

15125 GRATIOT

OETROIT MEMORIAL HOSP

20361 MACK AVE

DETROIT MI

48205

DETROIT MI

48226

DETROIT MI

48236

KENNETH M NOWICKI MD

JOS M OPPENHE I M MD

BEN J R PARKER MD

HUTZEL HOSPITAL

24091 DANTE

19149 W SEVEN MILE

RO

DETROIT MI

48201

OAK PARK MI

48237

DETROIT MI

48219

C NWOKEDI MD

RICHARD S OPPENHE I M MD A

BRUCE R PARKER MD

A

12000 VISGER RD

KRESGE EYE INSTITUTE

STANFORO UN I V MED CTR

OETROIT MI

48217

690 MULLETT ST

DEPT OF RADIOLOGY

VICTOR J NY80ER MD

DETRUIT MI

48226

STANFORD CALIF

94304

261 MACK BLVD
DETROIT MI

48201

HASAN Y ORGE MD

A

JOHN W PARNELL MD

951 E LAFAYETTE

21 WHITCOMB DR

LEON S OBUSHKEVICH MD

DETROIT MI

48207

GROSSE PTE FARMS MI

48236

5460 SCHAEFER RO

DEARBORN MI

48124

RANDALL M 0 ROURKE MD L

ROBT W PARR MD

A

8465 KENNEDY CIRCLE

109 CRESTWOOO LANE

LONIE 8 OCDOL MD

WARREN MI

48093

LARGO FL

33540

1449 DAV WHITNEY BLDG

DETROIT MI

48226

ARMANDO ORTIZ MD

RUFUS H PARRISH MD

15990 W NINE MILE RD

8401 WOODWARD AVE

KATHERYN L 0 CONNOR MD

SOUTHFIELD MI

48075

OETROIT MI

48202

17711 SCHOOLCRAFT

DETROIT MI

48227

EUGENE A OSIUS MD

L

BENJAMIN A PASSOS MD

901 DAV WHITNEY BLDG

P 0 BOX 1266A

DAYTON H 0 DONNELL MO

DETROIT MI

48226

DETROIT MI

48232

22000 GREENFIELD

DETROIT MI

48237

ARTHUR Z OSTROWSKI MD

MELVIN K PASTOR I US

MO

610 NORTHLAND MED BLDG

22835 WILSON

KEVIN T 0 DONNELL MD

SOUTHFIELD MI

48075

DEARBORN MI

48128

15901 W 9 MILE RD #514

SOUTHFIELD MI

48075

EUGENE A OTLEWSKI MD

ROY 8 PATTON MD

15901 W 9 MILE RD

665 WINTER ST

EOWARD M OETTING M D

SOUTHFIELD MI

48075

SALEM OREGON

97301

1041 WHITTIER
GROSSE PTE MI

48236

JORGE V OTTAVIANO MD

LLOYD J PAUL MD

41001 W SEVEN MILE

19321 GREENFIELD

GILBERT M 0 GAWA MD

NORTHVI LLE MI

48167

DETROIT MI

48235

HENRY FORD HOSP
DETROIT MI

48202

JOHN P OTTAWAY MD

JEROME I PAWLOWSKI

MD

L

18226 MACK AVE

2009 E GRAND BLVD

JORDON OHL MO
SINAI HOSPITAL

GROSSE PTE FARMS MI

48236

DETROIT MI

48211

DETROIT MI

48235

DONALD OTTO MD

HALTER A PAYNE JR MD

DET MEMORIAL HOSPITAL

2 83 HILLCREST

GALEN B OHMART MO

L

DETROIT MI

48226

GROSSE POINTE MI

48236

275 GILCHRIST AVE
ALPENA MI

49707

CLARENCE I OWEN MD

L

HARRY A PAYSNER MD

L

2689 DUPONT

13105 IXORA COURT

JULIUS M OHOROONIK MD

JACKSONVILLE FL

32217

NORTH MIAMI FL

33161

21520 GOETHE AVE

GROSSE PTE WOODS MI

48236

S S PADILLA JR MD

A

EDWIN T PEARCE JR MD

305 S DELSEA

14411 E JEFFERSON

MILTON H OKUN MD

N

DEPTFORD N J

08096

DETROIT MI

48215

SCARBOROUGH MANOR #307

SCARBOROUGH N Y

10510

ARTEMIO E PACOUING MD

JACK PEARLMAN MD

25219 GRAND RIVER

25860 CONCORD

JOSEPH R OLDFORD MD

DETROIT MI

48240

HUNTINGTON WOODS MI

48070

17000 W 8 MILE RD
SOUTHFIELD MI

48075

A G PAGDANGANAN MD

HARRY A PEARSE MO

L

HARPER HOSPITAL

17000 W EIGHT MILE

STANLEY OLE JNICZAK MD
WAYNE COUNTY GEN HOSP

DETROIT MI

48201

SOUTHFIELD MI

48075

ELOISE MI

48132

MILTON R PALMER MD

HERBERT E PEDERSEN

MD

3800 WOODWARD AVE #218

3815 PELHAM RD

ALEX OLEN MD

DETROIT MI

48201

DEARBORN MI

48124

13100 HARPER AVE
DETROIT MI

48213

PETER PALMER MD

GEO F PEGGS MD

13479 NORTHLINE

5419 LIVERNOIS AVE

FRANCIS P 0 LINN MO
18430 MACK AVE

SOUTHGATE MI

48195

DETROIT MI

48210

GROSSE PTE FARMS MI

48236

I J PALMISANO MD

LUZVIMINOA PENALOZA

MD

32300 SCHOOLCRAFT

CHILDRENS HOSPITAL

GEO S OLMSTED MD

LIVONIA MI

48150

DETROIT MI

48202

17550 W 12 MILE RD
SOUTHFIELD MI

48075

TAMARA PANCZAK MD

GEO V PENDY MD

PLYMOUTH STATE HOSP

1001 DAV WHITNEY BLDG

AVIS M OLSON M D
MT CARMEL MERCY HOSP

NORTHVILLE MI

48167

DETROIT MI

48226

DETROIT MI

48235

NANA N PANTOS MD

JOHN M PENDY MD

17800 E 8 MILE RD

1001 DAVID WHITNEY

BL

OONALD T OLSON MD

DETROIT MI

48236

DETROIT MI

48226

17701 W MCNICHOLS RD
DETROIT MI

48235

STEPHEN M PANIC MO

DAVID A PENNER MD

28091 DEQUINORE

18530 GRAND RIVER

GEORGE P OLSON MO

MADISON HEIGHTS MI

48071

DETROIT MI

48223

7900 JOSEPH CAMPAU
HAMTRAMCK MI

48212

THEO G PANTOS MD

MEYER PENSLER MD

JAMES A OLSON MO

1536 DAV WHITNEY BLOG

10151 MICHIGAN AVE

DETROIT MI

48226

DEARBORN MI

48126

17000 WEST 8 MILE RD

SOUTHFIELD MI 48075

DONALD F PERCY MD
15901 GREENFIELD AVE

DETROIT MI 48227

GRACE M PERDUE MD R

1438 S OCEAN 8LV0 #7
POMPANO BEACH FL 33062

JOSE L PEREZ MD

2799 ORCHARO TRAIL

TROY MI 48084

CARLOS PEREZ-BORJA MD
11885 E TWELVE MILE RD
WARREN MI 48093

RENE PEREZ-TERAN MD
13326 SHERWOOD
HUNTINGTON WOODS MI 48070

CLINTON J PER I N I MD A

WAYNE STATE UNIVERSITY
DETROIT MI 48207

FRANK S PERKIN MO L

828 FISHER BLDG

DETROIT MI 48202

HYMAN L PERLIS MD L

10 PETERBORO

DETROIT MI 48201

MARVIN S PERLIS M D

1030 FISHER BLDG

OETROIT MI 48202

HAROLD PERRY MD
SINAI HOSP

DETROIT MI 48235

JOSEPH H PERRY MD

259 LEWISTON RD

GROSSE PTE MI 48236

CLAUS PETERMANN MD
20927 KELLY RD
E OETROIT MI 48021

WM R PETERS MD
670 PEACH TREE
GROSSE PTE MI 48236

GUSTAV PETERSON MD
FISHER BODY WILLOW RUN
YPSILANTI MI 48197

ROBERT A PETERSON MD

18700 MEYERS RD

DETROIT MI 48235

RONALD D PETERSON MD
FORO MOTOR CO

DEARBORN MI 48121

SAMUEL C PETIX MD
17640 W 12 MILE RD
SOUTHFIELD MI 48075

EDWARD A PETOSKEY MD
5656 W FORT
DETROIT MI

THOS J PETRICK MD
15101 SOUTHFIELD
ALLEN PARK MI

ANTHONY PETRILLI MD
951 E LAFAYETTE
DETROIT MI

MARIO A PETRINI M D
1080 FISHER BLDG
DETROIT MI

LOUIS A PETRUCCO MD
14044 W MC, NICHOLS RD
DETROIT MI 48235

THOS A PETTY MD
17300 E JEFFERSON AVE
GROSSE PTE MI 48236

ARTHUR JOHN PETZ MO
36000 FIVE MILE RD
LIVONIA MI 48154

48209

48101

48207

48202

80 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

THOMAS J PETZ MD
605 DAV WHITNEY BLDG
DETROIT MI

68226

ROBERT T POLACK MD
26625 HOOVER
WARREN MI

68089

PREM S PRASAD MD
32900 FIVE MILE RD
LIVONIA MI

68156

PHILIP S PEVEN MO
18709 MEYERS RD
DETROIT MI

68235

CHAS P POLENTZ MD
31815 SOUTHFIELD
BIRMINGHAM Ml

68009

ANANDA S PRASAD MD
WAYNE STATE UNIVERSITY
DETROIT MI 68207

JOS D PICARD MD
5237 OAKMAN BLVD
DEARBORN MI

68126

JOHN E POLK MD
8721 12TH ST
DETROIT MI

68206

JEAN P PRATT MD
2608 N E 21ST COURT
FT LAUDERDALE FL

L

33305

LOUISA I PICCONE MD
17700 W WARREN
DETROIT MI

68228

JEROME L POLLACK MD
15615 CRESCENT DR
ALLEN PARK MI

68101

LAWRENCE A PRATT MD
US AID PH E APO
SAN FRANCISCO CA

A

96263

J WALTON PICHETTE MD
6650 GREENFIELO RD
DEARBORN MI

68126

JOHN J POLLACK MD
3901 BEAUBIEN
DETROIT MI

68201

C PREDETEANU MD
810 DAV WHITNEY BLDG
DETROIT MI

68226

ORLANOO W PICKARD MD
6676 BERKSHIRE RD
DETROIT MI

L

68226

R J POLLARO MD
GRACE HOSP
DETROIT MI

68201

RUTH E PRESTON MD
3011 W GRAND BLVD
DETROIT MI

68202

SOL D PICKARD MD
HENRY FORD HOSPITAL
DETROIT MI

68202

LOUIS S POLLENS MD
15621 W 9 MILE RD
OAK PARK MI

68237

A HAZEN PRICE MD
18605 BIRCHCREST AVE
DETROIT MI

L

68221

L M PICKERING MD
13679 NORTHLINE
SOUTHGATE MI

68195

CLEMENT J POLL I NA MD
21620 HARPER
ST CLAIR SHORES MI

68080

ALVIN E PRICE MD
1553 WOODWARD AVE
DETROIT MI

L

68226

JAMES M PIERCE JR MD
3800 WOODWARD AVE
OETROIT MI

68201

JOS L PONKA MD
2799 W GRAND BLVD
DETROIT MI

68202

SCOTT K PRICE MO
OAKWOOD HOSP
DEARBORN MI

68126

A W PIETRA HD
1750 VERNIER RD #27
GROSSE POINTE MI

L

68236

WALTER D POOL MD
20901 MOROSS RD
DETROIT MI

68236

ROBT J PRIEST MD
HENRY FORD HOSP
DETROIT MI

68202

LEONARD R PIGGOTT MD
951 E LAFAYETTE
DETROIT MI

68207

SON J A I POONPANIJ MD
15231 W SEVEN MILE RD
DETROIT MI 68235

ADDISON E PRINCE MD
8962 DEXTER
OETROIT MI

68206

JOHN T PILIGIAN MD
3825 BRUSH ST
DETROIT MI

68201

KEO POOPAT MD
WAYNE STATE UNIV
DETROIT MI

A

68207

EDWARD J PR I SBE MD
16603 PLYMOUTH RD
DETROIT MI

68227

JAMES F PINGEL MD
998 NORFOLK
BIRMINGHAM MI

68009

GERALD POPE MD
HENRY FORD HOSP
DETROIT MI

68202

JULIEN PRIVER MD
6767 W OUTER DR
DETROIT MI

68235

RALPH H PINO MD
31861 KINGSWOOD SQ
FARMINGTON MI

L

68026

CHAS A PORRETTA MO
507 NORTHLAND MED BLDG
SOUTHFIELD MI 68075

A B PROCAILO MD
6033 MIDDLEBELT RD
GARDEN CITY MI

68135

RALPH R PIPER MD
1695 MC KINSTRY
DETROIT MI

L

68209

FRANCIS S PORRETTA MD L

18591 SARATOGA BLVD
LATHRUP VILLAGE MI 68075

LORNE D PROCTOR MD
19515 MACK AVE
GROSSE PTE WOODS HI

68236

JOHN E PITTMAN MD
1553 WOODWARD AVE
DETROIT MI

L

68226

GEORGE F PORRETTA MD
23077 GREENFIELD
SOUTHFIELD MI

68075

FRANK P PROKOP MD
12760 S MARROW ST
DEARBORN MI

68126

CAROL K PLATZ MD
20631 BALFOUR
HARPER WOODS MI

68225

FREOK G PORTER MD
29590 FIVE MILE
LIVONIA MI

68156

V PROKUPOW YCZ MD
19666 CONANT
DETROIT MI

68236

HERMAN M PLAVNICK MD

A

HARRY PORTNOY MD

R

RUSSEL F PROUD MD

5005 VAN BUREN ST
HOLLYWOOD FL

33021

26710 SUSSEX AVE
DETROIT MI

68237

26151 HURON RIVER OR
FLAT ROCK MI

68136

HAROLD PLISKOW MD
15901 W 9 MILE RD #202
SOUTHFIELD MI 68075

JOS L POSCH MD
1608 KALES BLDG
OETROIT MI

68226

A MICHAEL PRUS MD
6160 JOHN R STREET
DETROIT MI

68201

HAROLD PLOTNICK M D
18656 MUIRLAND
DETROIT MI

68221

IRVING POSNER MD
18111 MUIRLAND AVE
DETROIT MI

68235

SIDNEY PRYSTOWSKY MD
1800 TUXEDO
DETROIT MI

68206

EUGENE I PLOUS MD
569 FISHER BLDG
DETROIT HI

68202

ELIHUE B POTTS MD
7606 DEXTER
DETROIT MI

68206

THOM J PRZYBYLSKI MD
770 FISHER BLDG
DETROIT MI

68202

HAROLD M PODOLSKY MD
3755 FORT
LINCOLN PARK MI

68166

JOSEPH T POWASER MD
26906 WILSON DR
DEARBORN HEIGHTS MI

68127

ANDRE PUGEL MD
VET ADMIN HOSP
ALLEN PARK MI

68101

A POGREBNIAK MD
25210 GRAND RIVER
DETROIT MI

68260

LAWRENCE POWER MD
1600 CHRYSLER EXPWY
DETROIT MI

68207

JOSEPHINE PUGEL MD
918 HOLLYWOOD
GROSSE PTE WOODS MI

68236

SENTA V POIM MD
1069 FISHER BLDG
DETROIT MI

68202

JOHN R PRACHER MD
3815 PELHAM RD
DEARBORN MI

68126

HOWARD C PUGH MD
1553 WOODWARD AVE
DETROIT MI

68226

BENEDETTO PUGLIESl MD L
21811 KELLY RD
EAST DETROIT MI

FRANK H PURCELL MD
869 EDGEMONT PARK
DETROIT MI

PRITPAL S PURI MD
WAYNE STATE UNIV
DETROIT MI

HENRY E PURO M D
1733 TRENTON OR
TRENTON MI

STEWART E PURSEL MD
1016 PROF PLAZA
DETROIT MI

W L PURVES M D
17595 PARKSIDE
DETROIT MI

SEONG KYUN PYUN MO
2003 WICKFORD CT
BLOOMFIELD HILLS MI

RICHARD G QUEVY MD
29290 CHENWOOD CT
FARMINGTON MI

EUGENE H QUIGLEY MD
635 N GULLEY
DEARBORN HGHTS MI

WM G QUIGLEY MD
16210 W NINE MILE RD
SOUTHFIELD MI 68075

EDWARD L QUINN MD
1161 GOLF V I E W

BIRMINGHAM MI 68009

RAFAEL E QUINONES MO

17200 E WARREN

DETROIT MI 68226

MOHAMMED RABBANI HD
1600 CHRYSLER EXPWV
DETROIT MI 68207

BELLA M RABINOVITCH MD
26590 WELLINGTON DR
FRANKLIN MI 68025

NAIM M RABY MD
15830 FORT

SOUTHGATE Ml 68195

N RACHMANINOFF MD
HARPER HOSP

DETROIT MI 68201

PAUL D RADGENS MD

751 S MILITARY

DEARBORN MI 68126

KIANOOSH RADSAN MD

15101 SOUTHFIELD

ALLEN PARK MI 68101

SAMIR RAGHEB MD
6607 ROEMER

DEARBORN MI 68126

LAMBERT P RAHM MD L

16611 E JEFFERSON AVE
DETROIT MI 68215

FRANK P R A I FORD 111 MD
3800 WOODWARD AVE #300
DETROIT MI 68201

JAMES A RAIKES MD

SINAI HOSPITAL

DETROIT MI 68235

IMBI RALYEA MD

7815 E JEFFERSON AVE

DETROIT MI 68216

CHARLES 0 RAMIN MD
DETROIT GENERAL HOSP
DETROIT MI 68226

68021

L

68230

68207

68183

68201

68221

68013

68026

68127

A

JANUARY, 1972/Michigan Medicine 81

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

BENJAMIN R RAMOS MD
5071 LAKE BLUFF RD
WALLED LAKE MI

48088

MELVIN L REED MD
4160 JOHN R ST
DETROIT MI

48201

HAROLD B RICE MD

513 GORRION

PALOS VERDES EST CA

R

90274

ROBT H RAMSEY MD
3815 PELHAM RD
DEARBORN MI

48124

CARL E REICHERT MD
18412 MACK AVENUE
GROSSE PTE MI

48236

MESHEL RICE MO
533 COATS RD
OXFORD MI

R

48051

DAVIO S RANDALL MD
3955 FORT ST
LINCOLN PARK MI

48146

JOHN G REID MD
1553 WOODWARD AVE
DETROIT MI

48226

WILLIAM J RICE MD

550 EASTLAND PROF BLDG

DETROIT MI 48236

BERNARD RAPOPORT MO
1800 TUXEDO
DETROIT MI

48206

WESLEY G REID MD
34186 SPRG VALLEY OR
WESTLAND MI

R

48185

M A RICHARDS MD
6309 CHARLEVOIX
OETROIT MI

48207

SEYMOUR L RAPP MD
22711 WREXFORD DR
SOUTHFIELD MI

48075

WILLIAM U REIDT MD
1800 TUXEDO
DETROIT MI

48206

PAUL J RICK MD
29630 HOOVER RD
WARREN MI

A

48093

F Q RASAY-FAROOKI MD
OETROIT GENERAL HOSP
DETROIT MI

48226

MORRIS V RE IFF MD
21701 W 11 MILE RD
SOUTHFIELD MI

48075

WILFRED A RIDDELL MD
16985 FARMINGTON RD
LIVONIA MI

48154

CARL A RASIMAS MD
1210 KALES BLDG
OETROIT MI

48226

RICHARD E REINHARD MD
7815 E JEFFERSON AVE
DETROIT MI 48214

RICHARD A RIDEOUT MD
6071 W OUTER DR
DETROIT MI

48235

HERBERT A RASKIN MD

ERNEST R REINSH MD

L

GEO G RIECKHOFF MD

L

20100 W 10 1/2 MILE

RD

600 TRA ILWOOD PATH

14905 E JEFFERSON AVE

SOUTHFIELD MI

48075

BIRMINGHAM MI

48010

DETROIT MI

48215

PETER B RASTELLO MD
3295 WEST SHORE DR
ORCHARD LAKE MI

R

48033

ROBERT 0 REISIG M D
20867 MACK
DETROIT MI

48236

JAMES A RIEDEN M D
18053 MUIRLAND
DETROIT MI

48221

WM H RATTNER MD
954 FISHER BLDG
DETROIT MI

48202

SAML G REISMAN MD
1553 WOODWARD AVE
DETROIT MI

48226

JOHN B RIEGER MD
746 PALL1STER
DETROIT MI

L

48202

FREDK W RAU MD
2730 E JEFFERSON
DETROIT MI

48207

DAVID L E REIVE MD
8125 BRANCH DR-ORE LK
BRIGHTON MI 48116

MARY H RIEGER MD
19285 LUCERNE DR
HIGHLAND PARK MI

L

48203

CLARA RAVEN MD
8114 ST PAUL
DETROIT MI

48214

JAMES E REMSKI MD
32301 CAMBRIDGE
LIVONIA MI

48154

ROBT F RIETHMILLER MD
12444 E SEVEN MILE RD
DETROIT MI 48203

HERBERT A RAVIN MD
6767 W OUTER DR
OETRUIT MI

48235

GEORGE L RENO M D
970 FISHER BLDG
DETROIT Ml

48202

GHASSAN M RIFAI MD
17533 FORT ST
RIVERVIEW MI

48192

LOUIS A RAVITZ MD
23150 RIVERSIDE *415
SOUTHFIELD MI

48075

ROBT F RENTENBACH MD
501 DAV WHITNEY BLDG
DETROIT MI

48226

JOSEPH RINALDO JR MD
16001 W NINE MILE RD
SOUTHFIELD MI

48075

KENNETH J RAY MD
28059 ELBA DR
GROSSE ILE MI

48138

MANUEL RESTO MD
2310 CASS
DETROIT MI

48201

ROBERT W RINKEL MD
7319 PARK AVE
ALLEN PARK MI

48101

HAROLD F RAYNOR MD
6097 S MAIN
CLARKSTON MI

L

48016

A D RESTO SOTO MD
17644 W WARREN
DETROIT MI

48228

JAMES A RISING MD
432 E HANCOCK
DETROIT MI

48201

FLORO V RAYOS MD
13020 MACK AVE
DETROIT MI

48215

WM S REVENO MD
3001 W GRAND BLVD
DETROIT MI

L

48202

RICARDO A RIVAS MD
995 E JEFFERSON
DETROIT MI

48207

MASSOUD RAZI MD
30900 FORD RD
GARDEN CITY MI

48135

CLARENCE E REYNER MD
10 PETERBORO ST
DETROIT MI

L

48201

JOSEPH V RIZZO MD
260 EASTLAND CTR
PROFESSIONAL BLDG

RAYMOND W REBANDT MD
2615 W JEFFERSON
TRENTON MI

48183

ROBT M REYNOLDS MD
856 FISHER BLOG
DETROIT MI

48202

DETROIT MI
PAUL RIZZO MD

48225

JOHN W REBUCK MD
2799 W GRAND BLVD
DETROIT MI

48202

WM A REYNOLDS MD
HENRY FORD HOSPITAL
DETROIT MI

48202

38 WARNER RD
GROSSE PTE MI

EDWARD L ROBB MD

48236

L

LOWELL G REDDING MD

HAROLD J REZANKA MO

L

R R 02 BOX 249A
GAYLORD MI

49735

1336 SOUTHFIELD RD
LINCOLN PARK MI

48146

1553 WOODWARO AVE
DETROIT MI

48226

HERBERT J ROBB MD

BENJAMIN REDER MD
17301 W EIGHT MILE RO
DETROIT MI

48235

SHI HUNG RHEW MO
P 0 BOX 45
ELOISE MI

48132

2706 COMFORT
BIRMINGHAM MI

ARTHUR J ROBERTS MD

48010

R

W EARL REOFERN M D
2799 W GRAND BLVD
DETROIT MI

48202

FRANCIS P RHOADES MD
2414 16 BRODERICK TWR
OETROIT MI

48226

859 WINCHESTER
LINCOLN PARK MI

GEORGE A ROBERTS MD

48146

JOSEPH 0 REED JR MD
448 LINCOLN
DETROIT MI

48230

ROGER L RIAN MO
HENRY FORD HOSPITAL
DETROIT MI

48202

21510 HARPER AVE
ST CLAIR SHORES MI

48080

ERWIN ROBIN MD

18811 HAMPSHIRE

LATHRUP VILLAGE MI 48075

HOWARD ROBINSON MD

953 FISHER BLDG

DETROIT MI 48202

JAMES H ROBINSON JR MD
10440 W 7 MILE RO
DETROIT MI

ERNST A RODIN MD
951 E LAFAYETTE
DETROIT MI

ANA G RODRIQUEZ MD
P 0 BOX 5374
DETROIT Ml

KARL H RQEHL MD
1800 GRINDLEY PARK
DEARBORN MI

AARON Z ROGERS MD
COTTAGE HOSPITAL
GROSSE POINTE MI

GEO E B ROGERS MD
8425 TWELVE MILE RO
WARREN MI

J SPEED ROGERS MD
HENRY FORD HOSPITAL
DETROIT MI

ROBERT P ROGERS MD
14200 PURITAN
OETROIT MI

ABRAHAM S ROGOFF MD
17000 W EIGHT MILE RD

SOUTHFIELD MI 48075

DIETtR J ROHL MD
ST MARYS HOSPITAL
LIVONIA MI 48150

PAUL C ROHDE MD L

12282 E OUTER DR

DETROIT MI 48224

GRACIELA R ROJAS MD
17300 SCHAEFER HWY
DETROIT MI 48235

MICHAEL E ROLLINS MD

929 FISHER BLDG

OETROIT MI 48202

STANLEY J ROMAN MD
15020 MICHIGAN AVE
DEARBORN MI 48126

RAYMOND ROMANSKI MD
16001 W NINE MILE RD
SOUTHFIELD MI 48075

CARLOS P ROMERO JR MD

3105 CARPENTER

DETROIT MI 48212

I ENRIQUE ROMERO MD
532 EASTLAND PROF BLOG
DETROIT MI 48225

JOHN J RONAYNE JR MD
16345 W MCNICHOLS RD
DETROIT MI

RICHARD A ROOD MD
7900 JOSEPH CAMPAU
DETROIT MI

ROBERT C ROOD MD
134 W SECOND ST
GAYLORD MI

FAYETTE C ROOT MD
719 NEW CENTER BLDG
OETROIT MI

0 PAUL ROSBOLT JR MD

8505 PLYMOUTH RO

DETROIT MI 48204

48235

48212

48735

48202

48221

48207

48211

48124

48236

48093

48202

48227

L

82 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

JAMES F ROSBOLT MD

EDWARD M ROTARIUS MD R

RICHARD E RUEL MD

8505 PLYMOUTH RD

PARKE DAVIS CO

33750 FREEDOM RD

DETROIT MI

48204

OETROIT MI

48232

FARMINGTON MI

48024

ARTHUR ROSE MD

INA A C ROTHER MD

BENEDICTO A RUIZ MD

7401 THIRD

101 CHICAGO BLVD

3001 MILLER RD

DETROIT MI

48202

DETROIT MI

48202

DEARBORN MI

48124

JOHN L ROSEFIELD MD

L

WALTER S ROTHWELL M

D

LUIS C RUIZ MD

65 W HANCOCK

2730 CHELSEA

1678 MERRIANN RD

OETROIT MI

48201

TRENTON MI

48183

WAYNE MI

48184

HAROLD M ROSEN MD

C M J ROTTENBERG MD

EDWARD F RUNGE MD

A

8620 W MC NICHOLS RD

13419 FENKELL

8295 39TH AVENUE N

DETROIT MI

48221

DETROIT MI

48227

ST PETERSBURG FL

33709

HARVEY ROSEN MD

E N ROTTENBERG MD

CLARENCE E RUPE MD

1151 TAYLOR

20725 W SEVEN MILE RD

22101 MOROSS RD

OETROIT MI

48202

DETROIT MI

48219

DETROIT MI

48236

THEODORE S ROSEN MD

A

LEON ROTTENBERG MD

EMIL F RUPPRECHT MD

1712C NEW JERSEY

13419 FENKELL AVE

15901 GREENFIELD RD

SOUTHFIELD MI

48075

DETROIT MI

48227

DETROIT MI

48227

HERBERT ROSENBAUM MD

NORMAN J ROTTER MD

EMIL 10 RUSCIANO MD

6720 EDINBOROUGH

3815 PELHAM RD

GRACE HOSP

BIRMINGHAM MI

48010

DEARBORN MI

48214

OETROIT MI

48201

JERRY C ROSENBERG MD

WILLIAM ROUBECK MD

DESMOND K RUSH MO

1400 CHRYSLER EXPWY

17000 W EIGHT MILE RD

1429 DAV WHITNEY BLOG

DETROIT MI

48207

SOUTHFIELO MI

48075

DETROIT MI

48226

M K ROSENBERG MD

MICHAEL S ROWDA MD

ROBERT L RUSKIN MD

SINAI HOSPITAL

7 CAMBRIDGE

SINAI HOSPITAL

DETROIT MI

48235

PLEASANT RIDGE MI

48069

DETROIT MI

48235

IRWIN K ROSENBERG MD

JOS J ROWE JR MD

SAML H RUSKIN MD

L

1400 CHRYSLER FREEWAY

401 N BRADY

15901 W 9 MILE RD

DEPT OF SURGERY

DEARBORN MI

48124

SOUTHFIELD MI

48075

OETROIT MI

48207

RENATO S ROXAS MD

GEORG RUSSANOW MD

3901 BEAUBIEN

400 E LAFAYETTE

ALVIN B ROSENBLOOM MD

DETROIT MI

48201

DETROIT MI

48226

17555 PARKSIDE

DETROIT MI

48221

L JAMES ROY MD

HENRY N RUSSELL JR MD

3800 WOODWARD AVE #512

15101 SOUTHFIELD

ALBERT ROSENTHAL MD
27855 PLYMOUTH RD

DETRUIT MI

48201

ALLEN PARK MI

48101

LIVONIA MI

48150

RICHARD R ROYER MD

ISOBEL RUTHERFORD MD

18101 E WARREN AVE

DETROIT MEMORIAL HOSP

LOUIS H ROSENTHAL MD

OETROIT MI

48224

DETROIT MI

48226

15401 W MC NICHOLS
DETROIT MI

48235

ALFRED I RUBENSTEIN

MO

RICHARD A RUZUMNA MD

6767 OUTER DR W

23300 GREENFIELD RD

SAML ROSENTHAL MO

DETROIT MI

48235

OAK PARK MI

48237

18055 GREENFIELD
DETROIT MI

48227

EPIMACO RUBIO MD

JAMES M RYAN MD

27139 SKYE DR WEST

16888 GREENFIELD

FELIX F ROSENWACH MD

FARMINGTON MI

48024

DETROIT MI

48235

19149 W SEVEN MILE RD

DETROIT MI

48219

WILLIAM RU8IN0FF MD

JAMES R RYAN MD

21000 MIDDLEBELT RD

3930 E EIGHT MILE RD

NORMAN ROSENZWEIG MD
6767 W OUTER DR

FARMINGTON MI

48024

DETROIT MI

48234

OETROIT MI

48235

MEL V YN RUBENFIRE MD

RICHARD D RYSZEWSKI MD

6767 W OUTER DR

36300 VAN DYKE AVE

SAUL ROSENZWEIG MD
2114 DAV BROD TOWER

L

DETROIT MI

48235

STERLING HEIGHTS MI

48077

DETROIT MI

48226

PAUL E RUBLE MD

RASSUL S SABER MD

605 DAVID WHITNEY BLDG

1400 CHRYSLER EXPWY

ARTHUR J ROSS MD

DETROIT MI

48226

OETROIT MI

48207

18215 GREENFIELD
DETROIT MI

48235

NEWTON C RUCH MO

LUTFI M SA D I MD

L

MT CARMEL MERCY HOSP

72445 LASSIER RD

CHARLES V ROSS MD

DETROIT MI

48235

ROMEO MI

48065

25329 8RIARWYKE DR
FARMINGTON MI

48024

EARL J RUDNER MD

HENRY H SADLER JR MD

N

18181 W 12 MILE RD

11 BELVEDERE

MERVYN B ROSS MD

LATHRUP VILLAGE MI

48075

BELVEDERE CA

94920

19075 MIDDLEBELT RD
LIVONIA MI

48152

A D RUEDEMANN SR MD

A

JOSEPH F SADUSK MD

1633 DAV WHITNEY BLDG

JOS C AMP AU a RIVER

ROBERT R ROSS MO

A

OETROIT MI

48226

PARKE DAVIS & CO

1400 CHRYSLER FREEWAY

DEPT OF UROLOGY

A D RUEDEMANN JR MD

DETROIT MI

48232

1633 DAV WHITNEY BLDG

DETROIT MI

48207

DETROIT MI

48226

JOS T SADZIKOWSKI MD
6033 MIDDLEBELT RD

ROBERT R ROSS JR MD

MILTON J RUEGER MD

GARDEN CITY MI

48135

540 E CANFIELD

17220 MACK AVE

DETROIT MI

48201

GROSSE PTE MI

48224

SHEIKH M SAEED MD
HENRY FORD HOSPITAL

ALEXANDER N ROTA MD

RALPH C RUEGER MD

L

OETROIT MI

48202

4363 SUNNINGDALE DR

3399 DALEVIEW DR

BLOOMFIELD HILLS MI

48013

ANN ARBOR MI

48103

BERNARD A SAGE MD

210 W00DCREST DR

DEARBORN MI 48124

HECTOR J ST AMOUR M D L

25515 BL0SS1NGHAM DR
DEARBORN HGHTS MI 48127

S N SAKORRAPHOS MD L

66 CRESTVIEW RD

BELMONT MA 02178

SAUL SAKWA M D

17000 W EIGHT MILE RD

SOUTHFIELD MI 48075

FREDK A SALAMON MD
6102 E EDGEMONT
SCOTTSDALE AR I Z 85252

LACY J SALAN MD

1257 S MAIN ST

PLYMOUTH MI 48170

FERNANDO N SALAZAR MO

2645 GRANGE RD

TRENTON MI 48183

PAUL T SALCHOW MO R

8285 HARTWELL

DETROIT MI 48228

GINO G SALCICCIOLI MD
3930 E EIGHT MILE RD
DETROIT MI 48234

EDWARD S SALEM MD
22420 TWYCKINGHAM WAY
SOUTHFIELD MI 48075

MICHAEL S SALESIN MD

SINAI HOSPITAL

DETROIT MI 48235

MITCHELL SALHANEY MO
15370 LEVAN RD
LIVONIA MI

CAROLINE D SALL MD
5858 MCDONIE AVE
WOODLAND HILLS CA

WILLIAM T SALLEE MD
17000 W 8 MILE
SOUTHFIELD MI

WILLIAM H SALOT MD
220 EASTLAND PROF BLDG
DETROIT MI 48236

HARRY C SALTZSTEIN MD L
16500 NORTH PARK DR
SOUTHFIELD MI 48075

A T SAL VAGG 10 MO

21811 KELLY RD

EAST DETROIT MI 48021

L CARL SAMBERG MD

2338 N WOODWARD

ROYAL OAK MI 48073

HUGO M SANCHEZ MD
2155 YORKTOWN

ANN ARBOR MI 48105

HARRY H SAND MD
24110 OXFORD

DEARBORN MI 48124

HERSHEL SANDBERG MD
17550 W 12 MILE RD
SOUTHFIELD MI 48075

IRVIN W SANDER MD R

4461 N E 3 1 ST AVE
LIGHTHOUSE PTE FL 33064

ALVORD R SANDERSON MD L

978 PEMBERTON RD

GROSSE PTE MI 48230

MANMOHAN S SANDHU MD
2300 OAK ST

WYANDOTTE MI 48192

48154

91364

48075

JANUARY, 1972/Michigan Medicine 83

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

NATHANIEL SANDLER MO
15901 W NINE MILE RD
SOUTHFIELD MI 48075

ALICIA C SANDOVAL MD
DETROIT GENERAL HOSP
DETROIT MI 48226

E M SANTIAGO MD

ST JOHN HOSPITAL

DETROIT MI 48236

ALPHONSE M SANTINO MD M

21811 KELLY SUITE F

EAST DETROIT MI 48021

MANUEL I SANTOS MD

36616 PLYMOUTH RD

LIVONIA MI 48150

RAUL R SANTOS MO A

NORTHVILLE STATE HOSP
NORTHV I LLE MI 48167

M ANDREW SAPALA MD
21471 CHERRY HILL RD
DEARBORN MI 48124

DOUGLAS A SARGENT MD

816 GRAND MARAIS

GROSSE PTE PARK MI 48236

RICHARD C SARGENT MD

17357 FENKELL ST

DETROIT MI 48227

WILLIAM R SARGENT MD

17357 FENKELL ST

DETROIT MI 48227

AREK L SARK I SS I AN MD
3800 WOODWARD AVE
DETROIT Ml 48201

MANUEL SARMIENTO MD
15600 PENNSYLVANIA
SOUTHFIELD MI 48075

JOHN B SARRACINO MD R

4309 FORESTWOOD DR

SAN JOSE CALIF 95121

JOHN J SAUK MD
29210 HOOVER

WARREN MI 48093

GUY 0 SAULSBERRY MD

4059 W DAVISON

DETROIT MI 48238

GENE A SAUNDERS MD
10933 FARMINGTON RD
LIVONIA MI 48150

DARIA H SAWDYK MD
7012 MICH AVE

DETROIT MI 48210

JOSEPH S SAZYC MD

22101 MOROSS RD

DETROIT MI 48236

HERMAN D SCARNEY MD L

3535 W 13 MILE RD

ROYAL OAK MI 48072

H C SCHAEFER MD

1081 SO OXFORD

GROSSE PTE WOODS MI 48236

R08T L SCHAEFER MO A

76 W ADAMS AVE

DETROIT MI 48226

ROBT L SCHAEFER JR MD
74 W ADAMS

DETROIT MI 48226

JOSEPH N SCHAEFFER MD
261 MACK BLVD

DETROIT MI 48201

MARTIN SCHAEFFER MO
16186 OXLEY RD
SOUTHFIELD MI 48075

DAVID A SCHANE MD

19159 BERKELEY

DETROIT MI 48221

IVAN C SCHATTEN MD
14626 E SEVEN MILE RD
DETROIT MI 48205

IRWIN J SCHATZ MD
1400 CHRYSLER EXPWY
DETROIT MI 48207

DANIEL E SCHECHTER MD
17000 W 8 MILE RD
SOUTHFIELD MI 48075

ALAN C SCHEER MD
DETROIT MEMORIAL HOSP
DETROIT MI 48226

ISAAC S SCHEMBECK MD L

1553 WOODWARD AVE
DETROIT MI 48226

THOMAS M SCHENK MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

ALAN D SCHER MD

19190 GREENFIELD

DETROIT MI 48235

R08ERT A SCHERER MD

470 FISHER BLOG

DETROIT MI 48202

PETER S SCHIDLOWSKY MD

18917 SHADYSIDE

LIVONIA MI 48152

OLEG P SCHIDLOWSKY MD
32300 SCHOOLCRAFT D-3
LIVONIA MI 48150

ARTHUR E SCHILLER MD L

1553 WOODWARD AVE
DETROIT MI 48226

RAYMOND 0 SCHIRACK MD R
P 0 BOX 41

WATERS MI 49797

NORMAN SCHKLOVEN MO

430 LOMA MEDIO RD

SANTA BARBARA CA 93103

NATHAN H SCHLAFER MD L

304 DAV WHITNEY BLDG
DETROIT MI 48226

HENRY SCHLESINGER MD
13534 WOODWARD AVE
DETROIT MI 48203

H L SCHLUSSELL MD

1812 MIDDLEBELT

GARDEN CITY MI 48135

GEORGE J SCHMIDT MD
7106 PARK AVE

ALLEN PARK MI 48101

HARRY E SCHMIDT MD R

10406 EL CAPITAN CIR

SUN CITY ARIZ 85351

JOHANN SCHMIDT MD

7815 E JEFFERSON

DETROIT MI 48214

KLAUS P SCHMIDT MD
871 FISHER BUILDING
DETROIT MI 48202

WERNER F SCHMIDT MD
17800 E EIGHT MILE RD
DETROIT MI 48225

NORMAN L SCHMITT MD
17590 W 12 MILE RD
SOUTHFIELD MI 48075

ROBT J SCHNECK MD L

1553 WOODWARD AVE
DETROIT MI 48226

CHAS L SCHNEIDER MO
22148 MICHIGAN AVE
DEARBORN MI 48124

CURT P SCHNEIDER MD L

655 FISHER BLDG

DETROIT MI 48202

JOHN R SCHNEIDER MD
15001 W 8 MILE RD
DETROIT MI 48235

KENNETH G SCHOOFF MD

951 E LAFAYETTE

DETROIT MI 48207

SARAH S SCHOOTEN MD L

15901 W 9 MILE RD *214
SOUTHFIELD MI 48075

CALVIN E SCHORER MD

951 E LAFAYETTE

DETROIT MI 48207

C F SCHROEDER MD
26505 E RIVER RD
GROSSE ILE MI 48138

GISELA SCHROEDER MD

22408 PARK LANE

ST CLAIR SHORES MI 48080

HEINZ R SCHROEDER MD
1941 HAWTHORNE BLVO
DEARBORN MI 48128

KARL F SCHROEDER MO

17725 PARK LANE

GROSSE ILE MI 48138

S L SCHUCHTER MD
24425 HOOVER

WARREN MI 48089

CARL H SCHULTE MD L

717 REDDING RD
BIRMINGHAM MI 48009

CLARENCE H SCHULTZ MD
23100 CHERRY HILL
DEARBORN MI 48124

DONALD V SCHULTZ MO
23100 CHERRYHILL
DEARBORN MI 48124

E C SCHULTZ JR MD
610 N WOODWARD AVE
BIRMINGHAM MICH 48011

ERNEST C SCHULTZ MD L

1553 WOODWARD AVE
DETROIT MI 48226

BERNARD M SCHUMAN MD
HENRY FORD HOSPITAL
OETROIT MI 48202

BEN J SCHWARTZ MD
275 W GRAND BLVD
DETROIT MI 48216

EUGENE L SCHWARTZ MD
METROPOLITAN HOSP
OETROIT MI 48206

LOUIS A SCHWARTZ MD A

P 0 BOX 315

ROCKPORT MA 01966

J A SCHWARTZBERG MD

19445 PLYMOOTH

DETROIT MI 48228

C F SCHWEIGERT MD

10627 CADIEUX RD

OETROIT MI 48224

BENJAMIN SCHWIMMER MD
27549 W 6 MILE RD
LIVONIA MI 48152

STANLEY V SCIARRINO MD L
16190 JAMES COUZENS
DETROIT MI 48221

WM J SCOTT MD L

20170 MACK AVE

GROSSE PTE WOODS MI 48236

GORDON P SCRATCH MO

1005 MOTUAL BLDG

DETROIT MI 48226

RAYMOND J SCREEN MD A

18520 W SEVEN MILE RD
OETROIT MI 48219

F E SEABROOKS MD

13800 LIVERNOIS

DETROIT MI 48238

ANDREW E SEGAL MD
19481 LIVERNOIS AVE
DETROIT MI 48221

NATHAN P SEGEL MD
27650 FARMINGTON RD
FARMINGTON MI 48024

ALVIN H SEIBERT MD L

1180 BEDFORD RD

GROSSE PTE PARK MI 48230

A L SEIFERLEIN MD

68 PUTMAN PLACE

GROSSE PTE SHORES MI 48236

T DAVID SEIGNE MD

GRACE HOSPITAL

DETROIT MI 48201

ELMER J SEIM MD
GRACE HOSP

DETROIT MI 48201

KARL SEITAM MD
10149 MICHIGAN AVE
DEARBORN MI 48126

RONALD A SELBST MD

26339 WOODWARD

HUNTINGTON WOODS MI 48070

MARTIN J SELDON MD

3750 WOODWARD AVE
DETROIT MI 48201

WM G SELF MD

20861 MACK AVE

GROSSE PTE MI 48236

GRAHAM A SELLERS MD A

10535 W SEVEN MILE RD
DETROIT MI 48221

JOSEPH SELTZER M D
20905 GREENFIELD
SOUTHFIELD MI 48075

I S I DURE SELZER MD
1151 TAYLOR LABS DEPT
DETROIT MI 48202

STEPHEN D SENECOFF MD

18055 GREENFIELD

DETROIT MI 48235

POVILAS SEPETYS MD

25466 CLAIRVIEW

DEARBORN MI 48124

ARTHUR G SESKI MD

1069 FISHER BLDG

DETROIT MI 48202

FRED R SEVERYN MD
15830 FORT ST

SOUTHGATE MI 48195

GEO SEWELL MD L

31801 ARLINGTON DR
BIRMINGHAM MI 48009

GUY W SEWELL MD
17751 EAST WARREN AVE
DETROIT MI 48224

MARIA SEXON-PORTE MD
3800 WOODWARD AVE
DETROIT MI 48201

84 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

JEROME E SEYMOUR HD A

DETROIT GENERAL HOSP
DETROIT MI 48226

A KARIM SHAALAN MD
415 BURNS DR

DETROIT HI 48214

EUGENE M SHAFARMAN MD
3790 WOODWARD

DETROIT MI 48201

ASGHAR SHAFADEH MD
14339 HUBBARD

LIVONIA MI 48154

JOS H SHAFFER MD L

2401 RADNOR DR
BIRMINGHAM MI 48009

LOREN W SHAFFER MD R

P 0 BOX 215

BOYNTON BEACH FL 33435

PARVIZ SHAMS— AVARI MD
27584 SCHOOLCRAFT
LIVONIA MI 48150

STANLEY J SHANOSKI MD
1910 DAV BRODERICK TWR
DETROIT MI 48226

H S SHAPIRO MD
19630 W MCNICHOLS RD
DETROIT MI 48219

JACK SHAPIRO MO
22669 GLASTONBURY
SOUTHFIELD MI 48075

REUBEN I SHAPIRO MD

18041 GREENFIELD

DETROIT MI 48235

ELIAS A SHAPTINI MD
1 WOODWARD AVENUE
DETROIT MI 48226

GEO M J SHARGEL MD
1800 TUXEDO

DETROIT MI 48206

WM D SHARPE MD
24621 W MCNICHOLS RD
DETROIT MI 48219

CHAS H SHARRER MD L

1133 GRAYTON RD

GROSSE PTE PARK MI 48230

FRANCIS P SHEA MD
HARPER HOSP

DETROIT MI 48201

HARRY SHECTER MO

2200 E GRAND BLVD

DETROIT MI 48211

IRENE C SHEEHAN MO

15520 GARFIELD

ALLEN PARK MI 48101

SHELIA SHEEHAN MD
3011 W GRAND BLVD
DETROIT MI 48202

MARCUS B SHEFFER MD
32900 FIVE MILE RD
LIVONIA MI 48154

AURANGZEB SHEIKH MD

3800 WOODWARD AVE

DETROIT MI 48202

PHILIP SHEINBERG MD A

OPHTHALMOLOGY DEPT
DETROIT GENERAL HOSP

DETROIT MI 48226

ARMEN SHEKERJIAN MD
13815 PURITAN

DETROIT MI 48227

DOLORES J SHELFOON MD

LORRAINE A SIEVERS MD

20101 BRIARCLIFF RD

1457 DAVID WHITNEY BG

DETROIT MI

48221

DETROIT MI

48226

ALBERT SHEMT08 MD

JOHN W SIGLER MD

12010 LINWOOD

HENRY FORD HOSP

DETROIT MI

48206

DETROIT MI

48202

MARVIN SHERMAN MD

ENRIQUE E SIGNORI MD

20100 W 10 1/2 MILE RD

30900 FORD RO

SOUTHFIELD MI

48075

GARDEN CITY MI

48135

WM L SHERMAN JR MD

A

ALLEN S ILBERGLE IT MD

201 E KIRBY

1400 CHRYSLER EXPWY

DETROIT MI

48202

DETROIT MI

48207

EDGAR R SHERRIN MD

JACOB A SILL MD

19021 W MCNICHOLS

1125 ARDMOOR DR

DETROIT MI

48219

BIRMINGHAM MI

48010

FREDERICK F SHEVIN MD

JOHN J SILLER MD

671 FISHER BLDG

17000 W 8 MILE RO

DETROIT MI

48202

SOUTHFIELD MI

48075

A P SHEWCHUK MD

ROBT J SILLERY MD

7300 ALLEN RD

460 LAKELAND

ALLEN PARK MI

48101

GROSSE PTE MI

48236

WM L SHIELDS MD

L

RICHARD D SILLS MD

510 HILDALE

5675 FORMAN DR

DETROIT MI

48203

BIRMINGHAM MI

48010

MILTON M SHIFFMAN MD

YVAN J SILVA MD

MT SINAI HOSPITAL

3800 WOODWARD AVE

DETROIT MI

48235

DETROIT MI

48201

LOUIS Z SHIFRIN MD

ISRAEL Z SILVARMAN MD L

HENRY FORD HOSPITAL

9105 VAN DYKE AVE

DETROIT MI

48202

DETROIT MI

48213

PETER G SHIFRIN MD

DONALD F SILVER MD

3535 W 13 MILE NO 507

467 FISHER BLDG

ROYAL OAK MI

48072

DETROIT MI

48202

LOUIS SHIOVITZ MD

ISRAEL W SILVER MD

5419 MICHIGAN AVE

20000 W CHICAGO

DETROIT MI

48210

DETROIT MI

48228

BEN J SHLAIN MD

A

ROBERT R SILVER MD

31156 HUNTLEY SQ EAST

60 W HANCOCK

BIRMINGHAM MI

48009

DETROIT MI

48201

CLAYTON M SHORS M D

MAURICE M SILVERMAN MD

20861 MACK

17301 W EIGHT MI RD

GROSSE PTE WOODS MI

48236

DETROIT MI

48235

ALFRED J SHREVE MD

MAX SILVERMAN MD

4520 FIRESTONE AVE

2240 W GRAND BLVD

DEARBORN MI

48126

DETRUIT MI

48208

JOHN M SHUEY MD

M E SILVERSTEIN MD

17198 OAK DR

20970 INDEPENDENCE

DETROIT MI

48221

SOUTHFIELD MI

48075

ARTHUR S SHUFRO MD

0 D SILVERSTEIN MD

28585 RIVERCREST DR

17000 W 8 MILE RD

SOUTHFIELD MI

48075

SOUTHFIELD MI

48075

HERSCHEL A SHULMAN MO

DONALD R SIMMONS MD

207 NORTHLAND MED BLD

529 FISHER BLOG

SOUTHFIELD MI

48075

DETROIT MI

48202

EDWARD J SHUMAKER MD

HEINZ G SIMON MD

950 FISHER BLDG

12206 MORANG

DETROIT MI

48202

DETROIT MI

48224

EDWARD H SIEBER MD

DAVID F SIMPSON MD

6650 GREENFIELD RD

20512 ARDMORE PARK

DEARBORN MI

48126

ST CLAIR SHORES MI

48080

WILLIAM E SIEBERT MD

GORDON E SIMPSON MD

23023 ORCHARD LAKE RD

18101 E WARREN AVE

FARMINGTON MI

48024

DETROIT MI

48224

JOHN L SIEFERT MD

R

CLYDE B SIMSON MD

PO BOX 601

951 E LAFAYETTE

JUPITER FL

33458

DETROIT MI

48207

HENRY SIEGEL MD

A S l NGHAKOW INTA MD

18400 W 12 MILE RD

3800 WOODWARD AVE

SOUTHFIELD MI

48075

OETROIT MI

48201

JOSE M SIERO MD

9105 VAN DYKE

DETROIT MI

48213

BAGESHWARI P SINHA MD A

DETROIT GENERAL HOSP
DEPT OF UROLOGY A

48B20

JEAN SINKOFF MD
27301 DEOUINORE #202

MADISON HEIGHTS MI 48071

GEO W SIPPOLA MD L

13603 LA SALLE BLVD
DETROIT MI 48238

ORLANDO S SISON MD
1400 CHRYSLER EXPWY
DETROIT MI 48207

B J SIVAK MD

24665 SANTA BARBARA

SOUTHFIELD MI 48075

MICHEL A SKAFF MD
1059 BEDFORD

GROSSE PTE PARK HI 48236

MANUEL SKLAR M D

18400 SCHAEFER RD

DETROIT MI 48235

EDWARD J SKULLY MD

14000 LINNHURST

DETROIT MI 48205

FRANK J SLADEN MD L

HENRY FORD HOSP

DETROIT MI 48202

LEO W SLAZINSKI MD L

7618 MICHIGAN AVE
DETROIT MI 48210

JOHN G SLEVIN MD

1132 WHITTIER AVE

GROSSE PTE PARK MI 48236

EDWARD P SLIWIN MD

13244 W WARREN

DEARBORN MI 48126

JOS SLUSKY MD

854 FISHER BLDG

DETROIT MI 48202

ROBT F SLY MD

2101 MONROE BLVD

DEARBORN MI 48124

HENRY SMALL MD
15300 W MCNICHOLS RD
DETROIT MI 48235

JOHN SMALL MD
19223 CONANT

DETROIT MI 48234

HOMER M SMATHERS MD
17620 W MCNICHOLS
DETROIT MI 48235

WARD M SMATHERS MD

17620 W MCNICHOLS

DETROIT MI 48235

ARTHUR R SMECK MD L

1036 WATERMAN AVE
DETROIT MI 48209

BARRY G SMILER MD
20925 ANDOVER

SOUTHFIELD MI 48075

JAMES J SMIGGEN MD
15901 W 9 MILE RO
SOUTHFIELD MI 48075

ANDREW J SMITH JR MD
2950 PURITAN

DETROIT MI 48238

DOUGLAS H SMITH MD

10151 MICHIGAN

DEARBORN MI 48126

JANUARY, 1972/Michigan Medicine 85

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

HENRY L SMITH HD L

16401 GRAND RIVER AVE
DETROIT MI 48227

RICHARD H SMITH MD
5050 JOY RO

DETROIT MI 48204

RICHMOND W SMITH JR MD

2799 W GRAND BLVD
DETROIT MI 48202

ROGER F SMITH M D
28400 W SUNSET BLVD
LATHRUP VILLAGE MI 48075

STANLEY M SMYKA MD

20945 KELLY RD

EAST DETROIT MI 48021

EUGENE A SNIDER MO
20905 GREENFIELD
SOUTHFIELD MI 48075

EDWIN C SNOKE MO
2901 WEST RD

TRENTON MI 48183

LINWOOD W SNOW MD L

502 W MAIN ST

NORTHVILLE MI 48167

RICHARD J SNYDER MD
33433 SIX MILE RD
LIVONIA MI 48152

ROBT A SOBEL MO

20211 GREENFIELD

DETROIT MI 48235

RALPH B SODERBERG MD
7815 E JEFFERSON AVE
DETROIT MI 48214

SIONEY SOIFER MD

SINAI HOSPITAL

DETROIT MI 48235

WM M SOKOL MD

15901 W NINE MILE RD

SOUTHFIELD MI 48075

RAYMOND A SOKOLOV MD R

8162 E JEFFERSON

DETROIT MI 48104

A H SOKOLOWSKI MD
20445 VAN DYKE AVE
DETROIT MI 48234

LINCOLN E SOLBERG MD
2021 MONROE

DEARBORN MI 48124

FRANK J SOLER MD

25447 PLYMOUTH

OETROIT Ml 48239

SION SOLEYMANI MD

4400 LIVERNOIS

OETROIT MI 48210

ALEX S SOLLER MD
19309 GREENFIELD
DETROIT MI 48235

A B SOLOMON MD
26440 SOUTHFIELD RO
LATHRUP VILLAGE MI 48075

ROBERT J SOLOMON MD

15101 SOUTHFIELD

ALLEN PARK MI 48101

OTTO P SOLTES MD
17000 W EIGHT MILE
SOUTHFIELD MI 48075

THOS H SOMERVILLE MD
36475 FIVE MILE RD
LIVONIA MI 48154

LEWIS P SONOA JR MD
10951 FARMINGTON RO
LIVONIA MI 48150

ROBERT A SONGE MD
OAKWOOD HOSPITAL
DEARBORN MI

48121

FREDK C STEBNER MD
OETROIT GENERAL HOSP
DETROIT MI

48226

MASSOUD SOOUDI MD
6650 PRUTZMAN 113C
BEAUMONT TEXAS

77706

WILLIAM B STEEL MD
HUTZEL HOSP
DETROIT MI

48232

MILTON L SOROCK MD
20905 GREENFIELD RD
SOUTHFIELD MI

48075

CHAS A D STEEPE MD
20340 HARPER
HARPER WOOOS MI

48236

CARLOS M A SOSA MD
6307 W FORT ST
FISHER BODY OIV

ANDREW E STEFANI MD
471 OXFORD RD
GROSSE PTE WOODS MI

48236

GMC

DETROIT MI

48209

ERNEST L STEFANI MD

L

FREDDY R SOSA MD

18455 JAS COUZENS HWY
DETROIT MI 48235

28245 SOUTHFIELD
LATHRUP VILLAGE Ml

48075

RAYMOND T STEFANI MD

RAYMOND D SPHIRE MD

13516 STOEPEL
DETROIT MI

48238

1420 ST ANTOINE
OETROIT MI

48226

ZWI STEIGER MD

ADOLPH S SPIRO MD

V A HOSPITAL
ALLEN PARK MI

48101

13240 HARPER
DETROIT MI

48213

ALBERT H STEIN MD

BERTRAM J SPIWAK MD

16300 W 9 MILE RD
SOUTHFIELD MI

48075

7407 CATHEDRAL DR
BIRMINGHAM MI

48010

HARVEY S STEIN MD

BEN J R SPRINGBURN MD

L

21000 MIDDLEBELT RO
FARMINGTON MI

48024

15818 E WARREN AVE
DETROIT MI

48224

SAUL C STEIN MD

CARL J SPRUNK MD

23105 VAN DYKE
WARREN Ml

48089

2900 OAKWOOD BLVD
MELVINDALE MI

48122

A L STEINBACH MD

ETHELBERT SPURRIER MD L

7815 E JEFFERSON
DETROIT MI

48214

261 KENWOOD CT
GROSSE PT FARMS MI

48236

E J STEINBERGER MD

L

WALTER M SQUIRES MD

R

6402 W FORT
DETROIT MI

48209

1616 S 28 AVE
ST PETERSBURG FL

33712

FREDK B STEINER MD

MARY S STAHLY MD

29108 FORD RO
GARDEN CITY MI

48135

SINAI HOSP
OETROIT MI

48235

S D STEINER MD

HUGH STALKER MD

R

3044 W GRAND BLVO
DETROIT MI

48202

824 LAKESHORE RD
GROSSE PTE SHRS MI

48236

MILTON J STEINHARDT

MD A

BENJAMIN B STAMELL MD

18910 BIRCHCREST
DETROIT MI

48221

17000 W EIGHT MILE RD
SOUTHFIELD MI 48075

BRUCE W STEINHAUER MD

MEYER STAMELL MD

HENRY FORD HOSP
DETROIT MI

48202

14634 GREENFIELD ST
DETROIT MI

48227

CHESTER E STELLHORN

MD L

MYRON R STANTON MD

16589 WARWICK
DETROIT MI

48219

7441 W 7 MILE RD
DETROIT MI

48221

MARY C STELLHORN MD

A

WM J STAPLETON JR MD

L

16616 MACK AVE
DETROIT MI

48224

201 E KIRBY AVE
DETROIT MI

48202

EDWARD M STEMPEL MD

RENA 10 STARICCO MD

18324 FAIRFIELD AVE
DETROIT MI

48221

3783 FORT ST
LINCOLN PARK MI

48146

RICHARD F STERBA MD

L

DARRELL E STATZER MD

861 WHITTIER BLVD
GROSSE PTE MI

48230

3800 WOODWARD #502
DETROIT MI

48201

EDWARD A STERN MD

L

HOWARD P STAUB MD

R

15901 W 9 MILE RD
C/0 DR J STERN

9210 JEROME
DETROIT MI

48239

SOUTHFIELD MI

48075

LOUIS W STAUDT MD
1201 PILGRIM
BIRMINGHAM MI

48009

JOSEPH W STERN MO
1590 1 W 9 MILE RD
SOUTHFIELD MI

48075

CHAS E STEBBINS MD
705 NORTHLAND MED BLDG

JULIAN STERN MD
15121 W MCNICHOLS RD

SOUTHFIELD MI

48075

DETROIT MI

48235

LEONARD H STERN MD

22699 VAN DYKE

WARREN MI 48089

LOUIS 0 STERN MD L

1553 WOODWARD AVE
DETROIT MI 48226

VERNON STERNHILL MD
1800 TUXEDO

DETROIT MI 48206

CHAS H STEVENS MD
15901 W 9 MILE RD
SOUTHFIELD MI 48075

TATJANA STEVENS MD
34815 MICHIGAN AVE
WAYNE MI 48184

CHAS S STEVENSON MD

960 FISHER BLDG

DETROIT MI 48202

LEE B STEVENSON MD
22812 WALSINGHAM RD
FARMINGTON MI 48024

M N STEWART JR MD
20905 GREENFIELD
SOUTHFIELD MI 48075

MARJORIE STEWART MD A

581 GOLFCREST

DEARBORN MI 48124

ROBERT M STEWART MD

10933 FARMINGTON

LIVONIA MI 48150

DANL M STIEFEL MD L

1563 DAV WHITNEY BLDG
DETROIT MI 48226

KARL STILLWATER MD
29305 PTE-O-WOODS #207
SOUTHFIELD MI 48075

DWIGHT E STITH MD

505 OWEN ST

DETROIT MI 48202

GODFREY D STOBBE MD
GRACE HOSP

OETROIT MI 48201

THOMAS B STOCK MD
25500 FRIAR LANE
SOUTHFIELD MI 48075

LAWRENCE L STOCKER MD

26615 GREENFIELD
SOUTHFIELD MI 48075

MARVIN L STOCKER MD
16401 GRAND RIVER
DETROIT MI 48227

BEN J W STOCKWELL MD

1553 WOODWARD AVE

DETROIT MI 48226

THADDEUS STOKFISZ M D L
7012 MICHIGAN

DETROIT Ml 48210

RAYMOND STOLLER M 0
25210 GRAND RIVER AVE
DETROIT MI 48240

SIONEY L STONE MD

22790 KELLY RD

E OETROIT MI 48021

MICHAEL R STOYKA MD
155 STEPHENS

GROSSE PTE MI 48236

MARTIN E STRAND MD

22400 CHERRY HILL

WEST DEARBORN MI 48124

PETER K STRATTON MD
5237 OAKMAN

DEARBORN MI 48128

86 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wayne County

HENRY D STRICKER MD

L

CARL W SWANSON MD

L

NATALIA M TANNER MD

930 WEAVER RD R#2

523 LAKEPOINTE

8401 WOODWARO AVE

MILFORD MI

48042

GROSSE PTE MI

48230

OETROIT MI

48202

FRED L STRICKROOT MD

ROBT G SWANSON MD

JULIUS C TAPERT MD

A

3800 BISHOP RD

314 EASTLAND PROF BLDG

120 MACKINAC

DETROIT MI

48224

DETROIT MI

48236

HARSENS ISLAND MI

48028

DOUGLAS D STRONG MD

FRED G SWARTZ JR MD

HARRY TARPINIAN MD

5050 JOY RD

377 FISHER RD SUITE

F

10955 FARMINGTON RD

DETROIT MI

48204

GROSSE PTE MI

48230

LIVONIA MI

48150

G E STRONSKI MD

DONALD N SWEENY JR

MD

HELEN E TASKER MD

9901 WHITTIER

8445 E JEFFERSON

10454 KINGSTON

DETROIT MI

48224

DETROIT MI

48214

HUNTINGTON WOODS MI

48070

JOSEPH T STROYLS MD

LAWRENCE C SWEET MD

RALPH N T A SSI E MD

L

3800 WOODWARD

HENRY FORD HOSPITAL

15000 GRATIOT AVE

DETROIT MI

48201

DETROIT MI

48202

DETROIT MI

48205

JOAN C STRYKER MD

BERTRAND C SWITZER

MO R

GABRIEL A TATELIS MD

L

2853 BIDDLE

1862 RIVERSIDE

21811 KELLY RD

WYANDOTTE MI

48192

COLUMBUS OH

43212

E OETROIT MI

48021

WALTER A STRYKER MD

JOHN T SYDNOR MD

MAURICE TATELMAN MD

P 0 BOX 10

3800 WOODWARD AVE

6767 W OUTER DR

WYANDOTTE MI

48192

DETROIT MI

48201

DETROIT MI

48235

CLAYTON T STUBBS MD

R

G G SZAPPANYOS MD

A

WM H TAURENCE MD

5 BELLEVIEW

HOSP CANTONAL DEGENEVE

1860 FORD AVE

MT CLEMENS MI

48043

GENEVE SWITZERLAND

WYANDOTTE MI

48192

HAROLD W STUBBS MD

L

D EMERICK SZILAGYI

MD

CEMALETTIN TAVLAN MD

13700 WOODWARD AVE

HENRY FORD HOSP

35779 JOHNSTOWN RD

DETROIT MI

48203

DETROIT MI

48202

FARMINGTON MI

48024

JANUSZ SUBCZYNSK I MD

JOSEPH P SZOKOLAY MD

AMOS TAYLOR III MD

17800 EIGHT MILE RD

HENRY FORD HOSP

4059 W DAVISON

HARPER WOOOS MI

48225

DETROIT MI

48202

OETROIT MI

48238

LEONARD SUDAKIN MD

ROMEO H TABBILOS MD

JUNIUS L TAYLOR MD

15901 W 9 MILE RD

1315 KALES BLDG

1566 W GRAND BLVD

SOUTHFIELD MI

48075

OETROIT MI

48226

DETROIT MI

48208

IRENE T S SUEN MD

RODMAN E TABER MD

MILES TAYLOR MD

CHRYSLER CORP BOX 1919

520 SADDLE LN

550 ESTLO PROF BLDG

DETROIT MI

48231

GROSSE PTE WOODS MI

48236

DETROIT MI

48236

H SAUL SUGAR MD

ALBERT J TACTAC MD

NELSON M TAYLOR MD

970 FISHER BLDG

15240 MERRIMAN

722 NOTRE DAME AVE

DETROIT MI

48202

LIVONIA MI

48154

GROSSE PTE MI

48230

MARCUS H SUGARMAN MD

JOELLA G TADIAN MD

RICHARD A TAYLOR MD

15201 W MC NICHOLS

23100 CHERRY HILL

28 W ADAMS ST

DETROIT MI

48235

DEARBORN MI

48124

DETROIT MI

48226

NORBERTO A SUGAYAN MD

JOHN P TAGETT MD

WARD M TAYLOR MD

34275 MUNGER DR

25750 W OUTER OR

424 W WOODRUFF #101

LIVONIA MI

48154

LINCOLN PARK MI

48146

TOLEDO OHIO

43624

PAUL J SULLIVAN MD

FRANK G TALBOT MD

WM V TAYLOR MD

26711 WOODWARD

1365 CASS

17200 E WARREN

HUNTINGTON WOODS MI

48070

DETROIT MI

48226

DETROIT MI

48224

THOMAS M SULLIVAN MD

EDWARD J TALLANT MD

HENRY A TAZZIOLI MD

951 E LAFAYETTE

18041 GREENFIELD

21970 MOROSS RD

DETROIT MI

48207

DETROIT MI

48235

OETROIT MI

48236

L CARL SULTZMAN HD

ROBT W TALLEY MO

MALCOLM J J TEAR MD

55 VENDOME

HENRY FORD HOSP

862 W MC NICHOLS RD

GROSSE PTE FARMS MI

48236

DETROIT MI

48202

DETROIT MI

48203

BERNARD T SUMCAD MD

FREDK N TALMERS MD

MYER TE I TELBAUM MD

861 MONROE BLVD

VA HOSPITAL

18510 MEYERS ROAD

DEARBORN MI

48124

ALLEN PARK MI

48101

DETROIT MI

48235

WM A SUMMERS MD

E J TAMBLYN MD

L

ERTUGRUL TEKISALP MD

1553 WOODWARD AVE

737 MARLBOROUGH

32300 SCHOOLCRAFT

DETROIT MI

48226

DETROIT MI

48215

LIVONIA MI

48150

RICHARD W SUNDLING MD

LIONG G TAN MD

ALLEN J TELMOS MD

714 NEW CENTER BLDG

22813 CANTERBURY DR

16401 GRAND RIVER AVE

DETROIT MI

48202

ST CLAIR SHORES MI

48092

DETROIT MI

48227

COLIN T SUTHERLAND MD

EMANUEL TANAY MD

THOS A TENAGLIA MD

39000 MOUND RD

861 FISHER BLDG

3180 FORT ST

STERLING HEIGHTS MI

48659

DETROIT MI

48202

LINCOLN PARK MI

48146

RAYMOND H SUWINSKI MD

JOSE S TANDOC MD

E M TENDERO MD

9801 CONANT ST

P 0 BOX 570

1151 TAYLOR

HAMTRAMCK MI

48212

FORD MOTOR CO

DETROIT MI

48202

LIONEL F SWAN MD

WARREN MI

48090

ELMER C TEXTER MD

L

8300 MACK AVE

16840 E WARREN

DETROIT MI

48214

DETROIT MI

48224

ANNA M THEODOULOU MD
18700 MEYERS RD
GRACE HOSPITAL N W

DETROIT MI 48235

GLAFKOS THEODOULOU MD
1800 TUXEDO

DETROIT MI 48206

LEON D THOMAS MD

17320 LIVERNOIS

DETROIT MI 48221

L MURRAY THOMAS MD
801 DAV WHITNEY BLDG
DETROIT MI 48226

ARTHUR L THOMPSON MD
12632 DEXTER

DETROIT MI 48238

HUGH 0 THOMPSON MD A

ROUTE 3 BOX 388

GAYLORD MI 49735

WM A THOMPSON MD R

12632 DEXTER

DETROIT MI 48238

NORMAN W THOMS MD
1400 CHRYSLER EXPWY
DETROIT MI 48207

JERRY A THORNTON MD
525 VISGER RD

ECORSE MI 48229

G C THOSTESON MD
14596 GRANDVILLE
DETROIT Ml 48223

ROBT C THUMANN MD

21223 MACK AVE

GROSSE PTE WOODS MI 48236

SADIE THUMIM MD
10445 BELTON

DETROIT MI 48204

RICHARD J TIMMA MD
17220 W 8 MILE RD
SOUTHFIELD MI 48075

SIK WOO TING MD
22700 GARRISON #408
DEARBORN MI 48124

YOEH MING TING MD
29555 BRISTOL LN
BIRMINGHAM MI 48010

JOYCE TIPPINS MD
4732 BARCROFT WAY
STERLING HEIGHTS MI 48077

ROBERT E TOAL MD

18901 GRAND RIVER

DETROIT MI 48223

RODRIGO R TOBAR MD
21110 WINCHESTER
SOUTHFIELD MI 48075

THEODORE G TOOOROFF MD
2021 MONROE

DEARBORN MI 48124

JESSE C TOLBERT MD
10326 W SEVEN MILE RD
DETROIT MI 48221

AMOD S TOOTLA MD
HENRY FORD HOSPITAL
DETROIT MI 48202

ESTELLE P TORRES MD
3985 CANIFF

HAMTRAMCK MI 48212

RAUL M TORRES JR MD

3985 CANIFF ST

HAMTRAMCK MI 48212

JANUARY, 1972/Michigan Medicine 87

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

LAWRENCE P TOURKOW MD

BENJAMIN S TURLA MD

H J VANDEN BERG JR MD

8319 HENDRIE

GRACE HOSPITAL

612 PROFESSIONAL PLAZA

HUNTINGTON WOODS MI

48070

DETROIT Ml

48201

DETROIT MI

48201

FRANK M TOWNSEND JR

MD L

HENRY TURKEL MD

F G VAN DEVENTER MD

1055 TRUMBULL

8000 W SEVEN MILE RD

19959 VERNIER RD

DETROIT MI

48216

DETROIT MI

48221

HARPER WOODS MI

48236

MARGARET 0 TOXOPEUS

MD

JACK V TURNBULL MD

JAMES E VAN ECK MD

DETROIT GENERAL HOSP

22243 W WARREN AVE

11540 MORANG DR

DETROIT MI

48226

DEARBORN HEIGHTS MI

48127

DETROIT MI

48224

JOHN M TRACEY M D

EDWARD T TURNER MO

DONALD E VAN HOEK MD

15317 W MC NICHOLS

5050 JOY RD

20323 MACK

DETROIT MI

48235

DETROIT MI

48204

GROSSE PTE WOODS MI

48236

EDWARD G TRACY MD

RACHEL E TURNER MD

L F VAN RAAPHORST MD

233 WARRINGTON RD

895 W OAKRIDGE

18560 W OUTER DR

BLOOMFIELD HILLS MI

48013

FERNOALE MI

48220

DEARBORN MI

48128

L I BOR I A TRANCHIDA MD

ROBERT R TURNER MD

STEVEN L VAN RIPER MD L

DETROIT GEN HOSP

3745 MONROE BL VD

1490 IROQUOIS

DETROIT MI

48226

DEARBORN MI

48124

DETROIT MI

48214

HAROLD L TREMA1N MD

ODIE T UDDYBACK MD

E J VAN SLYCK MD

1300 LAFAYETTE E *1306

8401 WOODWARD AVE

HENRY FORD HOSP

DETROIT MI

48207

DETROIT MI

48202

DETROIT MI

48202

GEO A TROESTER MD

CHESTER J UJDA MD

HENRY J VANVALZAH MD

18633 MACK

32302 W00D8R00K

22000 GIBRALTER RD

DETROIT Ml

48236

WAYNE MI

48184

FLAT ROCK MI

48134

MARTIN B TROTSKY MD

ARTHUR A ULMER MD

HABIB VAR I Z I-NAZAR I MO

7411 THIRD AVE

79 GREENBRIAR

4400 ORCHARD LAKE RD

OETROIT MI

48202

GROSSE PTE SHORES MI

48236

ORCHARD LAKE MI

48033

PAUL K TRUBA MD

JOHN L ULRICH MD

HRATCH VARTANIAN MD

22770 KELLY RD

18550 W OUTER DR

952 DAV WHITNEY BLDG

EAST DETROIT MI

48021

DEARBORN MI

48128

DETROIT MI

48226

JOHN M TRUDEAU MD

WILLIS H ULRICH MD

VASILE 0 VASU MD

L

14200 PURITAN

22365 GRAND RIVER AVE

12897 WOODWARD AVE

DETROIT MI

48221

DETROIT MI

48219

HIGHLAND PK MI

48203

PAUL E TRUDGEN MD

ANSELMO F UNITE MD

CLARENCE B VAUGHN MD

1224 BEECHMONT

770 FISHER BLOG

GRACE HOSPITAL

DEARBORN MI

48124

DETROIT MI

48202

DETROIT MI

48201

RONALD E TRUNSKY MD

WM T UNKEFER MD

WILLIAM F VELING MD

SINAI HOSPITAL

174TI1 GREENFIELD RD

13700 WOODWARD

DETROIT MI

48235

DETROIT MI

48235

HIGHLAND PARK MI

48203

SAMUEL TRUPIANO MO

RUT I L 10 URIBE MD

RAMON W VERA MD

420 EASTLAND PROF BLDG

ST JOSEPH HOSPITAL

15901 W 9 MILE RD

DETROIT MI

48236

DETROIT MI

48211

SOUTHFIELD MI

48075

S S TSANGAL IAS MD

HAROLD E USNDEK MD

JAY VICTOR MD

63 KERCHEVAL

18485 MACK AVE

14575 SOUTHFIELD

GROSSE PTE FARMS MI

48236

DETROIT MI

48236

ALLEN PARK MI

48101

GEORGE T C TSENG MD

OTONAS VAITAS M 0

ISAIAS S VILLAROSA MD

16749 WHITLEY DR

10531 FARMINGTON RD

GRACE HOSP

LIVONIA MI

48154

LIVONIA MI

48150

DETROIT MI

48201

ERNESTO C TUAZON MD

V K VAITKEVICIUS MD

CARLOS G VILLARREAL MD

DETROIT MEM HOSP

1400 CHRYSLER FREEWAY

20225 ANN ARBOR TRAIL

DETROIT MI

48226

DETROIT MI

48207

DEARBORN HEIGHTS MI

48127

FLOYD S TUKEL MD

R I VALDESUSO MD

CHARLES C VINCENT MD

1922 MONROE

19200 COLLINSON

2424 PURITAN

DEARBORN MI

48124

EAST DETROIT MI

48021

DETROIT MI

48238

JOHN A TULLOCH MD

EMILIO E VALENZUELA MD

PATRICK A VILLANI MD

326 EASTLAND CTR

28382 HARWICH

20811 KELLY RD

PROFESSIONAL BLDG

FARMINGTON MI

48024

EAST DETROIT MI

48021

HARPER WOODS MI

48225

VIMAL P VALSANGKAR MD

JOHN W VINCENT MD

1151 TAYLOR

22146 FORD RD

OSCAR C TUMACDER MD

DETROIT MI

48202

DEARBORN MI

48128

771 FISHER BLOG
DETROIT MI

48202

JOSE V VALDEZ MO

W FRASER VIPOND MD

5450 FORT ST

15398 GRATIOT AVE

THELMA T TUMACDER MO
DETROIT GENERAL HOSP

TRENTON MI

48183

DETROIT MI

48205

DETROIT MI

48226

F G P VALVEKENS MO

M

GEO J VISCOMI MD

1800 TUXEDO

24240 MICHIGAN AVE

R T TUMBOKON MD

DETROIT MI

48206

DEARBORN MI

48124

700 STEWART RD
MONROE MI

48161

WM L VAN ARSDALE MD

A

DONALD W VISSCHER MD

1000 CHUNG CHENG RD

12922 W WARREN

VINCENT J TURCOTTE MD A

TAIPEI TAIWAN

DEARBORN MI

48126

545 LAKELAND RD
GROSSE PTE MI

48230

L A VAN BECELAERE MD

MILTON D VOKES MD

L

15830 FORT

10182 GRATIOT AVE

SOUTHGATE MI

48195

DETROIT MI

48213

VOLLRAD J VONBERG MD
232 EASTLAND PROF BLDG

HARPER WOODS MI 48225

E C VONDERHE I DE MD A

22431 NORCREST

ST CLAIR SHORES MI 48080

NOEL A VONGLAHN MD

29927 W SIX MILE

LIVONIA MI 48152

ARTHUR J VORWALD MD A

1741 DECKNER AVE

GREEN BAY W I SC 54302

ALBERT E VOSSLER MO L

1144 DAV WHITNEY BLDG
DETROIT MI 48226

I J VOUDOUKIS MD

3800 WOODWARD AVE

DETROIT MI 48201

JOHN WADE MD

17000 W EIGHT MILE RD

SOUTHFIELD MI 48075

HAROLD R WAGENBERG MD
19201 W 7 MILE RD
DETROIT MI 48219

LYLE G WAGGONER MD
1010 PROFESSIONAL PL
OETROIT MI

JOHN R WAGNER MD
17712 MACK AVE
DETROIT MI

RICHARD A WAHL MD
18211 W 12 MILE RD
LATHRUP VILLAGE MI

BEN J J WAILES JR MD
3800 WOODWARD AVE
DETROIT MI

MAX J WAINGER MD
17550 W 12 MILE RD
SOUTHFIELD MI

48201

48224

48075

48201

48075

MICHAEL A WAINSTOCK MO
621 DAVID WHITNEY BL

DETROIT MI 48226

EVERAL M WAKEMAN MO
155 S DENWOOD

DEARBORN Ml 48124

GEO L WALDBOTT MD L

28411 HOOVER RD

WARREN MI 48093

FRANK B WALKER II MD

1206 BALFOUR RD

GROSSE PTE PARK MI 48230

GEO L WALKER MO
7815 E JEFFERSON AVE

DETROIT MI 48214

ROBERT M WALKER MD
2101 MONROE

OEARBORN MI 48124

ROBT G WALKOWIAK MD

76 W ADAMS AVE

DETROIT MI 48226

JOHN P WALLER MD

32238 SCHOOLCRAFT

LIVONIA MI 48150

ALEXANDER J WALT MD
DETROIT RECEIVING HOSP
DETROIT MI 48226

ARTHUR W WALTER MD
7165 OLD MILL RD
BIRMINGHAM MI 48010

FLOYD J WALTER MD
18211 W 12 MILE RD
LATHRUP VILLAGE MI 48075

88 JANUARY, 1972/Michigan Medicine

48025

3

48135

48207

48075

48075

48075

48101

48219

)

48203

48120

48124

48223

48201

48224

48206

48075

L

48221

48101

R

33441

R

48224

48236

A

48236

48009

48202

Wayne County

HILTON R WEED HD

1059 BERKSHIRE RO

6R0SSE PTE PARK HI 48230

RICHARD S WEGRYN HD

661 WASHINGTON RD
DETROIT HI 48230

ALBERT H WEHENKEL HD L

3929 CHAUCER PL 602H
SARASOTA FL 33577

HAURICE B WEHR H D

2355 FORT STREET

LINCOLN PARK HI 48146

JOHN H WE I ONER HD
25701 JOY RD

DEARBORN HGHTS HI 48127

JOHN F WE I K SNAR HD
1800 TUXEDO

OETROIT HI 48206

ALLEN D WEINER HD
21000 HIDDLEBELT RD
FARHINGTON HI 48024

HAURICE B WEINER HD

20211 GREENFIELD

DETROIT HI 48235

RICHARD WEINER MD

20211 GREENFIELD

DETROIT HI 48235

JACOB WEINSTEIN HD

751 FISHER BLDG

DETROIT HI 48202

BURTON H WEINTRAUB HD
15121 W HCNICHOLS RD
DETROIT HI 48235

A ALLEN WEISBERG HD
20 W SEVEN HILE RD
DETROIT HI 48203

HARRY WEISBERG HD
15101 W HC NICHOLS RD
DETROIT HI 48235

JACOB WEISBERG HD A

15101 W HC NICHOLS RD
DETROIT HI 48235

IRVIN I WEISENTHAL HD
5764 WOODWARD AVE
DETROIT MI 48202

CASIHIR P WEISS HD

10036 JOS CAMPAU

DETROIT HI 48212

HILFORD E WENOKUR HD

26070 HEADOW DR

FRANKLIN MI 48025

JACOB F WENZEL MO

18555 E WARREN

DETROIT MI 48236

PETER P WERLE MD
62 GREENBRIAR LANE
GROSSE PTE SHORES MI 48236

WM J WERTZ MD
20101 JAMES COUZENS
DETROIT MI 48235

HOWARD G WEST MD
12739 PURITAN

DETROIT MI 48227

BERNARD WESTON MD

20403 SNOWDEN CT

OETROIT MI 48235

EARL E WESTON MD
18101 JAS COUZENS HWY
OETROIT MI 48235

HORACE L WESTON HD
15901 W NINE MILE
SOUTHFIELD MI 48075

BURT T WEYHING MD A

18700 MEYERS RD

DETROIT MI 48235

NEIL J WHALEN MD L

1553 WOODWARD AVE
DETROIT MI 48226

ROBERT L WHALEY MD

3150 SECOND AVE

DETROIT MI 48201

THOS V WHARTON MD L

1809 OAK ST

WYANDOTTE MI 48192

BRUCE T WHEATLEY MD

26451 RYAN ROAD

WARREN MI 48091

CHARLES E WHEATLEY MO A

4407 ROEMER

DEARBORN MI 48126

STEWART C WHEELER MD
18901 W MC NICHOLS RD
DETROIT MI 48219

JOS L WHELAN MD

28 W ADAMS AVE

DETROIT MI 48226

ROBT K WHITELEY MD
608 EASTLAND PROF BLDG

DETROIT MI 48225

EDWARD H WHITELOCK MD
1809 OAK ST

WYANDOTTE MI 48192

JAMES E WHITMAN MD
3920 E EIGHT MILE RD
DETROIT MI 48234

ALFREO H WHITTAKER HD L

3 ELMSLEIGH LANE

GROSSE PTE MI 48230

JAMES I WHITTEN MD
14500 W HCNICHOLS RD
DETROIT MI 48235

STANLEY WICHA MD
1232 GENEVA

DEARBORN MI 48124

HENRY E WIECHOWSKI MD
10345 JOSEPH CAMPAU
DETROIT MI 48212

ISRAEL WIENER MD
13011 W MC NICHOLS RD
DETROIT MI 48235

MORTON J WIENER MD
1253 TWIN MAPLES LN
BIRMINGHAM MI 48010

FRED K WIETERSEN MD

18700 MEYERS RD

DETROIT MI 48235

EDWARD S WIKIERA HD

15120 MICHIGAN

DEARBORN MI 48126

LESLIE F WILCOX MD L

505 MIDDLESEX RD
GROSSE PTE PARK MI 48236

RUDOLF E WILHELM MD
751 S MILITARY RD
DEARBORN MI 48124

SEYMOUR K WILHELM MD
13011 W MC NICHOLS
DETROIT MI 48235

ARTHUR P WILKINSON MD R

615 N LAKESIDE DR

LAKE WORTH FL 33460

OELFORD G WILLIAMS HD
5050 JOY RD

DETROIT MI 48204

ROBERT M WEISS HD M

1215 LAFAYETTE TWRS E
OETROIT MI 48207

MARTIN L WEISSMAN HD
15822 FAIRFAX

SOUTHFIELD MI 48075

FREDRICK WEISSMAN HD
20905 GREENFIELD RD
SOUTHFIELD MI 48075

JOHN H WELCH HD

18550 W OUTER DR

OEARBORN MI 48128

WILLIAM R WELHAF HO

22101 MOROSS RD

DETROIT MI 48236

HERSCHEL J WELLS MD
WAYNE CO GEN HOSP
ELOISE MI 48132

MARTHA L WELLS MD

584 PILGRIM RD

BIRMINGHAM MI 48009

DONALD H WHITE MD

20685 MERIDIAN

GROSSE ILE MI 48138

JACOB E WHITE MD

3413 MCOOUGALL

DETROIT MI 48207

MILTON W WHITE MD

1439 E OUTER DR

DETROIT MI 48234

PROSPER D WHITE MD

58 W ADAMS AVE

DETROIT MI 48226

THEODORE M WHITE MO
7341 W WARREN

DETROIT MI 48210

LESTON S WHITEHEAD MD
1553 WOODWARD AVE
DETROIT MI 48226

WALTER K WHITEHEAD MD L
17800 E EIGHT MILE RD
DETROIT MI 48236

EARL R WILLIAMS MD
4407 ROEMER

OEARBORN MI 48126

EUGENE R WILLIAMS HD
6246 CHASE RD

DEARBORN MI 48126

EUGENE W WILLIAMS HD
6246 CHASE RD

DEARBORN HI 48126

JOHN H WILLIAMS MD

18633 MACK AVE

DETROIT MI 48236

JOSHUA S WILLIAMS MD
5050 JOY RO

DETROIT MI 48204

W A WILLIAMSON MD

17130 SCHAEFER

DETROIT MI 48235

WM A WILLOUGHBY MD

974 FISHER BLOG

DETROIT MI 48202

GARY

J 0

WELSH

MD

3535

W 13

MILE

RD

ROYAL

OAK

MI

48072

FRED W WHITEHOUSE MD
2799 W GRAND BLVD
DETROIT MI 48202

HARVEY I WILNER MD

HARPER HOSPITAL

DETROIT MI 48201

JANUARY, 1972/Michigan Medicine 89

Wayne County

LISTED BY COMPONENT MEDICAL SOCIETIES

FREEMAN M WILNER MD

BONNIE R WOLFRAM MD

ARA YARJANIAN MD

15001 W EIGHT MILE RO

620 NEW CENTER BLDG

3815 PELHAM RD

DETROIT MI

48235

DETROIT MI

48202

DEARBORN MI

48124

IRVIN A WILNER MD

WM 0 WOLFSON MD

MORTON I YARROWS MD

L

17701 W MCNICHOLS RD

3000 SEMINOLE

455 MEDBURY ST

DETROIT MI

48235

DETROIT MI

48214

DETROIT MI

48202

ANDREW G WILSON MD

JOSEPH WOLODZKO MD

ARTHUR J W YATES MD

26711 SOUTHFIELD

32900 FIVE MILE RD

16355 E JEFFERSON

LATHRUP VILLAGE MI

48075

LIVONIA MI

48154

GROSSE PTE PARK MI

48236

FRANCIS M WILSON MO

MEL I SANDE WOMACK MD

H G YESAYIAN MD

L

DEPT OF MEDICINE

1800 TUXEDO

609 KALES BLDG

HUTZEL HOSPITAL

DETROIT HI

48206

DETROIT MI

40226

DETROIT MI

48201

K I AN H WONG MD

ROBT R YODER MD

10151 MICHIGAN

20189 WHIPPLE

GERALD S WILSON MD

DEARBORN MI

48126

NORTHVILLE MI

48167

3011 W GRAND BLVD

DETROIT MI

48202

ALFRED L WOOD MD

WM J YOTT MD

23100 CHERRY HILL

854 LAKESHORE RD

MERTON C WILSON MD

DEARBORN MI

48124

DETROIT MI

48236

15439 HARPER AVE

DETROIT MI

48224

DOUGLAS J WOOD MD

DONALD A YOUNG MD

A

2860 CLARK AVE

132 CAMBRIDGE

PAUL H WILSON MD

DETROIT MI

48210

PLEASANT RIDGE MI

48069

901 W GRAND BLVD

DETROIT MI

48208

KENNETH A WOOD MD

DAVID J YOUNG MD

3800 WOODWARD AVE

19820 PLYMOUTH ROAD

ROBERT F WILSON MD

DETROIT MI

48201

DETROIT MI

48228

DETROIT RECEIVING HOSP

DETROIT MI

48226

WILFORD C WOOD MD

L

DON A YOUNG MD

3011 W GRAND 8LV0

14807 W MCNICHOLS

HELMUT WIMMER MD

DETROIT MI

48202

OETROIT MI

48235

1337 JOLIET PL

DETROIT MI

48207

RALPH F WOODBURY MD

DONALD C YOUNG MD

R

21223 MACK

43875 NINE MILE RD

ARLENE V WINFIELD MD

GROSSE PTE MI

48236

NORTHVILLE MI

48167

WAYNE COUNTY GEN HOSP

ELOISE MI

48132

BERNARD J WOODLEY MD

IRVING I YOUNG MD

3700 WEST RD

3319 BLOOM V I ELD SHORE

HELEN H WINKLER MD

TRENTON MI

48183

ORCHARD LAKE MI

48033

445 NEFF ROAD

GROSSE PTE MI

48230

JOSEPH J WOODS M D

RICHARD D YOUNG M D

23871 W MCNICHOLS

31500 SCHOOLCRAFT

LAWRENCE C WINNICK MD

OETROIT MI

48219

LIVONIA MI

48150

13340 W 7 MILE RD

DETROIT MI

48235

FREDK M WORLEY JR MD

SHUN-CHUNG YOUNG MD

987 E JEFFERSON

23077 GREENFIELD

GEO J WINTON MD

DETROIT MI

48207

SOUTHFIELD MI

48075

1150 GRISWOLD ST

OETROIT MI

48226

CAL I ER H WORRELL MD

WATSON A YOUNG MD

20250 MACK

3508 HARRISON

EOWARD A WISHROPP MD

L

GROSSE PTE WOODS MI

48236

INKSTER MI

48141

20250 MACK

GROSSE PTE MI

48236

JOS J WORZNIAK MD

ERNEST G YUDASHKIN MD

2312 BIDDLE AVE

1510 LOCKBRIDGE

GRANT J WITHEY MD

WYANDOTTE MI

48192

LANSING MI

48910

719 NEW CENTER BLDG

DETROIT MI

48202

WINSTON R WREGGIT MD

C S YOUNGSTROM MD

17 COLORADO AVE

8004 LOCHDALE

ARTHUR A WITTENBERG MD

HIGHLAND PARK MI

48203

DEARBORN MI

48127

7101 W CHICAGO BLVD

DETROIT MI

48204

CHARLES H WRIGHT MD

LEONARD E YOVIS MD

50 WESTMINSTER

28700 EIGHT MILE RD

D H WITTENBERG MD

DETROIT MI

48202

FARMINGTON MI

48024

1535 E STATE FAIR

OETROIT MI

48203

CLYDE YING CHAU WU MD

EDWARD J ZABINSKI MD

22190 GARRISON #300

585 8ALLANTYNE RD

SYDNEY S WITTENBERG MD

DEARBORN MI

48124

DETROIT MI

48236

4400 LIVERNOIS AVE

DETROIT MI

48210

RUDOLPH A WYATT MD

BURTON J ZACK MO

2785 S FORT ST

19190 GREENFIELD

JOS A WITTER MD

DETROIT MI

48217

DETROIT MI

48235

1745 TIVERTON RD #23

BLOOMFIELD HILLS MI

48013

JAN WYBR ANOWSK I MD

A T ZADEH MD

17644 W WARREN

29911 W SIX MILE RD

MORRIS WITUS MD

A

DETROIT MI

48228

LIVONIA MI

48152

3140 S OCEAN DR #1505

HALLANDALE FL

33009

ROBERT WYLIN MD

LOUIS R ZAKO MD

HARPER HOSPITAL

7720 ALLEN RD

A J WLODARCZYK MD

DETROIT MI

48201

ALLEN PARK MI

48101

3215 W LONG LAKE RD

ORCHARD LAKE MI

48033

RAYMOND L WYSOCKI MD

EDWARD J ZALESKI MD

2536 RUTLEDGE

4520 FIRESTONE

JOHN N WOLFE MD

TRENTON MI

48183

DEARBORN MI

48126

432 E HANCOCK

DETROIT MI

48201

JOSE E YANEZ MD

ALAN IRVING ZANE MD

1400 CHRYSLER EXPWY

7411 THIRD AVE

STANLEY B WOLFE MO

DETROIT MI

48207

DETROIT MI

48202

18510 MEYERS RD

DETROIT MI

48235

RODOLFO YAPCHAI MD

SABAH E ZARA MD

20927 KELLY RD

15830 FORT

E DETROIT MI

48021

SOUTHGATE MI

48195

PAUL M ZAVELL MD
92 MORAN RO

GROSSE PTE FARMS MI 48236

SIGMUND G ZAWACK I MD
22146 FORD RD

DEARBORN MI 40128

JOS ZBIKOWSKI MD
31500 SCHOOLCRAFT RD
LIVONIA MI 48150

Z T ZBIKOWSKI MD
31500 SCHOOLCRAFT RD
LIVONIA MI 48 1 50

MYRON R ZBUDOWSKI MD
10040 JOS CAMPAU AVE
DETROIT MI 48212

MICHAEL N ZELENOCK MD
15830 FORT

SOUTHGATE MI 48195

PETRAS ZEMAITIS MD

33000 PALMER RD

WAYNE MI 48184

JOS L ZEMENS MD
13087 E ELEVEN MILE
WARREN MI 48093

CARLOS ZEVALLOS MD

5800 W FORT ST

DETROIT MI 48209

SEYMOUR ZIEGELMAN MD
20905 GREENFIELD *700
SOUTHFIELD MI 48075

GEO H ZINN MD L

1553 WOODWARD AVE
DETROIT MI 48226

RICHARD M ZIRKIN MD
3105 CARPENTER AVENUE
DETROIT MI 48212

ELDRED ZOBL MD
15901 W 9 MILE RD
SOUTHFIELD MI 48075

MARGARET Z ZOLLIKER MD

289 MOROSS ROAD

GROSSE PTE FARMS MI 48236

L S ZUBROFF MD

760 FISHER BLDG

DETROIT MI 48202

WOLF W ZUELZER MD
5224 ST ANTOINE ST
DETROIT MI 48202

HENRY J ZUKOWSKI MD

72 N DEEPLANDS

DETROIT MI 48236

SIGMUND A ZUKOWSKI MD

1952 MANCHESTER

GROSSE PTE WOODS MI 48236

T S ZWIRKOSKI MD
25000 W 10 MILE RD
SOUTHFIELD MI 48075

MICHAEL K ZYLIK MD

RIVER DISTRICT HOSP

ST CLAIR MI 48079

WEXFORD

R E ANDERSON MD
520 COBB ST

CADILLAC MI 49601

ROBERT F BARNETT MD

MERCY HOSPITAL

CADILLAC MICHIGAN 49601

M D BENTLEY MD
828 OAK ST

CADILLAC MICHIGAN 49601

90 JANUARY, 1972/Michigan Medicine

DIRECTORY OF MSMS MEMBERS

Wexford County

JOHN P CANNON MO
107 1/2 N MITCHELL ST

CADILLAC MICHIGAN 49601

THOS H CARDINAL MD
600 CADILLAC SQUARE
CADILLAC MICH 49601

ROOT V DAUGHARTY MD

107 N MITCHELL

CADILLAC MICH 49601

LAWRENCE 0 GARBER MD
520 COBB ST

CADILLAC MI 49601

JOHN C INMAN MD

LAKE CITY MICH 49651

KENNETH A KLEYN MD
105 1/2 N MITCHELL ST
CADILLAC MI 49601

ROBERT E PIERCE MO
1430 SUNNYSIDE DR
CADILLAC MICHIGAN 49601

MILLARD POSTHUMA MD

520 COBB

ST

CAOILLAC

MICHIGAN

49601

THOMAS F

RICHMOND

MD

520 COBB

ST

CADILLAC

MI

49601

JAMES M SANDERSON MD
520 COBB ST

CADILLAC MICHIGAN 49601

DEAN W SEGER MD

LAKE CITY MICH 49651

EDWARD STEHOUWER MD
520 COBB ST

CADILLAC MI 49601

L LEO TINKEY MD

20170 MACK AVE

GROSSE PTE WOODS MI 46236

CARLETON F TYRRELL DO 0

MANTON MI 49663

DENNIS E VAN ALST MO
520 COBB ST

CADILLAC MICHIGAN 49601

GEORGE F WAGONER MD
530 COBB

CADILLAC MI 49601

ARNO WHIPPLE MD
RURAL STATION

MOORESTOWN MI 49651

Mark your calendar now !

Future Annual Session dates

1972 — March 20-21, House of Delegates, Detroit
Sept. 24-29, Detroit

1973— Oct 7-11, Detroit

1974— Oct. 6-10, Detroit

1975— Oct. 5-9, Detroit

1976— Oct. 3-7, Grand Rapids

JANUARY, 1972/Michigan Medicine 91

I

I

Handy List of Some Often -Used Addresses:

Michigan State Medical Society, 120 West Saginaw, East Lansing 48823

American Medical Association

Headquarters: 535 N. Dearborn, Chicago 60610
Washington Office: 1776 K Street NW, Washington, DC. 20006

Michigan Association for Regional Medical Programs, 1111 Michigan, East
Lansing 48823

Theodore Lopushinsky, PhD, Acting Program Coordinator

Michigan Council on Smoking and Health, 712 Abbott Street, East Lansing
48823

Michigan Doctors Political Action Committee
P.O. Box 769, East Lansing 48823

Michigan Foundation for Medical and Health Education
120 West Saginaw, East Lansing 48823

Michigan Health Council

712 Abbott Street, East Lansing 48823
John A. Doherty, Executive Vice President

Michigan Hospital Association, 2213 E. Grand River Ave., Lansing 48913

Michigan Hospital Service (Blue Cross)

600 E. Lafayette, Detroit 48226
Bennett J. McCarthy, President

Michigan Medical Service (Blue Shield)

600 E. Lafayette, Detroit 48226
John C. McCabe, President

State of Michigan:

Board of Examiners in Basic Science, 1033 S. Washington, Lansing 48933
Jeanette Hicks, Administrative Secretary

Board of Registration in Medicine, 1033 S. Washington, Lansing 48933
John R. Wellman, M.D., Secretary

Department of Mental Health, Lewis Cass Bldg., Lansing 48913
E. Gordon Yudashkin, M.D., Director

Department of Public Health, 3500 N. Logan, Lansing 48906
Maurice S. Reizen, M.D., Director

Department of Social Service, Lewis Cass Bldg., Lansing 48913
R. Bernard Houston, Director

UNIVERSITY OF CAL
LIBRARY SCH OF MED
THIRD L PARNASSUS AVE
SAN FRANCISCO CAL 94122

Directory of MSMS Members

The brown lines on the map indicate the boundaries
for the component medical societies.

Total membership

Dec. 8, 1971 7,981

Military 20

Associate 347

Life 633

Retired 227

Osteopathic 4

Non-Resident 7

Honorary 1

Ntt paid members: 6,742

/

l^Michigaii (^Medicirie

OFFICIAL JOURNAL OF THE MICHIGAN STATE MEDICAL SOCIETY • VOLUME 71, NUMBER 5 • FEBRUARY, 1972

Focus on Foundations

First spring meeting • MSMS House of Delegates • March 20-21, Detroit

See also news story on spring House of Delegates meeting, page 81; MSMS leaders
discuss foundation in “Your opinion please” section, page 87.

OUR NEW HOME

We hope you will visit our new main office when you are
in the Lansing area. It was designed to provide for efficient
service and for our growing staff.

bps

BEN P. STRATTON AGENCY, INC.

MSMS Insurance Administrators
Serving the Michigan
State Medical Society
Since 1954

MAIN OFFICE

5848 Executive Drive
Lansing, Michigan 48910
(517) 393-7660

BRANCH OFFICE

19400 West Ten Mile Road
Southfield, Michigan 48075
(313) 357-5083

NOW!

PRICE CUT

FOR EVEN
GREATER PATIENT
ECONOMY..

VersapenK

’POTASSIUM *HETACILLIN
THE AMPICILLIN
DERIVATIVE

. BRISTOL LABORATORIES

BRISTOL Division of Bristol-Myers Company
I Syracuse, New York 13201

MICHIGAN MEDICINE FEBRUARY 1972 79

Ouir leaders

MSMS Officers

PRESIDENT

PRESIDENT-ELECT

SECRETARY

TREASURER

ASST SECRETARY

ASST TREASURER

SPEAKER

VICE SPEAKER

PAST PRESIDENT

Sidney Adler, MD

John R. Ylvisaker, MD

Ross V. Taylor, MD

Ernest P. Griffin, MD

Vernon V. Bass, MD

James D. Fryfogle, MD

. . . Harold H. Hiscock, MD

Detroit

Port Huron

Pontiac

Jackson

Flint

Saginaw

Detroit

DIRECTOR

GENERAL COUNSEL

LEGAL COUNSEL

ECONOMIC CONSULTANT

SCIENTIFIC EDITOR

Warren F. Tryloff

Lester P. Dodd

A. Stewart Kerr

Clyde T. Hardwick, PhD

John W. Moses, MD

.... East Lansing

Detroit

Houghton

Detroit

MSMS Council

CHAIRMAN

VICE CHAIRMAN

AMA DELEGATION CHAIRMAN

Brooker L. Masters, MD

Robert M. Leitch, MD

Donald N. Sweeny, Jr., MD . . . ,

Fremont

Battle Creek

Detroit

COUNCILOR

First District Councilors: (Wayne County) ’ DISTRICT MAP

Edward J. Tallant, MD, Detroit
Ralph R. Cooper, MD, Detroit
Frank G. Bicknell, MD, Detroit
Brock E. Brush, MD, Detroit
Louis R. Zako, MD, Allen Park
Second District Councilor: Ross V. Taylor, MD, Jackson
Counties: Clinton, Eaton, Hillsdale, Ingham, Jackson
Third District Councilor: Robert M. Leitch, MD, Battle Creek
Counties: Branch, Calhoun, St. Joseph
Fourth District Councilor: W. Kaye Locklin, MD, Kalamazoo
Counties: Allegan, Berrien, Cass, Kalamazoo, Van Buren
Fifth District Councilor: Noyes L. Avery, MD, Grand Rapids
Counties: Barry, Ionia-Montcalm, Kent, Ottawa
Sixth District Councilor: Ernest P. Griffin, Jr., MD, Flint
Counties: Genesee, Shiawasse^

Seventh District Councilor: James H. Tisdel, MD, Port Huron
Counties: Huron, Sanilac, Lapeer, St. Clair
Eighth District Councilor: William A. DeYoung, MD, Saginaw
Counties: Gratiot-Isabella-Clare, Midland, Saginaw, Tuscola
Ninth District Councilor: Adam C. McClay, MD, Traverse City

Counties: Grand Traverse-Leelanau-Benzie, Manistee, Northern Michigan (Antrim, Charlevoix,
Cheboygan and Emmet combined), Wexford-Missaukee
Tenth District Councilor: Robert C. Prophater, MD, Bay City

Counties: Alpena-Alcona-Presque Isle, Bay-Arenac-Iosco, North Central Counties, (Otsego, Mont-
morency, Crawford, Oscoda, Roscommon, Ogemaw, Gladwin and Kalkaska, combined)

Eleventh District Councilor: Brooker L. Masters, MD, Fremont

Counties: Mason, Mecosta-Osceola-Lake, Muskegon, Newaygo, Oceana
Twelfth District Councilor: Raymond Hockstad, MD, Escanaba

Counties: Chippewa-Mackinac, Delta-Schoolcraft, Luce, Marquette-Alger
Thirteenth District Councilor: Donald T. Anderson, MD, Wakefield

Counties: Dickinson-Iron, Gogebic, Houghton-Baraga-Keweenaw, Menominee, Ontonagon
Fourteenth District Councilor: Donato F. Sarapo, MD, Adrian
Counties: Lenawee, Livingston, Monroe, Washtenaw
Fifteenth District Councilor: Sydney Scher, MD, Mount Clemens
Counties: Macomb, Oakland

80 MICHIGAN MEDICINE FEBRUARY 1972

Democratic
national policy council
hears Doctor Masters

Six major Michigan medical needs were identi-
fied in Detroit January 12 in testimony before the
national Democratic Policy Council by MSMS
Council Chairman Brooker L. Masters, MD, Fre-
mont.

Doctor Masters cited these Michigan health
needs:

MSMS House,
in first spring session,
to discuss foundation

1. Michigan medical schools should be en-
larged.

2. Michigan needs more family physicians.

3. The distribution of physicians must be im-
proved.

4. There must be more preventive medicine.

5. There must be improvements in current
governmental health programs.

6. Physicians must be permitted, as they are
now, to practice medicine in many different ways.

Doctor Masters was critical of “political parties,
candidates and the elected representatives who
have not generally sought the views of practicing
physicians on health issues.” “These doctors who
actually see patients every day can accurately
evaluate the problems and suggest possible work-
able solutions,” Doctor Masters stressed.

“MSMS is dedicated to working for further im-
provements. Toward this end, Michigan doctors
are prepared to work with any responsible political
force,” Doctor Masters said.

After the statement by Doctor Masters, the
leaders of the Democratic Policy Council expressed
their appreciation. They voiced their sincere thanks
that the medical society had accepted their invi-
tation and that the physicians had helped to iden-
tify health needs and had described efforts of the
doctors. There was a 15-minute question and an-
swer period. Doctor Masters was joined for the
question period by Donald N. Sweeny, Jr., MD,
member of the MSMS Council and a delegate to
the AMA.

The testimony of the Michigan State Medical
Society, Doctor Masters pointed out, dealt with
with Michigan issues because the American Medi-
cal Association will discuss national health con-
cerns before the national Democratic party plat-
form committee later.

Consideration of the proposed medical founda-
tion for Michigan will be the major subject for
the first spring meeting of the MSMS House of
Delegates in Detroit, Monday and Tuesday, March
20-21.

The meeting will be held at the Detroit Hilton.
The delegates at the fall session voted that here-
after the House also will hold a spring meeting.

The foundation idea was proposed to the 1970
House of Delegates by Ralph Cooper, MD, Detroit,
member of the MSMS Council. The resolution was
adopted to ask the Council to investigate the
desirability of forming a medical foundation.

The Council requested the Committee on Utiliza-
tion Review and Health Insurance to study the
concept and the committee with legal counsel de-
veloped a set of proposed bylaws. The bylaws
were revised several times and Draft #5 was sent
to the MSMS House of Delegates last fall. The ref-
erence committee had a lively session and the
House asked the Council to reconsider several
further revisions.

The Committee on Utilization Review and Health
Insurance rewrote parts and the Council sent
Draft #6 to all delegates for their comments. The
replies were studied and the committee presented
Draft #7 to the Council on January 26 and it was
sent on to the House for its consideration in
March.

This issue of Michigan Medicine contains sev-
eral different viewpoints about the Foundation pro-
posal in the “Your Opinion Please” section of this
issue. (See page 87).

A question-and-answer feature will be carried
in the March issue.

The MSMS House will be prepared to handle
other resolutions and matters of business as pre-
sented by the delegates. Vernon V. Bass, MD,
Saginaw, will preside again as speaker and James
D. Fryfogle, MD, Detroit, will return as vice speaker.

MICHIGAN MEDICINE FEBRUARY 1972 81

Coqteqts

SCIENTIFIC ARTICLES

95 Diabetic ketoacidosis in community hospitals; Roger K.
Ferguson, MD

99 Petit mal epilepsy; V. N. Samuel, MD
101 Granulomatous colitis; William J. Foley, MD
105 Epidural blood patch; Frank S. DuPont, MD; Raymond
D. Sphire, MD

109 Management of spastic diplegia by the physiatrist;

Leonard F. Bender, MD; Nancy M. Bender, RPT
113 The effect of a nursing bottle on the teeth of a young
child; Harvey A. Beaver, DDS

SPECIAL ARTICLES

81 MSMS testifies before national Democrats; MSMS
house to discuss foundation

116

Emergency treatment for

effects

of commonly abused

drugs; Edward J. Lynn, MD

125

New MSMS committee structure

146

How medical students are taught; Herbert A. Auer

148

Is there an HMO is your

future? Herbert Mehler

162

Jackson leads counties

in recruiting new doctors;

Judith Marr

176

Managing patients under
tracts; Russell J. Burns

Blue

Cross non-group con-

NEW

FEATURES

162

County in the spotlight

173

PR notebook; Herbert A. Auer

181

Sound Off

OTHER FEATURES

80

Our leaders

132

Michigan mediscene

87

Your opinion please

133

Zip code 48823

98

Monthly surveillance report 134

In small doses

103

Drug therapy problems

148

Medical care programs

104

Michigan authors

150

Ancillary

107

Perinatal tips

164

County scenes

125

MSMS in action

174

In memoriam

128

Welcome

Publication of Michigan Medicine is under the direction
of the Publication Committee, Michigan State Medical So-
ciety. The scientific editor is responsible for the scientific
content. The managing editor is responsible for the pro-
duction, correspondence and contents of the journal. He
and the executive editor share final responsibility of the
entire publication.

Neither the editors nor the state medical society will
accept responsibility for statements made or opinions ex-
pressed by any contributor in any article or feature pub-
lished in the pages of the journal. In editorials, the views
expressed are those of the writer and not necessarily offi-
cial positions of the society.

SCIENTIFIC EDITOR

John W. Moses, MD

EXECUTIVE EDITOR

Herbert A. Auer

MANAGING EDITOR

Judith Marr

PUBLICATION COMMITTEE
Edward J. Tallant, MD
Detroit
Chairman

Robert M. Leitch, MD
Battle Creek
Donato F. Sarapo, MD
Adrian

(fMichigari £Mediciqe

Devoted to the interests of the medical profession and
public health in Michigan.

INFORMATION FOR CONTRIBUTORS

1. Address scientific manuscripts to the Publication Com-
mittee, Michigan State Medical Society, 120 West Saginaw
Street, East Lansing, Michigan 48823. Submit original, double-
spaced typewritten copy and two carbon copies or photo copies
on letter size (8V2 x 11 inch) paper. On page one, include
title, authors, degrees, academic titles, and any institutional or
other credits.

2. Authors are responsible for all statements, methods, and
conclusions. These may or may not be in harmony with the
views of the Editorial Staff. It is hoped that authors may have
as wide a latitude as space available and general policy will
permit. The Publication Committee expressly reserves the right
to alter or reject any manuscript, or any contribution, whether
solicited or not.

3. Illustrations should be submitted in the form of glossy
prints or original sketches from which reproductions will be
made by Michigan Medicine.

4. Articles should ordinarily be less than four printed pages
in length (3000 words).

5. References should conform to Cumulative Index Medicus,
including, in order: Author, title, journal, volume number,
page, and year. Book references should include editors, edition,
publisher, and place of publication, as well.

6. The editors welcome, and will consider for publication,
letters containing information of interest to Michigan physi-
cians, or presenting constructive comment on current contro-
versial issues. News items and notes are welcome.

7. It is understood that material is submitted for exclusive
publication in Michigan Medicine.

MICHIGAN MEDICINE is the official organ of the Michigan
State Medical Society, published under the direction of the
Publication Committee. Published Semi-Monthly, Trimonthly
in January and December; 26 issues, by the Michigan State
Medical Society as its official journal. Second class postage
paid at East Lansing, Mich, and at additional mailing offices.
Yearly subscription rate, $9.00; single copies, 80 cents. Addi-
tional postage: Canada, $1.00 per year; Pan-American Union,
$2.50 per year; Foreign, $2.50 per year. Printed in USA. All
communications relative to manuscripts, advertising, news,
exchanges, etc., should be addressed to Judith Marr, Mich-
igan State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. Phone Area Code 517, 337-1351.
© 1972 Michigan State Medical Society.

82 MICHIGAN MEDICINE FEBRUARY 1972

rheumatoid arthritic blowup...

Tandearil Geigy

oxyphenbutazone nf tablets of 100 mg.

mportant Note: This drug is not a simple analgesic.

Do not administer casually. Carefully evaluate patients
before starting treatment and keep them under close
iupervision. Obtain a detailed history, and complete
thysical and laboratory examination (complete
lemogram, urinalysis, etc.) before prescribing and at
requent intervals thereafter. Carefully select patients,
avoiding those responsive to routine measures, con-
raindicated patients or those who cannot be observed
requently. Warn patients not to exceed recommended
Josage. Short-term relief of severe symptoms with
he smallest possible dosage is the goal of therapy.
Dosage should be taken with meals or a full glass of
nilk. Patients should discontinue the drug and report
mmediately any sign of: fever, sore throat, oral
esions (symptoms of blood dyscrasia); dyspepsia,
apigastric pain, symptoms of anemia, black or tarry
stools or other evidence of intestinal ulceration or
temorrhage, skin reactions, significant weight gain or
adema. A one-week trial period is adequate. Discon-
inue in the absence of a favorable response. Restrict
reatment periods to one week in patients over sixty.

1 ndications : Acute gouty arthritis, rheumatoid arthritis,
Rheumatoid spondylitis.

Contraindications: Children 14 years or less; senile
patients; history or symptoms of G.l. inflammation or
Jlceration including severe, recurrent or persistent
dyspepsia; history or presence of drug allergy; blood
dyscrasias; renal, hepatic or cardiac dysfunction;
typertension; thyroid disease; systemic edema;
stomatitis and salivary gland enlargement due to the
drug; polymyalgia rheumatica and temporal arteritis;
patients receiving other potent chemotherapeutic
agents, or long-term anticoagulant therapy.

Warnings: Age, weight, dosage, duration of therapy,
existence of concomitant diseases, and concurrent
potent chemotherapy affect incidence of toxic reac-
tions. Carefully instruct and observe the individual
patient, especially the aging (forty years and over)
who have increased susceptibility to the toxicity of the
drug. Use lowest effective dosage. Weigh initially
unpredictable benefits against potential risk of severe,
even fatal, reactions. The disease condition itself is

unaltered by the drug. Use with caution in first trimes-
ter of pregnancy and in nursing mothers. Drug may
appear in cord blood and breast milk. Serious, even
fatal, blood dyscrasias, including aplastic anemia,
may occur suddenly despite regular hemograms, and
may become manifest days or weeks after cessation
of drug. Any significant change in total white count,
relative decrease in granulocytes, appearance of
immature forms, or fall in hematocrit should signal
immediate cessation of therapy and complete hema-
tologic investigation. Unexplained bleeding involving
CNS, adrenals, and G.l. tract has occurred. The drug
may potentiate action of insulin, sulfonylurea, and
sulfonamide-type agents. Carefully observe patients
taking these agents. Nontoxic and toxic goiters and
myxedema have been reported (the drug reduces
iodine uptake by the thyroid). Blurred vision can be
a significant toxic symptom worthy of a complete
ophthalmological examination. Swelling of ankles or
face in patients under sixty may be prevented by
reducing dosage. If edema occurs in patients over
sixty, discontinue drug.

Precautions: The following should be accomplished at
regular intervals: Careful detailed history for disease
being treated and detection of earliest signs of
adverse reactions; complete physical examination
including check of patient’s weight; complete weekly
(especially for the aging) or an every two week blood
check; pertinent laboratory studies. Caution patients
about participating in activity requiring alertness and
coordination, as driving a car, etc. Cases of leukemia
have been reported in patients with a history of short-
and long-term therapy. The majority of these patients
were over forty. Remember that arthritic-type pains
can be the presenting symptom of leukemia.

Adverse Reactions: This is a potent drug; its misuse
can lead to serious results. Review detailed informa-
tion before beginning therapy. Ulcerative esophagitis,
acute and reactivated gastric and duodenal ulcer
with perforation and hemorrhage, ulceration and per-
foration of large bowel, occult G.l. bleeding with
anemia, gastritis, epigastric pain, hematemesis, dys-
pepsia, nausea, vomiting and diarrhea, abdominal

distention, agranulocytosis, aplastic anemia, hemo-
lytic anemia, anemia due to blood loss including
occult G.l. bleeding, thrombocytopenia, pancytopenia,
leukemia, leukopenia, bone marrow depression, so-
dium and chloride retention, water retention and edema,
plasma dilution, respiratory alkalosis, metabolic
acidosis, fatal and nonfatal hepatitis (cholestasis may
or may not be prominent), petechiae, purpura without
thrombocytopenia, toxic pruritus, erythema nodosum,
erythema multiforme, Stevens-Johnson syndrome,
Lyell’s syndrome (toxic necrotizing epidermolysis),
exfoliative dermatitis, serum sickness, hypersensitivity
angiitis (polyarteritis), anaphylactic shock, urticaria,
arthralgia, fever, rashes (all allergic reactions require
prompt and permanent withdrawal of the drug), pro-
teinuria, hematuria, oliguria, anuria, renal failure with
azotemia, glomerulonephritis, acute tubular necrosis,
nephrotic syndrome, bilateral renal cortical necrosis,
renal stones, ureteral obstruction with uric acid crys-
tals due to uricosuric action of drug, impaired renal
function, cardiac decompensation, hypertension,
pericarditis, diffuse interstitial myocarditis with mus-
cle necrosis, perivascular granulomata, aggravation of
temporal arteritis in patients with polymyalgia rheu-
matica, optic neuritis, blurred vision, retinal hemor-
rhage, toxic amblyopia, retinal detachment, hearing
loss, hyperglycemia, thyroid hyperplasia, toxic goiter
association of hyperthyroidism and hypothyroidism
(causal relationship not established), agitation, con-
fusional states, lethargy; CNS reactions associated
with overdosage, including convulsions, euphoria,
psychosis, depression, headaches, hallucinations,
giddiness, vertigo, coma, hyperventilation, insomnia;
ulcerative stomatitis, salivary gland enlargement.

(B) 98-1 46-8 00-E

For complete details, including dosage, please see
full prescribing information.

GEIGY Pharmaceuticals

Division of CIBA-GEIGY Corporation

Ardsley, New York 10502

TA. 8356 -9

WHAT’S THE PEHALTY
fOR BOARMHG?

Two minutes in the penalty box for the offender
and possibly months of painful skeletal muscle
spasm for the victim.

For the skeletal muscle spasm of back sprains,
Valium® (diazepam) can be a valuable adjunct. A
dose of 2-10 mg, three or four times a day, goes to
work to help break up the cycle of spasm / pain/

spasm. The resultant relief of
skeletal muscle spasm may per-
mit greater mobilization of the
affected muscles and may help
the patient resume usual activi-
ties sooner than otherwise
possible.

Paraspinal muscle mass frequently vulnerable
to this type of trauma.

Before prescribing, please consult complete product information, a summary of
which follows:

Indications : Tension and anxiety states ; somatic complaints which are concomitants
of emotional factors ; psychoneurotic states manifested by tension, anxiety,
apprehension, fatigue, depressive symptoms or agitation ; symptomatic relief of
acute agitation, tremor, delirium tremens and hallucinosis due to acute alcohol
withdrawal ; adjunctively in skeletal muscle spasm due to reflex spasm to local
pathology, spasticity caused by upper motor neuron disorders, athetosis, stiff -man
syndrome, convulsive disorders (not for sole therapy).

Contraindicated: Known hypersensitivity to the drug. Children under 6 months of
age. Acute narrow angle glaucoma ; may be used in patients with open angle
glaucoma who are receiving appropriate therapy.

Warnings : Not of value in psychotic patients. Caution against hazardous occupations
requiring complete mental alertness. When used adjunctively in convulsive
disorders, possibility of increase in frequency and/ or severity of grand mal seizures
may require increased dosage of standard anticonvulsant medication; abrupt
withdrawal may be associated with temporary increase in frequency and/or severity
of seizures. Advise against simultaneous ingestion of alcohol and other CNS
depressants. Withdrawal symptoms (similar to those with barbiturates and alcohol)
have occurred following abrupt discontinuance (convulsions, tremor, abdominal and
muscle cramps, vomiting and sweating). Keep addiction-prone individuals under
careful surveillance because of their predisposition to habituation and dependence.

In pregnancy, lactation or women of childbearing age, weigh potential benefit
against possible hazard.

Precautions: If combined with other psychotropics or anticonvulsants, consider
carefully pharmacology of agents employed; drugs such as phenothiazines,
narcotics, barbiturates, MAO inhibitors and other antidepressants may potentiate
its action. Usual precautions indicated in patients severely depressed, or with latent
depression, or with suicidal tendencies. Observe usual precautions in impaired renal
or hepatic function. Limit dosage to smallest effective amount in elderly and
debilitated to preclude ataxia or oversedation.

Side Effects : Drowsiness, confusion, diplopia, hypotension, changes in libido, nausea,
fatigue, depression, dysarthria, jaundice, skin rash, ataxia, constipation, headache,
incontinence, changes in salivation, slurred speech, tremor, vertigo, urinary retention,
blurred vision. Paradoxical reactions such as acute hyperexcited states, anxiety,
hallucinations, increased muscle spasticity, insomnia, rage,
sleep disturbances, stimulation have been reported; should these occur,
discontinue drug. Isolated reports

of neutropenia, jaundice; periodic / \ Roche Laboratories

blood counts and liver function tests \ ROCHE / Division of Hoffn-iann-La Roche Inc

advisable during long-term therapy. \___/ Nutley. N.J. 07110

GALIUM (diazepam)

adjunct in skeletal muscle spasm

2 -mg, 5-mg, 10-mg tablets

^Youf opiqiori please

MSMS asked the question:

“The MSMS House of Delegates will
consider the final draft of the articles
of incorporation and bylaws for the
proposed MSMS Foundation at its
Spring Meeting . The proponents see the
Foundation as the best method of leav-
ing peer review in the hands of the
physicians. What do you think? And
what other functions do you suggest
the Foundation serve in the future?

(The main purpose of the MSMS Foundation
will he to negotiate contracts with the State
of Michigan for Medicaid, Blue Shield and
commercial health insurers, to set norms of
optimal medical care in hospitals and in offices,
and to review cases falling outside the norms.)

These doctors replied:

Sidney Adler, MD
Detroit

There would appear to be some very persuasive
reason for interposing a corporation between the
State Medical Society and the Physicians of Michi-
gan. At this point, I do not know what the reason
is. I read in the Special Report the statement that
otherwise the Society’s tax exempt status would be
put in jeopardy. I question whether this is so. If
the activity is of the type which results in tax
liability, I think the result is the same whether the
Society sponsors a corporation or whether the
Society engages in the activity. I would want to see
an opinion from a tax expert before I conclude
that the foundation gimmick results in different tax
consequences.

More importantly, I would want to see a com-
pelling policy consideration for putting what pur-
ports to be an agency of the Society out of reach
and out of the control of the House of Delegates.
The House is more or less democratically chosen
and representative of physicians, and if physicians’
utilization and charges are to be controlled, I
would rather see that control exercised under the
supervision of the House than by an autonomous
agency once or twice removed.

I see no reason why a contract with government
agencies and carriers should not be made with
the Society; why it is necessary to have some body
removed from the Society enter into the contract.
The fact that personnel will be needed is no ob-

Doctor Adler Doctor Coury

stacle, the Society has had no problem paying for
the personnel it now employs.

Moreover, both the peer review and the utiliza-
tion review projects are tied in with HMO’s under
HR1. Item 11 of the report of the Senate Finance
Committee’s staff questions addressed to HEW,
with responses of HEW, September 27, 1971, is
attached. It looks very much to me that until we
have learned to walk on water, the subject is one
that should be approached with much more caution
than the sponsors of our foundation have displayed.

(Doctor Adler is MSMS president. His remarks
are taken from an editorial in the Detroit Medical
News, Nov. 15, 1971.)

John J. Coury, MD
Port Huron

Many of our colleagues are fearful and distrust-
ing of an MSMS Foundation. They fear it will be
too regulatory, repressive, rigid, impersonal and
not representative.

I feel that the formation of a strongly organized,
democratically structured and operative MSMS
Foundation is necessary for the protection of a
dedicated profession.

The MSMS Foundation should have as its pri-
mary and basic function that of peer review by
and for physicians. Unless peer review is con-
ducted by physicians, it can no longer be termed
peer review. There is no other individual or group
having the qualifications to conduct peer review
of physicians.

A strong Foundation will not be pressured by
governmental or third party agencies to establish
rigid modalities of treatment for all medical and
surgical problems. It is also my sincere hope that
said parties will not attempt to enforce under
utilization in order to keep down health care costs.

To meet these problems, it is necessary that
(Continued on page 90)

MICHIGAN MEDICINE FEBRUARY 1972 87

In acute gonorrhea

(urethritis, cervicitis, proctitis when due
to susceptible strains of N. gonorrhoeae^

Sterile Trobicin®

(spectinomycin dihydrochloride pentahydrate)— For Intramuscu-
lar injections, 2 gm vials containing 5 ml when reconstituted
with diluent. 4 gm vials containing 10 ml when reconstituted with
diluent.

An aminocyclitol antibiotic active in vitro against most strains of
Neisseria gonorrhoeae (MIC 7.5 to 20 mcg/ml). Definitive in vitro
studies have shown no cross resistance of N. gonorrhoeae be-
tween Trobicin and penicillin.

Indications: Acute gonorrheal urethritis and proctitis in the male
and acute gonorrheal cervicitis and proctitis in the female when
due to susceptible strains of N. gonorrhoeae.

Contraindications: Contraindicated in patients previously
found hypersensitive to Trobicin. Not indicated for the treatment

of syphilis. ® 1972 The Upjohn Company

Warnings: Antibiotics used to treat gonorrhea may mask or
delay the symptoms of incubating syphilis. Patients should be
carefully examined and monthly serological follow-up for at
least 3 months should be instituted if the diagnosis of syphilis is
suspected.

Safety for use in infants , children and pregnant women has not
been established.

Precautions: The usual precautions should be observed with
atopic individuals. Clinical effectiveness should be monitored to
detect evidence of development of resistance of N. gonorrhoeae.

Adverse reactions: The following reactions were observed
during the single-dose clinical trials: soreness at the injection site,
urticaria, dizziness, nausea, chills, fever and insomnia.

During multiple-dose subchronic tolerance studies in normal
human volunteers, the following were noted: a decrease in hemo-

:!

teo

list

-

4

rfe

■

88 MICHIGAN MEDICINE FEBRUARY 1972

Irobkin

sterile spectinomycin di hydrochloride
penta hydrate, Upjohn

single-dose intramusct lealmeni

High cure rate:* 96% of 571 males, 95% of 294 females

(Dosages, sites of infection, and criteria for diagnosis and cure are defined below.)**

Assurance of a single-dose, physician-controlled treatment schedule

No allergic reactions occurred in patients with an alleged history of penicillin sensitivity
when treated with Trobicin, although penicillin antibody studies were not performed

Active against most strains of Neisseria gonorrhoeae in vitro (M I C. 7.5- 20 mcg/ml)

A single two-gram injection produces peak serum concentrations averaging about
100 mcg/ml in one hour (average serum concentrations of 15 mcg/ml present 8 hours after dosing)

Note: Antibiotics used in high doses for short periods of time to treat gonorrhea may mask or delay the
symptoms of incubating syphilis. Since the treatment of syphilis demands prolonged therapy with any
effective antibiotic, and since Trobicin is not indicated in the treatment of syphilis, patients being treated for
gonorrhea should be closely observed clinically. Monthly serological follow-up for at least 3 months should
be instituted if the diagnosis of syphilis is suspected. Trobicin is contraindicated in patients previously found
hypersensitive to it.

'Data compiled from reports of 14 investigators. **Diagnosis was confirmed by cultural identitication of N. gonorrhoeae on Thayer-
Martin media in all patients. Criteria for cure: negative culture after at least 2 days post-treatment in males and at least 7 days post-
treatment in females. Any positive culture obtained post-treatment was considered evidence of treatment failure even though the
follow-up period might have been less than the periods cited above under “criteria for cure" except when the investigator determined
that reinfection through additional sexual contacts was likely. Such cases were judged to be reinfections rather than relapses or
failures. These cases were regarded as non-evaluatable and were not included. J*72 1848-6

globin, hematocrit and creatinine clearance,- elevation of alka-
line phosphatase, BUN and SGPT. In single and multiple-dose
studies in norma! volunteers, a reduction in urine output was
noted. Extensive renal function studies demonstrated no con-
sistent changes indicative of renal toxicity.

Dosage and administration: Keep at 25°C and use within
24 hours after reconstitution with diluent.

Male — single 2 gram dose (5 ml) intramuscularly. Patients with
gonorrheal proctitis and patients being re-treated after failure
of previous antibiotic therapy should receive 4 grams (10 ml). In
geographic areas where antibiotic resistance is known to be pre-
valent, initial treatment with 4 grams (10 ml) intramuscularly is
preferred.

Female — single 4 gram dose (10 ml) intramuscularly.

How supplied: Vial s, 2 and 4 grams — with ampoule of Bacterio-

satic Water for Injection with Benzyl Alcohol 0.9% w/v. Recon-
stitution yields 5 and 10 ml respectively with a concentration of
spectinomycin dihydrochloride pentahydrate equivalent to 400
mg spectinomycin per ml. For intramuscular use only.
Susceptibility Powder— for testing in vitro susceptibility of N.
gonorrhoeae.

Human pharmacology: Rapidly absorbed after intramuscular
injection. A two-gram injection produces peak serum concentra-
tions averaging about 100 mcg/ml at one hour with 15 mcg/ml
at 8 hours. A four-gram injection produces peak serum concen-
trations averaging 160 mcg/ml at two hours with 31 mcg/ml at
8 hours.

For additional product information, see your Upjohn representa-
tive or consult the package insert. med-b-i-s ilwb)

Upjohn

The Upjohn Company, Kalamazoo, Michigan 49001

MICHIGAN MEDICINE FEBRUARY 1972 89

YOUR OPINION PLEASE/Continued

an MSMS Foundation be strong, well-organized
and representative of a united profession.

A unified, independent profession delivering
quality health care and subjecting itself to quality
peer review is definitely a benefit to the public
and the profession.

(Doctor Coury is MSMS president-elect.)

Doctor Prophater

Robert C. Prophater, MD
Bay City

FOUNDATIONS are the salvation of the private
practice of medicine — a BOLD statement, but
nevertheless, in my opinion, a true statement. The
time is now for a Foundation to become a reality
in the State of Michigan.

The medical scene is changing rapidly with in-
creasing third party involvement — government pro-
grams, Blue Shield and other insurance carriers.

What can be anticipated out of Washington in
the form of legislation in this Congressional Ses-
sion is a greater involvement of the US Govern-
ment in the health care field.

In testimony on hearings regarding peer review
— which have been going on for some time — the
proponents of the Bennett amendment emphatically
want medicine to police itself but they have stated
if peer review is not performed actively it will be
taken over by laymen.

At the present time we do not have an organi-
zation that can perform this function and I am
certain that a separate organization is a necessity.
It should include:

1) other health providers (who are not members
of MSMS)

2) involvement in setting norms of medical care
— in the hospital and office practice

3) the ability to negotiate peer review contracts
with carriers for services performed by mem-
bers

4) flexibility to handle problems that surely will
face medicine in the future

We have peer review now, but it is limited
mostly to hospital utilization. This is not facing the

problem of quality medical care; the too frequent
over-utilization of laboratory procedures; over-
medication carried on outside the hospital, the
frequency of office visits, injections properly used,
and nursing and convalescent homes.

Other functions the foundation may have to
deal with in the future:

1) involvement with HMO’s

2) negotiating fees

3) deciding who will be medically attended under
what program.

The medical scene is changing. No longer can
a medical practitioner sit in his castle and have
an uncomplicated physician-patient relationship.
There is third party involvement, and increasingly
more so, and we must be ready to meet the chal-
lenges as an organization working together for
the preservation of the private practice of medicine.
A foundation is an answer; but do not be misled
into thinking this will be the panacea for solving
all health care problems of the day.

Many other states have formed foundations under
duress. Let’s form a foundation for Michigan while
we can anticipate and be ready for problems that
medicine will be facing in the very near future.

(Doctor Prophater is chairman, MSMS Committee
on Utilization Review and Health Insurance Prob-
lems.)

Robert M. Leitch, MD
Battle Creek

In today’s medical community, peer review is a
fact of life; not only because of recent legislation
making it mandatory, but also from a practical
standpoint for increasing quality of care, decreas-
ing costs and offering both patient and physician
the most effective climate in which to further their
traditional relationship.

The principal question, then, would be how to
conduct peer review in the fairest and most effec-
tive manner.

It should be unanimously agreed that the re-
viewing should be controlled and performed by
one’s peers on a voluntary basis with the reviewers
appointed or elected by those being reviewed. At
the same time, it should be free of the internal
politics of medicine and also from outside pres-
sures.

A separate organization, organized and spon-
sored by the medical profession would seem to
offer the best mechanism for the conduct of peer
review.

Such an organization would appear to be the
“Foundation” now being developed by the Michigan
(Continued on page 92)

90 MICHIGAN MEDICINE FEBRUARY 1972

Porsche Audi: a division of Volkswagen

There is, of course, a dic-
tionary difference.

But Dr. Ferry Porsche sees
it another way.

Artist or engineer, there is
always a result. And that re-
sult is always judged 2 ways :
on idea, and on execution.

So it is under Dr. Ferry
Porsche that we build the
Porsche 911.

The idea was that a man
should be able to transport
himself in an exquisite piece
of machinery, with enormous
safety, ease and oontrol.

The execution was the de-
sign, making, and assembly
of thousands of parts of metal.
And every part had to make a
contribution to the idea.

This left no room for the
normal tricks of car making.

It meant forming much of
the car on workbenches, and
finishing most of it by hand.

It meant ignoring the ac-
countant’s cry for cost reduc-
tions (“You can make this
part cheaper and it’ll be al-
most as good. . .”).

It also meant we wouldn’t

just spot-check every 10th or
20th engine. (We run every
one on the test bench before
it’s put in the car— then run
it again on a test track before
the car leaves the plant. )

The result is a car with in-
credible balance and perform-
ance. A car that has won
repeatedly in competition rac-
ing-even beating cars with
more powerful engines.

The 911 didn’t win those
races on the racetrack. They
were won much earlier.

On idea. And execution.

Leonardo da Vinci was considered
first an artist, then an engineer.
What is your opinion, Dr. Porsche?”

r7s there any difference ?”

Prestige Porsche Audi, Inc. Tom Sullivan Porsche Audi Co. Traverse Motors, Inc.

2955 S. Division Ave., Grand Rapids 499 S. Hunter Blvd., Birmingham 1301 Garfield Ave., Traverse City

Wood Imports, Inc.

15415 Gratiot Ave., Detroit

Camp’s Cars, Inc.

2000 S. Saginaw Rd., Midland

Williams Porsche Audi

2924 E. Grand River Ave., Lansing

YOUR OPINION PLEASE/Continued

State Medical Society and the Michigan Association
of Osteopathic Physicians and Surgeons.

This foundation, with peer review its primary
objective, would offer a broad base of support
with participation from both MD’s and DO’s; it
would reflect the proportions of MD to DO in the
State as officers and committee members; it would
offer a “united front” by the medical profession
to any agency seeking peer review in this State.
If the foundation had the solid backing of the
MD’s and DO’s, which it must to succeed, it would
preclude any attempts to foster other types of peer
review efforts in Michigan.

An organization of this type would be in a posi-
tion to study all aspects of health care delivery
and should be able to make valuable contributions
to the future of this difficult subject. Some of the
objectives of area-wide health planning councils
might well be best attained through foundation ac-
tivity. Development of proper proportions of acute
care, convalescent care and custodial care beds
could well be done by an organization of doctors
who should know better than any other group
which patients belong in which type of facility.

The present condition of many patients occupy-
ing expensive acute care beds in general hospitals
for long periods of time, because no suitable situa-
tion exists elsewhere, should cease. This is one of
the major offenders in the high cost of care and
one which can be improved upon. The practice of
some patients shopping from doctor to doctor and
from one hospital emergency room to another for
unnecessary care could be detected and corrected
by proper foundation activity. The occasional doc-
tor who over-treats could be spotted and educated
towards more standard forms of practice.

Time is running out for effective peer review
in all its aspects to be initiated in Michigan and
I feel that our proposed foundation, “Medical Pro-
grams, Inc.,” offers the best opportunity to get
into this field effectively.

(Doctor Leitch is vice chairman of the MSMS
Council.)

Robert E. Rice, MD
Greenville

It would appear that the time is past for argu-
mentation as to whether we should have a founda-
tion. The necessity for one is amply clear to most,
I am sure.

As we lay plans leading to the formation of a
foundation, we still have the opportunity to con-
sider how broad or narrow the function of the
foundation should be. Too stringent restrictions of
purpose could lead to stymying an otherwise use-
fully-constructed organization. On the other hand,
the assumption of too many activities could result
in responsible efforts receiving diluted attention or

Doctor Rice

Doctor Jones

the performance of a number of services that are
not very essential.

It might be helpful at the outset if we are able
to specify the basic function that we consider the
foundation should perform, and then be able to
add other functions later if necessity dictates.

Our primary concern at the present time in form-
ing a foundation is to provide a mechanism for the
performance of peer review. Peer review has been
properly defined as evaluation of medical factors
by physicians, as contrasted with professional serv-
ice review which is evaluation of medical factors
by non-physicians (or physicians answerable to
non-physicians).

To find peer review as more acceptable is cer-
tainly understandable. However, it seems rather
ironic that the profession has been forced to
consider the foundation concept as necessary as
an alternative to professional service review which
the profession considers unnecessary in the first
place.

Peer review by foundation can be done, has been
done and will be done — and we can do it if we
desire. This will fulfill the requirements of review
of physicians by physicians. All this is well and
good, but it comes with a price. We will expect
good quality men to perform these tasks. They
can come only from the ranks of the busy and
dedicated physicians who have plenty to do al-
ready. This type of activity is not calculated to
win many friends and does not fit well with most
professional attitudes. Participation and cooperation
will be necessary to avoid this peer review result-
ing in an exercise in futility.

Professional service review would almost cer-
tainly result in profound beaurocratic meddling.
We will have to see to it that peer review does
not end up in professional bureaucratic meddling.

We were asked to comment on other possible
functions for the foundation.

For some time I have felt that our state society
should have a “business” arm. And more and more
it seems this arm had better have some muscle.
Since the law does not permit a society to engage
in some of these “business” activities, it is ob-
vious that we must be prepared to handle these
activities by some additional or parallel structure.

Events have clearly shown that third parties,
primarily governmental agencies or their agent,

92 MICHIGAN MEDICINE FEBRUARY 1972

find the medical profession a fairly easy mark when
it comes to the imposition of external decisions —
and all this with a rather high imputation quotient.
These scales would not tip so easily against us if
we had more weight on our side of the balance.
I would suggest that we acquire this muscle.
It may be that a foundation is a logical arrange-
ment for this acquisition.

(Doctor Rice is chairman of the MSMS Com-
mittee on Governmental Medical Care Programs.)

William S. Jones, Jr., MD
Menominee

It would be well for all to re-read the dynamic
inaugural address of Dr. Sidney Adler, president
of the Michigan State Medical Society. Read what
he has to say about foundations and then think
about it. I agree wholeheartedly with him.

So slight is the understanding of the political,
moral, and social implications of this total health
care package, to say nothing of the medical as-
pects, that to proclaim opposition to increased
federal subsidy is to evoke approbation from a
few and disdain from the majority.

For some reason we have a tremendous ca-
pacity for obscuring our problems. We appoint
study committees, establish foundations, conduct
endless polls, compile neat reports complete with
multicolor charts and graphs, then approve recom-
mendations of the committee without knowing any-
thing about the issues. The proceedings are then
published.

Patients are upset not only with the high cost
of the total medical care package but with the all
too often unavailability of this care. They are also

displeased with the results. Just witness the epi-
demic of malpractice suits and the problem of
obtaining malpractice insurance.

We as doctors have fostered much of the dis-
satisfaction by our affluence, by unavailability at
times, and most certainly by some of the out-
rageous and unreasonable fee schedules. It’s
no wonder that the image of the doctor is col-
lapsing and the credence in the AMA and MSMS
is waning.

Perhaps peer review committees are necessary
to curb the over-utilization of hospital beds, diag-
nostic X-rays, and laboratory tests as well as
medication.

Let’s not be deluded into thinking that this is
educational. It’s nothing but more committee work.

And don’t think it’s not punitive. This is what
peer review is all about. This is an experiment in
social engineering by the government to determine
how best to manipulate all who are engaged in
any endeavor of the health care field.

If forming a foundation is the only devious means
of protecting the tax-exempt status of the Michigan
State Medical Society in order to become a trade
union so as to enter into collective bargaining, then
I want no part of it. Why can’t we re-tool our own
society and not get everyone into the act. We’re
trying so desperately to catch up to the parade
of life that we find we’re out of step when we get
there.

Perhaps we ought to be considering some means
of re-cycling the total structure of all society be-
cause it’s obvious that the rate of change of what
the health consumer thinks he wants and what
he’s been told to expect far exceeds our capacity
to deliver.

(Doctor Jones is immediate past president of the
Menominee County Medical Society.)

MICHIGAN MEDICINE FEBRUARY 1972 93

Now in a
200 -ml.
Unbreakable
Plastic
Bottle

Same price as
150-ml. size’

Two dosage
strengths-
125 mg./5ml.
and

250 mg./5 ml.

V-Cillin K, Pediatric

potassium

phenoxymethyl :::iliona,inlormalion

, available to the

profession on request.

Uvl llvlllll I Eli Lilly and Company

1 Indianapolis, Indiana 46206

* Based on Lilly selling price to wholesalers.

94 MICHIGAN MEDICINE FEBRUARY 1972

Scientific paper's

Diabetic ketoacidosis
in community hospitals :

Management and results of therapy

By Roger K. Ferguson, MD
East Lansing

Most reports of the results of treatment of dia-
betic ketoacidosis have originated from university
medical centers or large teaching hospitals.1-5 No
survey of the modes and results of therapy of this
common emergency in community hospitals has
been published, to this author’s knowledge. Yet
there has been an increasing trend to utilize com-
munity hospitals for the training of physicians.
Accordingly, the present review was undertaken
to assess the experience of four community hos-
pitals in comparison with other reported series.

Study Methods

All records coded with the primary diagnosis
of diabetic acidosis (H-ICDA Code 250.2) were
retrospectively reviewed in the four community
hospitals. The patients were admitted during the
period from January 1, 1970 to March 31, 1971.
In addition, cases coded only diabetes mellitus
(H-ICDA Code 250.0) during the same period also
were sampled randomly to gauge coding specificity.
Patients were considered to warrant the diagnosis
of ketoacidosis if the following criteria were met:

Initial serum glucose was greater than 250
mg % .

Initial serum carbon dioxide content was less
than 15 mEq/L.

Acetone was present in the urine and/or
serum.

Sixty-three episodes in 45 patients met these
criteria and 31 cases coded with this diagnosis
were eliminated because of failure to meet the
three criteria. Two of the 31 patients died, both

The author is with the Departments of Medi-
cine and Pharmacology of the College of Hu-
man Medicine, Michigan State University.

of unrelated cardiac failure. Two cases included
in this survey were coded diabetes mellitus (250.0)
but met the criteria for inclusion.

Two hospitals each contributed 24 episodes to
the survey, while the other two contributed nine
and six cases, respectively. All laboratory studies
reported in this review were done in the clinical
laboratories of the four hospitals. Urine sugar
was estimated with Clinitest® tablets. Urine and
serum acetone were measured using Ketostix® or
Acetest® methods. The serum glucose was deter-
mined by comparable methods in all laboratories.
Serum carbon dioxide content was measured by
the Natelson microgasometer or an AutoAnalyzer
method. Serum Na+ and K+ were done by flame
photometry; serum Cl— was performed with a
chloridometer.

Results

Hospital Characteristics: All four hospitals are
general admission facilities; one of the four is an
Osteopathic Hospital. In 1970 the number of beds
in each hospital in order of size was 465, 366, 211
and 184. During the same year there were 22,883,
13,085, 7,579 and 6,781 admissions to each of the
hospitals, respectively.

Patient Characteristics: The average age of the

45 different patients at the time of their first ad-
mission in diabetic ketoacidosis was 34 years
(range, three to 71 years) . Twenty-one of the 45
patients were male. Eight of the patients were not
previously known to have diabetes at the time of
their first admission; six of these were under age
25. Five patients had multiple admissions; one
patient each was admitted nine, seven and three
times and two patients were admitted twice. Forty-
six of the 63 cases were admitted to the hospital
via emergency room.

Clinical Characteristics: Precipitating factors
could not be determined or were not recorded in
38 of the episodes; the three most common con-

MICHIGAN MEDICINE FEBRUARY 1972 95

DIABETIC KETOACIDOSIS/ Continued

Table 1

Initial Serum Values in 63 Cases
of Diabetic Ketoacidosis

Laboratory Test

Unit

Mean

Range

Serum Glucose

mg%

652

280-1900

Serum Sodium

mEq/L

133.9

125-164

Serum Potassium

mEq/L

4.8

3. 1-8.3

Serum Chloride

mEq/L

99.3

84-119

Carbon Dioxide

mEq/L

9.6

2-14.5

tributing factors

mentioned

were “flu,”

gastroen-

teritis and omission of insulin. All the patients,
except one, with known diabetes were taking in-
sulin before their admission in ketoacidosis. Con-
trol of diabetes before admission was not ascer-
tained in these patients. The most frequent symp-
toms were nausea, vomiting or increased thirst
and the most common sign was hyperventilation.
On admission six cases were recorded as comatose
and 20, as stuporous or semicomatose; the state
of consciousness in the remainder was judged as
drowsy or alert.

Admission Laboratory Values: Initial serum
values are summarized in Table 1. In 31 episodes
acidosis was severe (serum C02 content <10
mEq/L) . The mean serum glucose for this group
was 701 mg%. Urine sugar was reported as 4-|-
in all but nine episodes. Urine acetone was re-
corded as “large” in 50 cases, “moderate” in the
others. Serum acetone was reported as positive
in various dilutions in 22 of the episodes.

Treatment: Regular insulin was administered
in 61 of the 63 episodes; the other patients re-
ceived NPH insulin. In two-thirds of the cases
insulin was given in the emergency room or
shortly after admission. The average initial dose
of regular insulin was 56 units (range, five to
150 units) ; it was given subcutaneously or intra-
muscularly in 38 cases, intravenously in three cases
and part subcutaneous and part intravenous in
20 cases. The average dose of insulin given in the
first 24 hours was 184 units (range, 25 to 500
units) . In slightly over half the cases, insulin to
scale was administered on the basis of urine test-
ing during the hospitalization. In 42 episodes
longer-acting insulin was begun within 24 hours
after admission.

Intravenous fluids were administered in all but
one case. A wide variety of fluids was used, phy-
siologic saline being most frequently employed
(24 cases), followed by lactated Ringer’s solution.
The average amount of fluid infused in the first
24 hours was 3.4 liters with a range of 0.5 to 15
liters.

Potassium replacement was administered to 24
cases; in two of these the potassium was given
by mouth. Amounts during the first 24 hours

ranged from 20 to 200 mEq and averaged 53
mEq for the 22 cases receiving intravenous sup-
plement. Alkali therapy was given in 35 episodes;
the amount of sodium bicarbonate ranged from
20 to 250 mEq with an average of 70 mEq.

Results and Complications of Therapy: Hyper

glycemia and acidosis were corrected in most cases
within 12-18 hours. Correction was arbitrarily de-
fined as a serum glucose less than 250 mg% and
a serum carbon dioxide of 20 mEq/L or greater.
The average hospital stay was 8.0 days for the
cases that survived at least 24 hours.

The most common complication was hypogly-
cemia, occurring in eight patients in whom the
blood sugar was 50 mg% or less and symptoms
occurred. Hypokalemia was documented in two
patients with serum potassium levels of 1.8 and
2.5 mEq/L; one of whom died following cardiac
arrest. One patient developed hypernatremia (ser-
um sodium, 197 mEq/L) and hyperosmolarity
(428 mOsm/L), and one acquired a urinary tract
infection following catheterization.

Death occurred in five patients; however, in
three cases it could be directly attributed to other
causes. Two patients died within 24 hours of
admission from metastatic carcinoma of the pros-
tate and massive pulmonary infarction and an-
other patient who had had moderate proteinuria
and bilateral B-K amputations for peripheral ar-
terial disease, had a myocardial infarction three
days after admission for ketoacidosis. Two pa-
tients, ages 1 1 and 35, expired in diabetic coma
seven and 17 hours after admission. Both became
comatose shortly after admission. The initial serum
glucose levels were 1220 and 1400 mg%, respective-
ly, while the initial serum C02 contents were 2 and
4 mEq/L. An autopsy performed on the younger
patient showed marked cerebral edema; bilateral
papilledema had been noted on admission.

Differences Among Hospitals: The patients and
their clinical characteristics did not differ ap-
preciably among the four hospitals. The mean
laboratory values (Table 1) also did not differ sig-
nificantly. With respect to therapy, one hospital
was conspicuous because the average initial insulin
dose was 87 units compared to 51 units for the
other three hospitals. This difference tended to
diminish for total insulin given in the first 24
hours. In addition, at this same hospital, 89%
of the patients received intravenous KC1 and
NaHC03. There was no apparent difference in
the results or complications of therapy between
groups at each of the hospitals.

Discussion

In the past three decades there has been a
marked decrease in mortality due to diabetic
ketoacidosis. At one large city hospital mortality

96 MICHIGAN MEDICINE FEBRUARY 1972

decreased from 43.7% to 16.4% in two five year
periods 30 years apart.6 In another2 mortality de-
clined from 31.4% to 14.5% in consecutive five
year periods (1947-56) . In 67 cases on the medical
service of the Massachusetts General Hospital the
mortality was 1.5% while at the Boston City
Hospital 5.5% of 73 patients died. At a university
medical center from 1964 to 1968 there were no
deaths in 25 cases of diabetic ketoacidosis.4 In a
series of patients with severe ketoacidosis (C02
<10 mEq/L) there were 32 fatalities in 340 se-
quential episodes (9% mortality) ,5

All the above series originated from university
medical centers or large teaching hospitals with
house staffs and often special metabolic consult-
ants. It has been suggested that a higher mor-
tality rate might be expected in large city and
community hospitals in which such supervision
is not available.3-7 No survey of. the experience
in community hospitals has been published, how-
ever.

It was decided therefore to review the modes
and results of therapy in the four community
hospitals of Lansing. Diagnostic criteria similar
to those used in previous surveys were applied in
this one.1-4 In a 15-month interval 63 episodes of
ketoacidosis in 45 patients satisfied the criteria.
Comparison of the admission clinical characteris-
tics of the patients resembled those in other
series.1-4 Furthermore, the initial laboratory
values were within the ranges of those reported for
these same series in patients not divided as to
severity.1'2-4'6

In this series the patients in general were treated
somewhat more conservatively than those in com-
parable series. The average insulin dose given
initially and during the first 24 hours was ap-
preciably less than that in other series.1-4-6 Only
one of the hospitals could be said to employ a
high dose insulin regimen (average initial dose
of 88 units in 9 patients) .9 Nonetheless, hyper-
glycemia and acidosis in most of the patients were
controlled within 12 to 18 hours. Although
slightly more than half of the patients received
insulin to scale during their hospitalization, there
also was a shift to longer-acting insulin within 24
hours in two-thirds of the cases. This perhaps
was reflected in the average length of hospital
stay of eight days for the patients who survived.

Lesser volumes of intravenous fluids also were
infused in this as compared with recent series.3-5
Of more interest, however, was the fact that only
24 cases (38%) received potassium chloride sup-
plementation. Likewise, only 35 of the cases re-
ceived alkali therapy as intravenous sodium bi-
carbonate. This would tend to indicate a conserv-
ative approach to the replacement of potassium
and correction of acidosis. In the case of alkali

replacement there would appear to be some basis
for conservative use.10

As in most other series, hypoglycemia was the
most frequent complication of therapy. This event
did not seem to bear any relationship to the rate
of correction of hyperglycemia or acidosis. It was
more common in patients who received insulin to
scale or in younger patients whose diabetes was
difficult to control prior to admission. The de-
velopment of hypokalemia was infrequent and
did not bear any relationship to the administra-
tion of sodium bicarbonate or the initial serum
potassium level.

Overall mortality was 7.9% for the 63 episodes,
but only two deaths could be said to have resulted
from uncomplicated diabetic ketoacidosis (3.1%
mortality) . These results are within the range of
those reported in other series.1-6

Both patients who died with uncomplicated
diabetic ketoacidosis were previously undiagnosed
diabetics. Although a relationship between level
of unconsciousness and mortality has frequently
been noted, 3-6'8 it should be pointed out that
neither of these patients was deeply comatose on
admission. In both patients, there was marked
hyperglycemia and severe acidosis. In the younger
patient the blood sugar and C02 level were im-
proving before death, but hypokalemia developed
and she died in cardiac arrest.

Finally, a comment on the delivery of care to
these patients in community hospitals. As was
noted in the results, most of the patients entered
the hospital through the emergency room and in
almost all of these, initial treatment was given or
begun by physicians there. Care then was gen-
erally transferred to other physicians. Although
two of the hospitals had intern house staff, in
general, they did not play a major role in the
early management of the patients. Thus, it would
seem that one factor that would account for these
results might be the diagnosis and early treatment
received in the emergency room. This explanation
would be further supported if the results of a
comparable series before the institution of the
present emergency room systems were not as good.

Summary

The modes and combined results of therapy of
diabetic ketoacidosis have been surveyed in four
community hospitals. Overall mortality in the
series was 7.9% but only two patients died of un-
complicated diabetic acidosis (3.1% mortality) .
The average hospital stay was eight days. These
results compare favorably with those of series re-
ported from large teaching hospitals and univer-
sity medical centers.

MICHIGAN MEDICINE FEBRUARY 1972 97

DIABETIC KETOACIDOStS/Continued

References

1. Harwood, R.: Diabetic acidosis. Results of treat-
ment in 67 consecutive cases. New Eng. J. Med.
245:1-9, 1951.

2. Skillman, J. G., Wilson, R. and Knowles, H. C.,
Jr.: Mortality of patients with diabetic acidosis in
a large city hospital. Diabetes 7:109-113, 1958.

3. Cohen, A. S., Vance, V. K., Runyan, J. W., et al.:
Diabetic acidosis and an evaluation of the cause,
course and therapy of 73 cases. Ann. Intern. Med.
52:55-86, 1960.

4. Kiraly, J. F„ Becker, C. E., and Williams, H. E.:
Diabetic ketoacidosis. A review of cases at a uni-
versity medical center. Calif. Med. 112:1-9, 1970.

5. Beigelman, P. M.: Severe diabetic ketoacidosis

(diabetic “coma”). Diabetes 20:490-500, 1971.

6. Bortz, C. H. and Spoont, 3.: Diabetic acidosis and
transition: A report of 213 admissions to Philadel-
phia General Hospital in comparison with a similar
study done 30 years earlier. Penn. Med. 70:47-50,
1967.

7. Dillon, E. S., and Dyer, W. W.: Factors influencing
the prognosis in diabetic coma. Ann. Intern. Med.
11:602-617, 1937.

8. Zieve, L. and Hill, E.: Descriptive characteristics
of a group of patients with moderate or severe
diabetic ketoacidosis: Relation to recovery or death.
Arch. Intern. Med. 92:51-62, 1963.

9. Bradley, R. F.: Treatment of diabetic ketoacidosis
and coma. Med. Clin. N. Amer. 49:961-967, 1965.

10. Zimmet, P. Z., Taft, P., Ennis, G. C. and Sheath,
J.: Acid production in diabetic acidosis; a more
rational approach to alkali replacement. Brit. Med.
J. 3:610-612, 1970.

Acknowledgments

Grateful acknowledgment is made to medical
records personnel for retrieval of the charts and
to the hospital staffs for allowing them to be
reviewed.

MICHIGAN
DEPARTMENT
OF PUBLIC
HEALTH

Monthly Surveillance Report

Cases of Certain Diseases Reported
To the Michigan Department of Public Health

For the Five-Week Period Ending December 31, 1971

1971

1970

1971

1970

Total

This

Same

Total

Total

Cases

5-Week

5-Week

To Above

Same

for

Period

Period

Date

Date

1970

Rubella

101

129

2,955

3,012

3,012

Congenital Rubella Syndrome

0

0

1

2*

2

Measles

136

36

2,659

1,834

1,834

Whooping Cough

7

8

139

195

195

Diphtheria

1

0

1

0

0

Mumps

Scarlet Fever &

624

1,431

10,748

7,825

7,825

Strep Sore Throat

1,303

1,598

11,244

11,863

11,863

Tetanus

4

0

7

8

8

Poliomyelitis (paralytic)

0

1

0

2

2

Hepatitis

Salmonellosis

440

441

4,828

4,594

4,594

(other than S. typhi)

57

69

691

665

665

Typhoid Fever (S. typhi)

3

2

10

14

14

Shigellosis

66

31

295

225

225

Aseptic Meningitis

31

12

239

296

296

Encephalitis

8

13

108

155

155

Meningococcic Meningitis

5

4

64

69

69

H. Influenza Meningitis

7

10

82

61

61

Tuberculosis

141

181

1,824

1,957

2,006

Syphilis

555

442

4,689

3,900

3,900

Gonorrhea

2,167

2,170

22,115

20,676

20,676

Information can be supplied by the local health department on the local incidence of disease.

Maurice Reizen, M.D., Director
Michigan Department of Public Health

‘Corrected total

98 MICHIGAN MEDICINE FEBRUARY 1972

Petit mal epilepsy -
a closer look at an old malady

By V. N. Samuel, MD, MS
Detroit

Petit mal epilepsy as it is understood today,
was first described by Tissot in 1772. The term
“petit mal” was first used by the Parisian phy-
sicians of the 1800’s to refer to any epileptic attack
short of “grand mal.” Friedman, in 1906, was
one of the first to discuss petit mal at some length.

The name pyknolepsy for petit mal was coined
by Adie in 1924 to describe “a disease with an
explosive onset between the ages of 4 and 12 years,
of very frequent, short, very slight monotonous
minor epileptiform seizures of uniform severity,
which recur almost daily for weeks, months, or
years, are uninfluenced by anti-epileptic remedies,
do not impede normal mental and physical de-
velopment and ultimately cease spontaneously,
never to return.”

Of all the characteristics described above, the
extreme frequency and the benign nature are the
main features.

The first electro-clinical correlation of petit mal
came in 1935 when Gibbs, Davis and Lennox
recorded 3 per second spike and wave discharges
with a crude ink-writing oscillograph known as
the “undulator.” In the past 36 years, in spite
of modern technological advancement and our
ability to record electrical activity of the brain
at the cellular level, there has been very little
progress in our understanding of the basic mech-
anism underlying seizure disorder. Part of the
difficulty is due to an overabundance of investi-
gation repudiating present theories without simul-
taneous efforts to supply new ideas.

In 1945, Lennox grouped three clinically dif-
ferent seizure types into the “petit mal triad”
because they had similar EEG patterns: all ap-
peared during childhood, were of short duration,
and all responded to Tridione. Pyknolepsy, the
first member of the triad, represents what is truly
petit mal or absence. Myoclonic jerks and akinetic
attacks, the second and third members of the triad
are not generally considered to belong to the
petit mal group. Table 1 shows how petit mal fits
into the general classification of other seizures.

Doctor Samuel is Associate Neurologist, De-
partment of Neurology, Henry Ford Hospital,
Detroit.

Table 1

General Classification of Seizures

I. Centrencephalic Origin:

A. Petit mal group

B. Non-petit mal group

1. Myoclonic Jerks

2. Akinetic Attacks

3. Grand Mal or Generalized Seizures

II. Temporal lobe origin — Psychomotor seizures

III. Cortical genesis — Focal seizures — motor or sensory

IV. ? ? — Unclassified seizures

The petit mal group includes pure petit mal,
petit mal with focal components and petit mal
with psychomotor components as shown in Table
2.

The above subdivision of petit mal should not
be confused with the petit mal triad of Lennox.
As shown in Table 2, petit mal is not always mani-
fest as pure absence, but frequently occurs with
psychomotor or focal components. Patients with
psychomotor petit mal (PM psych.) may have
clinical attacks which are hard to distinguish from
psychomotor seizures. Simple or complex motor
movements with mental changes such as seen in
an automatism may be present. Patients suffering
from petit mal with focal components (PM foe.)
have deviation of the head and eyes to one side
or movement of one extremity. Patients with petit
mal complicated by focal or psychomotor com-
ponents can be differentiated from those with pure
focal (cortical) or psychomotor seizures (tem-
poral lobe) by the uniformity and lack of evolu-
tion of the attacks and by the high frequency and
brief duration of the attacks in the petit mal
group.

Most patients with petit mal epilepsy experience
50 or more electrographic or subclinical seizures
(also called larval seizures) for every clinical
seizure that is manifest. When examined more
closely, postural changes and clonic movements are

Table 2

Classification of Petit Mal Seizures

1. Pure petit mal: Corresponds to the definition of Pykno-
lepsy (Abbr. PM).

2. Petit mal with psychomotor components: May be present
at the start of epilepsy or developed later (Abbr. PM
psych.).

3. Petit mal with focal components: (Abbr. PM foe.).

MICHIGAN MEDICINE FEBRUARY 1972 99

PETIT MAL EPILEPSY/Contined

found in 60-70% of cases, usually consisting of
minimal movements, rarely with complete loss of
tone. Occasionally autonomic symptoms such as
brief apnea, incontinence, pupillary changes and
flushing are seen.

The actual incidence of petit mal is difficult to
determine because there is so much chaos in the
literature as to petit mal classification. Livingston
found an incidence of only 2.3% in 15,000 epilep-
tics. In Dalby’s series of 346 patients, all with 3
per second spike and wave, 30% of these had
pure petit mal, 55% had petit mal with psycho-
motor features, and 15% had petit mal with focal
features. Both Dalby and Livingston found that
males predominated over females in a ratio of
about 60:40. It is estimated that 2-9% of petit mal
patients have episodes of petit mal status.

Metrakos and Metrakos in 1961, studied the
heredity of three per second spike and wave epi-
lepsy. Their study included 211 patients with cen-
trencephalic epilepsy without a neurological lesion
to account for their seizures. Initially they felt
that the first child would be more subject to birth
trauma, but they found no correlation between
birth trauma and petit mal epilepsy. They con-
cluded that the centrencephalic type of EEG is
the expression of an autosomal dominant gene
with low penetrance at birth, nearly complete
penetrance from four to 16 years, and then almost
zero penetrance at 40 years.

The etiology of petit mal epilepsy is not well
understood and most attempts to find significant '
structural abnormality have been unsuccessful.
The number of petit mal patients found to have
brain damage varies from 0-40% depending on
the series. Among recent investigators Dalby’s
work is noteworthy. To see if brain damage is the
etiology of petit mal, Dalby evaluated 346 patients
by four criteria; known neurological disease, ab-
normal neurological examination, abnormal pneu-
moencephalogram, and an intelligence quotient of
under 90. Using these criteria he found evidence
of brain damage in 40% of his cases. A definite
etiologic factor such as birth trauma or develop-
mental anomaly could only be found in 1/3 of
this 40 percent.

The EEG abnormality of petit mal occurs
against normal background activity and consists
of a sudden, generalized, bilaterally synchronous
spike-wave discharges with an amplitude of up to
1000 microvolts and a frequency of 3 per second.
The best montage to see petit mal activity is the
reference run because it does not have the cancel-
ling effect of bipolar runs. Focal activity may oc-
casionally be found in petit mal, and when this
occurs it is more often seen in patients with other
seizure types complicating the petit mal. It is
also true that in patients with abnormal back-

ground activity there is a greater incidence of
grand mal seizures and some brain damage. Ac-
cording to Gibbs, sleep alters the spike-wave com-
plex by making it shorter, more frequent, and I

more disorganized. Sometimes it is reduced to a l

single spike occurring every three to six seconds
and is occasionally restricted to one cortical area.

Other activation techniques include hyperventila-
tion and photic stimulation. According to some
authors 50% of cases respond to hyperventilation
while only 13% to photic stimulation.

I

Gibberd in 1966 evaluated a number of factors
related to termination of petit mal seizures and
found that family history, sex, response to medica-
tion, EEG findings, and psychological state had
no influence. However, he noted that those who
eventually developed grand mal seizures had more
abnormal background EEG activity and poor con-
thol of petit mal seizures with medication. An
early onset of petit mal, high intelligence, positive
family history, and a normal CNS examination
according to some are factors which would make
eventual development of grand mal epilepsy un-
likely. Grand mal seizures seldom occur as a com-
plication after the age of eighteen.

The drug of choice in the treatment of petit
mal is ethosuximide (Zarontin) . The other most
common drug is trimethadion (Tridione) .

In conclusion, it may be said that petit mal is
a seizure pattern that can occur alone or with
focal or psychomotor components. Its etiology is
not well understood. There is evidence to indicate
that it is transmitted as a dominant genetic de-
fect. Even though significant structural abnormali-
ties in the brain are lacking, there is reason to
believe that brain damage may contribute to its
production.

Bibliography

1. Adie, W.J.: Pyknolepsy. A form of epilespy occur-
ring in children with a good prognosis, Brain 47:96-
102, 1924.

2. Dalby, M.A.: Epilepsy and 3 per second spike and
wave rhythms. A clinical, electroencephalographic
and prognostic analysis of 346 patients, Acta Neurol
Scand Suppl 40:3 + , 1969.

3. Gibberd, F.B.: The prognosis of petit mal, Brain
89:531-1, Sept. 1966.

4. Gibbs, F.A.; Davis, H., and Lennox, W.G.: The
electro encephalogram in epilepsy and conditions of
impaired consciousness, Arch Neurol Psychiat 34:

1133-48, Dec. 1935.

5. Livingston, S.: The diagnosis and treatment of con-
vulsive disorders in children, Springfield, 111.: C. C.
Thomas, 1954.

6. Metrakos, K., and Metrakos, J.D.: Genetics of con-
vulsive disorders. II. Genetic and electroencephal-
ographic studies in centrencephalic epilepsy, Neurol-
ogy 11:474-83, June 1961.

100 MICHIGAN MEDICINE FEBRUARY 1972

Granulomatous Colitis

By William J. Foley, MD
Ann Arbor

When Crohn1 described regional ileitis in 1932,
he thought that the ileocecal valve acted as a bar-
rier to distal progression of the disease. Two years
later, other investigators pointed out that exten-
sion of regional enteritis into the colon could
occur.2’34

Not until 1952, however, was it suggested that
a granulomatous disease resembling regional en-
teritis cotdd arise independently in the colon
without any associated ileal disease.5 In 1959 in
England, Brooke,0 and Morson and Lockhart-
Mummery7’8 described for the first time the clini-
cal and morphologic characteristics of granuloma-
tous colitis which distinguish it from ulcerative
colitis.

On this side of the Atlantic, recognition of
granulomatous colitis as an entity distinct from
the ulcerative type has been slow in developing.
This is true particularly among surgeons since
internists and pathologists now seem more re-
ceptive to this concept. There is little doubt that
the diagnosis of granulomatous colitis will be used
with greater frequency in the near future.

To avoid confusion w'ith terms such as regional
enteritis of the colon, the British refer to this
disease process as Crohn’s disease of the colon.
In America the term granulomatous colitis is pre-
ferred.

The purpose of this paper is to review briefly
the current understanding of granulomatous colitis
as it has evolved during the past 10 years.

Diagnosis

From the standpoint of pathologic changes,
granulomatous colitis is a transmural inflamma-
tion. Initially, aggregates of lymphocytes form in
the submucosa. Degeneration of the overlying mu-
cosal cells follows, producing ulcers. Crypt abcesses
and deep fissures then develop in the wall.9 These
fissures give rise to the fistulas that are so often
seen with granulomatous intestinal disease, al-
though less frequently in colitis than in regional
enteritis.

Doctor Foley is a surgeon living in Ann Arbor.
Please address reprint request to Dr. Foley at
1075 Barton Drive, Apt. 116, Ann Arbor, Mi 48105.

The most significant histologic change occurs
in the submucosa, which is thickened by edema
and fibrosis. Lymphocytic aggregates and the char-
acteristic sarcoid-like granulomas are seen scattered
throughout all layers of the wall. Granulomas ap-
pear in regional lymph nodes in about one-fourth
of cases and have also been noted in the liver.10-11
The presence of a “sarcoid reaction,” however, is
not essential to the microscopic diagnosis; granu-
lomas are absent in 30 to 45% of cases.12-13

The essential histologic findings, then, include
ulcers dispersed between normal mucosa, a trans-
mural inflammation with the submucosa thickened
by edema and fibrosis, and lymphocytic aggre-
gates.8-9 Fissures also suggest the diagnosis of
granulomatous colitis; these occur in 25 to 60%
of cases.9-14 This histologic pattern is to be dis-
tinguished from the inflammatory process of ul-
cerative colitis which tends to involve only the
mucosa and submucosa, although extension deeper
into the wall may be noted in acute fulminant
episodes.

On gross examination the colon wall in granu-
lomatous colitis is thickened and less pliable.
Diseased segments of colon may be interspersed
between normal areas. Ulcers and fissures connect-
ing between areas of normal mucosa produce a
“cobblestone appearance” of the mucosal surface.
Strictures and narrowing of the lumen from fibro-
sis, and fistulas extending into the surrounding
tissue, may be observed. The mesenteric lymph
nodes are usually enlarged. Associated ileal disease
is seen in 30 to 47% of cases, but the involvement
need not be contiguous.12-13

From the clinical standpoint, diarrhea is the
most frequent complaint, along with abdominal
cramping in most cases. Bleeding, however, does
not usually occur unless there is rectal involve-
ment.11 Weight loss and periodic fever are com-
mon. Acute fulminant episodes are unusual, and
toxic megacolon is rare.9-14-15-16

The disease has a tendency to begin in the right
colon and to spare the rectum— not more than
50% of cases show rectal involvement. Lockhart-
Mummery17 reported that in 80% of his cases, anal
lesions developed during the course of the disease
and sometimes were the initial complaint. He is of
the opinion that when the rectum is diseased, the
findings of granulomatous colitis at sigmoidoscopy
can usually be distinguished from ulcerative colitis.

MICHIGAN MEDICINE FEBRUARY 1972 101

GRANULOMATOUS COLITIS/Continued

but not all investigators agree.18 An increased inci-
dence of carcinoma has not been reported in these
cases. Regional enteritis and ulcerative colitis oc-
cur together only rarely, and it is likely that many
cases diagnosed as such in the past may have been
granulomatous ileocolitis.17

In radiographic studies, the distribution of dis-
ease often may suggest the diagnosis. Skip areas,
right-sided disease, associated colitis and regional
enteritis, and an uninvolved rectal segment favor a
diagnosis of granulomatous rather than ulcerative
colitis. On barium enema examination, findings
commonly noted in granulomatous colitis are: (1)
areas of narrowing, stenosis, and stricture; (2) si-
nuses and fistulas; (3) thickened colonic wall; (4)
cobblestone mucosal pattern; (5) pseuclodivertic-
ula; and (6) spikes of barium, representing deep
fissures, extending perpendicularly from the lu-
men.17 Pseudodiverticula result from eccentric in-
volvement of the colon wall, producing contrac-
tion of one side and an outpouching of the oppo-
site normal wall.19 Shortening of the colon and
loss of a haustral pattern which are so characteris-
tic of ulcerative colitis are less evident with gran-
ulomatous disease.

Treatment

As with regional enteritis, operation is indicated
in granulomatous colitis for complications of the
disease. Fistulas, obstruction, infection, and chron-
ic debility are the most frequent indications; occa-
sionally fulminating episodes require surgical in-
tervention. About three-fourths of the patients re-
ported by Lindner and his colleagues required
operation.18

The recurrence rate following resection for re-
gional enteritis is about 50%;20 in some patients
the recurrence involves the colon at the site of
anastomosis with small bowel. The recurrence rate
is high also for cases of localized granulomatous
colitis treated by segmental resection of the
colon.21-22 Nevertheless, these procedures seem
justified when all diseased areas can be excised
and intestinal continuity preserved. Diversionary
procedures are without value because the disease
progresses and a second operation is required in
practically every case.21 Total colectomy and ileos-
tomy for diffuse colonic disease, even when ileal
involvement is present, has given good results.
Goltzer et al.22 were able to find only 6 recurrences
reported in the literature after ileostomy and colec-
tomy for granulomatous colitis when the type of
operation could be determined from the data
given.

Comment

The histologic, radiographic, and clinical picture
that I have outlined describes “classic” granulo-

matous colitis as it appears at our present state of
knowledge.

From a clinical standpoint, there is a practical
value in differentiating granulomatous from ul-
cerative colitis whenever possible as the basis for
more effective management. The most striking
clinical features distinguishing granulomatous co-
litis are: (1) the insidious course, with acute

exacerbation and toxic megacolon being unusual;
(2) the tendency to form fistulas and the high
incidence of anal disease; (3) the value of seg-
mental resection for localized colonic disease in
spite of the high recurrence rate because of the
sphincter-preserving effect of these procedures;
and (4) the fact that there is not an increased
incidence of colonic carcinoma among these pa-
tients. Since total colectomy and ileostomy for
granulomatous colitis has been followed by a very
low incidence of recurrence in small bowel the
outlook for patients is favorable following this
procedure.

It must be kept in mind, however, that in some
patients with non-specific colitis there is a blend-
ing of patterns of both the granulomatous and
ulcerative types. A distinction useful to clinicians
cannot always be made between these two forms
of colitis. As such, cases of granulomatous colitis
should be defined carefully whenever the clinician
is to use this diagnosis as a basis for advising treat-
ment and determining prognosis. Indeed, until the
pathogenesis is better understood, there is no cer-
tain answer to the question of whether these two
forms of colitis are in fact separate diseases.

References

1. Crohn, B. B.; Ginzburg, L.; and Oppenheimer,
G. D.: Regional Ileitis; a Pathologic and Clinical
Entity. J.A.M.A. 99:1323, 1932.

2. Colp, R.: Case of Non-Specific Granuloma of Ter-
minal Ileum and Cecum. Surg. Clin. N. A. 14:443,
1934.

3. Brown, P. W.; Bargen, J. A.; and Weber, H. M.:
Chronic Inflammatory Lesions of the Small Intes-
tine (Regional Enteritis). Am. J. Dig. Dis. 1:426,
1934.

4. Donchess, J. C.; and Warren, S.: Chronic Cicatriz-
ing Enteritis with Involvement of the Cecum and
the Colon. Arch. Path. 18:22, 1934.

5. Wells, C.: Ulcerative Colitis and Crohn’s Disease.
Ann. Roy. Coll. Surg. Eng. 11:105, 1952.

6. Brooke, B. N.: Granulomatous Diseases of the In-
testine. Lancet 2:745, 1959.

7. Morson, B. C.; and Lockhart-Mummery, H. E.:
Crohn’s Disease of the Colon. Gastroenterologia
(Basel) 92:168, 1959.

8. Lockhart-Mummery, H. E.; and Morson, B. C.:
Crohn’s Disease (Regional Enteritis) of the Large
Intestine and Its Distinction from Ulcerative Co-
litis. Gut 1:87, 1960.

102 MICHIGAN MEDICINE FEBRUARY 1972

9. McGovern, V. J.; and Goulston, S. J. M.: Crohn’s
Disease of the Colon. Gut 9:164, 1968.

10. Lockhart-Mummery, H. E.: Some Inflammatory Dis-
orders of the Large Intestine. J. Roy. Coll. Surg.
Edinb. 10:282, 1965.

11. McGarity, W. C.; Ross, J. W.; Bobo, E.; Schroder,
J. S.; and Achord, J. L.: Granulomatous Colitis:
Recent Observations. Ann. Surg. 167:926, 1968.

12. Lennard-Jones, J. E.; Lockhart-Mummery, H. E.;
and Morson, B. C.: Clinical and Pathological Dif-
ferentiation of Crohn’s Disease and Proctocolitis.
Gastroenterol. 54:1162, 1968.

13. Hawk, W. A.; Turnbull, R. B.: Primary Ulcerative
Disease of the Colon. Gastroenterol. 51:802, 1966.

14. Hawk, W. A.; Turnbull, R. B.; and Farmer, R. G.:
Regional Enteritis of the Colon, Distinctive Fea-
tures of the Entity. J.A.M.A. 201:738, 1967.

15. Schachter, H.; Goldstein, M. J.; and Kirsner, J. B.:
Toxic Dilatation Complicating Crohn's Disease of
the Colon. Gastroenterol. 53:136, 1967.

16. Foley, W. J.; Weaver, D. K.; and Coon, W. W.:

Toxic Megacolon and Granulomatous Colitis, Re-
port of Two Cases. In Press.

17. Lockhart-Mummery, H. E.; and Morson, B. C.:
Crohn’s Disease of the Large Intestine. Gut 5:493,
1964.

18. Lindner, A. E.; Marshak, R. H.; Wolf, B. S.; and
Janowitz, H. D.: Granulomatous Colitis, A Clinical
Study. New Eng. J. Med. 269:379, 1963.

19. Wolf, B. S.; and Marshak, R. H.: Granulomatous
Colitis (Crohn’s Disease of the Colon), Roentgen
Features. Amer. J. Roentgen. 88:662, 1962.

20. Banks, B. M.; Zetzel, L.; and Richter, H. S.: Mor-
bidity and Mortality in Regional Enteritis: Report
of 168 Cases. Amer. J. Dig. Dis. 14:369, 1969.

21. Howel Jones, J.; Lennard-Jones, J. E.; and Lock-
hart-Mummery, H. E.: Experience in the Treat-
ment of Crohn’s Disease of the Large Intestine.
Gut 7:448, 1966.

22. Glotzer, D. J.; Stone, P. A.; and Patterson, J. F.:
Prognosis after Surgical Treatment of Granulo-
matous Colitis. New Eng. J. Med. 277:273, 1967.

’Drug therapy' problems

By John Marien, RPh, MBA
Ann Arbor

Q. Is Cholera Vaccine safe to use in pregnant
women? (C.S., Ann Arbor) .

A. Cholera Vaccine is the inactivated virus and
produces few reactions. It may be given to
patients of any age and to pregnant women.

Q. What is the recommended dosage adjustment
for the administration of cephalothin (Kef-
lin$) I.V. in the presence of elevated serum
creatinine? (J.T., Ann Arbor) .

A. For severe failure (creatinine clearance less
than 10 ml. per minute ), the dosage schedule
should be adjusted to every 8-12 hours.

Q. Why is the I.M. or I.V. route contraindicated
with bethanechol (Urecholine®) ; (W.S., Ann
Arbor) .

A. Violent cholinergic stimulation may cause
collapse of the circulatory system. Because of

Pharmacist Marien is author of this monthly
column. He is associated with the Drug Informa-
tion Center of University Hospital. Stewart B.
Siskin, Pharm.D, is supervisor of the Center.

this it is advisable when giving bethanechol
S.Q. to have atropine sulfate 0.6 mg. ready
for S.Q. or I.V. administration.

Q. Can cyclophosphamide (Cytoxan®) be re-
sponsible for premature menopause? (C. C.,
Ann Arbor) .

A. Ovarian suppression with amenorrhea and
hot flashes have been reported in some pre-
menopausal women.

Q. Will phenothiazines interfere with 5-hydroxy-
indole acetic acid tests? (B. S., Detroit) .

A. Yes, a false negative or diminished effect can
result.

Q. Is phenylbutazone dialyzable? (D. M., Ann
Arbor) .

A. Yes, use of artificial kidney may be life saving
for treatment of overdose. Also, phenylbuta-
zone shows a pH dependent excretion in
humans. It is excreted more rapidly in alka-
line than acid environment.

Q. Is Conray® excreted in breast milk? (W. B.,
Detroit) .

A. It is likely that it will be excreted since
Conray® is an iodine-containing compound
and iodine is excreted in breast milk.

Q. What is the blood level of cephalexin (Kef-
lex®) after a 500 mg. dose? (}. T., Ann
Arbor) .

A. The range would be 7.5 to 25.0 mcg./ml.
after one hour from fasting subjects.

MICHIGAN MEDICINE FEBRUARY 1972 103

cfifictiigaii authors

Lionel Dorfman, MD, Battle Creek, et al., “Suc-
cessful Renal Transplantation in an Infant with the
Hemolytic-Uremic Syndrome,” page 1097, The Ohio
State Medical Journal, December, 1971.

Robert L. Kerry, MD, and Chosen Lau, MD, Ann
Arbor, “Effect of 5-Fluorouracil on Skin-Graft
Survival,” page 1093, Ohio State Medical Journal,
December, 1971.

Gerald A. LoGrippo, MD, Klaus Anselm, MD and
Hajime Hayashi, PhD, Detroit, “Serum Immunoglo-
bulins and Five Serum Proteins in Extrahepatic
Obstructive Jaundice and Alcoholic Cirrhosis,”
page 357, American Journal of Gastroenterology,
October, 1971.

John H. Mayer, MD, James E. Herlocher, MD,
and Jack Parisian, MD, Ann Arbor, “Esophageal
Rupture After Mushroom-Alcohol Ingestion,” a let-
ter, page 1323, New England Journal of Medicine,
Dec. 2, 1971.

Lionel H. Lieberman, MD, PhD, William H. Beier-
waltes, MD, Jerome W. Conn, MD, Azizullah N.
Ansari, and Hiroshi Nishiyama, MD, Ann Arbor,
“Diagnosis of Adrenal Disease by Visualization of
Human Adrenal Glands with l-19-lodocholesterol,”
page 1387, New England Journal of Medicine, Dec.
16, 1971.

A. Robert Arnstein, MD, Irwin K. Rosenberg, MD,
Juan Belmaric, MD, James M. Pierce, MD, Daisy
McCann, PhD, JoAnn Prunty, BSc, Detroit, “Pal-
pable Calcified Parathyroid Gland in Primary Chief-
Cell Hyperplasia,” page 1365, New England Journal
of Medicine, Dec. 9, 1971.

Susan E. Adelman, MD, Detroit, “The Dying Pa-
tient: An Unspoken Dialogue,” page 707, The New
Physician, November, 1971.

R. M. Nalbandian, MD, Grand Rapids; R. L.
Henry, PhD, and J. M. Lusher, MD, Detroit, and
LTC F. R. Camp, Jr., MSC, USA, and COL. N. F.
Conte, MD, MC, USA, Fort Knox, “Sickledex Test
for Hemoglobin S,” page 1679, Journal of the
American Medical Association, Dec. 13, 1971.

R. M. Nalbandian, MD, and B. B. Nichols, Grand
Rapids; A. E. Heustis, MD, East Lansing; W. B.
Prothro, MD, and F. E. Ludwig, MD, Grand Rapids,
“Automated Mass Screening for Sickle Cells,” page
1680, Journal of the American Medical Association,
Dec. 13, 1971.

D. R. Kahn, MD, Madison, Wis.; E. A. Carr, MD,
and M. M. Kirsh, MD, Ann Arbor, “Long-Term
Function in Human Heart Transplants,” page 1699,
Journal of the American Medical Association, Dec.
13, 1971.

Joseph A. Rinaldo, Jr., MD, et al., “An Evaluation
of Reporting Systems,” page 72, Hospitals, Dec.
16, 1971.

L. K. Kuchera, MD, Ann Arbor, “Postcoital Con-
traception with Diethylstilbestrol,” page 562, Jour-
nal of the American Medical Association, Oct. 25,
1971.

R. L. Kerry, MD, Ann Arbor, “Repair and Con-
valescence after Herniorrhaphy,” a letter, page
740, Journal of the American Medical Association,
Nov. 1, 1971.

E. O. Luby, MD, David Schwartz, MD, and Her-
bert Rosenbaum, MD, Detroit, “Lithium-Carbonate-
Induced Myxedema,” page 1298, Journal of the
American Medical Association, Nov. 22, 1971.

Joel I. Hamburger, MD, Southfield, “Tests of
Adrenocortical Function,” a letter, page 1207, New
England Journal of Medicine, Nov. 18, 1971.

E. S. Caldwell, MD, Ann Arbor, “Homocystinuria,”
a letter, page 1050, Journal of the American Med-
ical Association, Nov. 15, 1971.

R. B. Merkle, MD, Oak Park; F. D. McDonald,
MD, Jordan Waldman, MD, G. D. Maynard, MD,
W. J. Murray, MD, PhD, Jay Petit, PhD, and P. J.
Fleming, Ann Arbor, “Renal Function after Meth-
oxyflurane Anesthesia,” page 841, Journal of the
American Medical Association, Nov. 8, 1971.

Dean Elliott, MD, Petoskey, consultant for the
subject “Otitis — Handling Your Patient’s Trouble-
some Ear,” page 20, Patient Care, Dec. 15.

Paul Lowinger, MD, Detroit, “Radical Psychiatry,”
International Journal of Psychiatry, pages 659-668,
September, 1970; “Do University Programs in Psy-
chiatry Serve the Inner City? A Demographic An-
alysis,” Journal of the National Medical Association,
pages 276-280, 1971; “Council of Health Organiza-
tions Statement on Drug Use and Abuse,” World
Journal of Psychosynthesis, pages 37-38, March,
1971; “Psychiatrists’ Attitudes About Marijuana,”
American Journal of Psychiatry, pages 146-147,
1971; “Mayday and the American Psychiatric As-
sociation Meetings,” The Radical Therapist, page
7, February, 1971; “Drug Evaluations in Man,” New
England Journal of Medicine, page 464, 1971; and
“Science, Medicine and Genocide,” American Jour-
nal of Psychiatry, pages 497-498, 1971.

James H. Tanton, MD, Petoskey, "How to Give
Your Money Away and Really Enjoy it,” page 161,
Medical Economics, Nov. 22, 1971.

Thomas B. Eyl, MD, St. Clair, “Current poncepts
in Organic-Mercury Food Poisoning,” page 706,
New England Journal of Medicine, April 1, 1971;
“Mercury Poisonings: The Sky Is Falling!” page 60,
Medical Opinion, October, 1971; and “Tempest in
a Teapot,” page 1199, The American Journal of
Clinical Nutrition, October, 1971.

BOOKS

Sidney Cobb, MD, Ann Arbor, “The Frequency of
the Rheumatic Diseases,” Vital and Health Statistics
Monograph, American Public Health Association,
Harvard University Press.

104 MICHIGAN MEDICINE FEBRUARY 1972

Epidural blood patch

An unusual approach,
to the problem

of post -spinal anesthetic headache

By Frank S. DuPont, MD
Raymond D. Sphire, MD
Detroit

Synopsis

Severe, incapacitating post-spinal anesthetic
headache was effectively relieved, without any
complications, in 40 post-partum patients by the
administration of an epidural blood patch. The
procedure consists of the injection of a small
amount of autologous blood into the epidural
space. The blood apparently seals the dural de-
fect, preventing further loss of spinal fluid and
thereby greatly assists in the restoration of normal
cerebro-spinal hydrodynamics. Until wider expe-
rience with this procedure has been gained, it
should be reserved for those cases of severe head-
ache which seriously interfere with normal post-
partum recovery.

“Epidural Blood Patch” is the somewhat eu-
phemistic phrase being used to describe the rela-
tively newr treatment for post-lumbar puncture
headache. The procedure involves the introduction
of a small amount of autologous blood into the
epidural space at the site of the original lumbar
puncture. The concept of using autologous blood
to seal the needle puncture opening in the dura
mater was first proposed by Gormley in I960.1 In
the intervening years his proposal has remained
largely unnoticed or ignored and only a few
papers have been published relative to this some-
what unusual approach to the treatment of spinal
cephalalgia. Ozdil and Powell in 1965, 2 injected
blood into the epidural space of clogs that had re-
ceived dural punctures. Their work, including
microscopic sectional study of the dura, demon-
strated that effective sealing of the dural defect
occurred in just a few hours. In 1970, DiGiovanni
and Dunbar3 reported on the clinical effectiveness
of this method of treatment in a series of 50 cases
of post-lumbar puncture headache.

Doctor DuPont is attending anesthesiologist
and Doctor Sphire is director, Department of
Anesthesiology, Detroit-Macomb Hospitals As-
sociation.

Table 1

5. Direct Surgical Closure of Defect
Treatment of Post Lumbar-Puncture Headache

Symptomatic:

1. Analeptics

2. Analgesics

3. Ataractics

4. Antihistamines

5. Narcotics

6. Sedatives

7. I-V Local Anesthetics
Correction of Fluid Loss:

1. Abdominal Binders

2. Epidural injection of air, saline, glucose

3. Mineralocorticoids

4. Plugging of Dural Defect with Catgut

There is a certain unattractiveness to the idea
of injecting blood into the epidural space to treat
what is ordinarily a self-limiting condition and
equally unattractive is the potential for infection,
neurologic and other possible sequelae.

It is generally accepted that the classic head-
ache which occurs following lumbar puncture is
caused by a continuing loss of cerebrospinal fluid
through the dural needle hole into the epidural
space.4

Two theories explain the origin of the head-
ache. The most common position states that the
loss of cerebrospinal fluid allows the brain to sag
when the patient assumes an upright position.
This sagging places traction on the pain-sensitive
supporting structures of the brain, e.g.— blood ves-
sels. The second, less commonly accepted, theory
states that the loss of cerebrospinal fluid causes
reflex compensatory cerebral vasodilatation which
in turn produces a “vascular type headache”
caused by vessel wall and perivascular edema.

Treatment of the problem rests in the ability to
restore normal cerebrospinal hydrodynamics.3 Ei-
ther by “stopping the leak” or by restoring the
fluid volume to a degree that exceeds loss. Table 1
indicates various methods used to date to accom-
plish this end.

None of these methods of treatment is entirely
satisfactory and all have a high rate of failure.

MICHIGAN MEDICINE FEBRUARY 1972 105

This is particularly true in the case of the severe
incapacitating post-spinal headache.

The highest incidence of spinal cephalalgia oc-
curs in the obstetrical patient.

In spite of faultless technique, utilizing very
small gauge spinal needles, headache will occur in
2-20% of these patients and many of these will be
of the incapacitating type.0

Early ambulation of post-partum patients is a
sine qua non of good obstetrical practice. Its great-
est value lies in the prevention of thrombo-embolic
and respiratory complications. The occurrence of a
severe incapacitating headache interferes with and
often prevents early ambulation. This then repre-
sents a serious hazard to the patient’s recovery.

Because of previous favorable experience with
“epidural blood patch” by one of the authors
(F.S.D.), it was decided to initiate a clinical study
of the merits of this procedure as related to the
Obstetrical Service of the Detroit-Macomb Hos-
pitals Association.

Method

This series consists of 41 cases of severe head-
ache following spinal anesthesia for either vaginal
delivery or Cesarean section. The patients were
referred to the Department of Anesthesiology for
treatment by the attending obstetrician only after
failure of conventional modes of therapy for at
least three days, and because the headache was
seriously interfering with post-partum recovery'
procedures. All patients in this series, except one,
demonstrated the signs and symptoms of a classic
post-spinal headache and were selected for the
“patch” procedure. Prior to performing the
“patch,” the patients were fully informed as to
the nature of the procedure and a consent was ob-
tained.

Technique

With the patient in the supine position, using
an aseptic technique, 10 cc’s of blood is drawn
from a suitable vein. This syringe is then care-
fully handled and secured so as to prevent its
possible contamination.

The patient is then turned on her side and
placed in the usual lumbar puncture position.
Ordinarily, the same interspace as was used for
the spinal anesthetic injection is selected for the
epidural injection of blood. Usually the skin
needle mark of the spinal injection is identifiable
and this locates the appropriate interspace. In
those cases where multiple needle marks are pres-
ent, the interspace equidistant between the highest
and lowest is selected for injection.

After scrupulous preparation of the back, epi-
dural placement of either a 16 g. Tuohy or a 20 g.

Crawford needle is accomplished using either the
“hanging drop” or “loss of resistance” technique
to identify the epidural space. Once the needle
tip is properly located in the epidural space, the
10 cc’s of previously drawn blood is slowly injected.
Following removal of the needle, the patient is re-
turned to the supine position.

Results

In this series a total of 42 epidural blood
patches were performed, with one patient receiv-
ing a second patch.

With this procedure, almost complete relief of
the headache was achieved following the injection
of blood. Determination of relief was accomplished
by asking the patient to sit up immediately after
the injection, and it was unusual for this position-
al maneuver to induce a recurrence of the head-
ache. In only two cases was the onset of relief de-
layed (two to four hours) and in all cases, except
one, relief continued and was sustained by the
next morning. The one failure to relieve head-
ache, occurred in a patient in whom there was
some question as to whether or not a typical post-
spinal anesthetic was actually present. A consultant
in neurosurgery examined the patient, and con-
cluded that this was a true spinal headache, and
suggested the patch procedure be performed.

In five of the “patch” procedures, inadvertent
entry into the sub-arachnoid space occurred. In
these cases, the needle was withdrawn and replaced
in the epidural space and the blood was then in-
jected. Complete relief followed in all these cases
with no subsequent problems.

Complications

No unusual or significant complications were
encountered in this series. Approximately one-
fourth of the patients experienced mild discomfort
of the back in the region of the epidural injection.
This discomfort disappeared in approximately 12
to 36 hours, and was readily relieved by aspirin.
In one case, the patient complained of a great
amount of severe interscapular pain radiating into
the arms, following the injection. This discomfort
slowly disappeared and was completely absent the
following day.

Comment

This is not a large series of cases, but we are
greatly encouraged by the results and the absence
of any major complications.

Infection is probably the most serious possible
complication to be considered, but with proper
care and aseptic technique, this should present no
problem.

Based on the clinical results of this study, “epi-

106 MICHIGAN MEDICINE FEBRUARY 1972

dural blood patch” is an effective treatment for
post-spinal headache occurring in the post-partum
patient. However, until wider experience has been
gained with this procedure, it should be reserved
for only those cases of severe incapacitating head-
ache which seriously interfere with normal post-
partum recovery and in which there has been no
response to conventional therapy.

References

1. Gormley, J.B.: Treatment of Post Spinal Headache.
Anesthesiology 21:565-566, 1960.

2. Ozdil, T. and Powell, W.F.: Post Lumbar Puncture
Headache: An Effective Method of Prevention. Anes-
thesia l r Analgesia 44:542-545, 1965.

3. Digiovanni, A.J. and Dunbar, B.S.: Epidural Injec-
tions of Autologous Blood for Postlumbar— Puncture
Headache. Anesthesia ir Analgesia 44:268-271, 1970.

4. Marx, G.F. and Orkin, L.R.: Physiology of Obstetric
Anesthesia. Springfield, Charles C. Thomas, 1969, p
186.

5. Tourtellotte, W.W., Haerer, A.F., Heller, G.L. and

Somers, J.E.: Post-Lumbar Puncture Headaches.

Charles C. Thomas, 1964, p 136.

6. Shnider, S.M.: Obstetrical Anesthesia: 174-176. Balti-
more, Williams & Wilkins, 1970, p 256.

Please send reprint requests to Doctor DuPont
at 1420 St. Antoine St., Detroit 48226.

Teriqatal 'Tips

By Paul M. Zavell, MD
Detroit

The following case from the files of the Wayne
County Medical Society Perinatal Mortality Com-
mittee is presented as an aid in continuing edu-
cation.

Maternal

This was the second pregnancy for this 28 year
old, gravida II, para 1, O positive white mother.
Estimated date of confinement was 10/9/70. After
five hours, 40 minutes of labor (the first stage
lasted five hours, 20 minutes; second stage 17 min-
utes, and third stage three minutes) she delivered
at 10:07 p.m. on 10/10/70.

One hour before delivery she was given 50 mgm
Demerol and 1/200 Scopalamine IM. Past history
revealed three kidney infections but none with
first or second pregnancies. First child alive and
well. At this delivery she was given N20 and 02
as well as Xylocaine locally.

During her five days in the hospital she showed
signs of a mild U.R.I. beginning on 10/11/70
(about 8 hours after delivery) with a raw throat
and some coughing. Her temperature stayed nor-

Doctor Zavell is chairman, Neo-Natal and Hos-
pital Care Committee, Michigan Chapter, AAP;
and chairman, Perinatal Mortality Study Com-
mittee, Wayne County Medical Society.

mal at all times. Later, on 10/11/70, her obste-
trician heard a few scattered crepitant rales at
both bases and he started her on V-Cillin-K 250
mgm qid. She was sent home on 10/15/70 with
three additional days on this medication. Her
cough was treated with Benylin Expectorant. No
studies other than those listed below were done.

10/10/70— Hgb=13. 5 gm with 40.0 Vol % Hct

10/11/70— VDRL=Neg

10/12/70— Hgb= 14.4 gm with 43.0 Vol % Hct

Fetal

The infant was a seven pound, 1 1 ounce white
female with Apgar of 10 at one and five minutes.
Other than a hasty exam in the delivery room
(this was said to be “normal”) , the infant was
not seen until the morning of 10/11/70. The pe-
diatrician noted nothing unusual. Cord blood was
reported back then as O-j- and Coombs Negative.

At about 30 hours of age (4 a.m. of 10/12/70)
she vomited her half-strength formula (Similac) .
The vomitus was dark (almost black) . Soon there-
after an intern examined her. She was not crying
or “upset” but he noted a heart rate of 204 with
shallow respirations (about 30 x/minute) . His
impression was “old blood vomited— Doubt G.I.
Bleeding.” One hour later the infant vomited
again but this time fresh bright red blood mostly
with bleeding from the nose and throat.

Respirations then became labored with retrac-
tions and the heart rate was recorded at 168 per
minute. The intern called the pediatrician who
saw the infant in 25-30 minutes (5:30 a.m.) . He
noted only shallow rapid respirations. (No num-
ber; heart rate was not recorded) . The impression
was “acute hemorrhage—?? Source.” A chest X-ray
(portable) showed “some haziness scattered over
both lung fields with heart a little enlarged.”

A CBC done at about 6 a.m. of 10/12/70 was
reported back at 6:15 a.m. as Hgb=18.5 gm,

MICHIGAN MEDICINE FEBRUARY 1972 107

PERINATAL TIPS/Continued

Hct=61 Vol %, WBC=9000, PMN=12, Eos=02,
Lymph =86 and 12 nuc Rbc’s 100/WBC. Smear
showed platelets decreased and moderate Macro-
cytosis and Polychromasia.

At 32 hours, 45 minutes of age (6:45 a.m.) the
pediatrician re-examined the infant and noted
slight abdominal distension. He noted that res-
pirations were now irregular and the condition
definitely had deteriorated. A flat plate done at
6:55 a.m. showed “a distended stomach but other-
wise normal gas pattern.” The infantly quickly
deteriorated and expired at 7:45 a.m. (about
33i/2 hrs. of age) . (At 1 hour of age the infant
had been given 1.0 mgm of Aqua Mephyton IM) .

An autopsy was done revealing acute broncho-
pneumonia (cultures not done but colonies of
gram -J- cocci noted) and left hemithorax.

Perinatal Committee Comments

1. (a) Here is a case where communication be-
tween the obstetrician and the pedia-
trician was poor. If the pediatrician had
known eight to 12 hours earlier about

the illness of the mother, antibiotics
may have been life-saving.

(b) If it is necessary to treat a post partum
mother with, antibiotics the Committee
suggests:

1. The nursery should be notified
either by the obstetrician or by the
OB nursing department.

2. There is no substitute for direct
communication between the obste-
trician and the pediatrician when
anything other than normal occurs
in either the mother or the baby.

2. The usual WBC in a newborn ranges 12,000
to 25,000 or more. Infants react frequently
to infection in the newborn period with de-
pression of the WBC. The 9,000 here should
have been a clue to look for possible infec-
tion.

3. Differential diagnosis here cotdd have in-
cluded at least the following: Ulcer of the
Intestinal Tract, Hepatitis, and Coxachie
Viral Myocarditis.

108 MICHIGAN MEDICINE FEBRUARY 1972

Management of spastic diplegia
by the physiatrist

By Leonard F. Bender, MD
Ann Arbor

Nancy M. Bender, RPT
Detroit

Presented at the annual convention of the American
Medical Association, July 15, 1969. New York City.

Frequently the physiatrist is the last physician
to be consulted by the family of the patient with
spastic diplegia— a type of cerebral palsy character-
ized by spasticity which is wTorse in the legs than
in the arms. This is not an enviable position, al-
though there is some advantage in the fact that
previous examinations by other specialists have
already elicited and graded the normal and ab-
normal reflexes present, gauged and documented
the developmental level of the patient, and arrived
at a diagnosis. By the time the physiatrist is con-
sulted these children may be 6 to 12 months old
and many have failed to pass normal develop-
mental milestones such as sitting up, reaching out,
and pulling up to standing.

Evaluation begins with the gestational history,
particularly with respect to the patient's weight
and degree of maturity at birth. Spastic diplegia is
often associated with prematurity, but it is also
seen in near-term babies who are underweight.
Among diplegic infants with a history of pre-
mature birth but normal birthweight in relation
to stage of development, girls outnumber boys
two-to-one (Fuldner 1969) . The “small-for-dates”
baby, an infant whose birthweight was subnormal
regardless of whether the birth was premature, is
more likely to be subject to convulsions and will
probably exhibit intellectual deficit (Fuldner 1969)
and impaired somatic growth (Sinclair, et al.
1969) . Thus from the physiatrist’s standpoint the
rehabilitation potential in any given case is par-
tially related to birthweight and length of gesta-
tion.

Accurate assessment of the patient’s muscle
strength, tone, and control is often difficult, since
the over all muscle tone is altered by head position
and increases when the child is under emotional

Doctor Bender is professor, Department of
Physical Medicine and Rehabilitation, The Uni-
versity of Michigan, Ann Arbor while Nancy
Bender is staff physical therapist, United Cere-
bral Palsy Association of Detroit, Inc.

stress, hungry or crying. It may be very difficult to
grade strength of individual muscles by the man-
ual muscle testing methods used in lower motor-
neuron weakness; however, one may grade the
strength and ease of movements requiring groups
of muscles; and the degree of cortical control may
be graded. Since movement patterns are influenced
by both spinal and supraspinal reflexes, a com-
bination of these forms of muscle evaluation may
be useful.

Joint range of motion, especially in the hips,
knees, and ankles, must be measured and deform-
ities of soft tissue and bone assessed. Common
problems include shortening of the gastrocnemius-
soleus mechanism and/or hamstring muscles, hip
flexion contracture with femoral anteversion and
increased lumbar lordosis, and occasionally a dis-
located hip.

Accurate assessment of the child’s mobility,
whether in scooting, rolling, creeping, crawling, or
walking, may not be possible on one or two brief
examinations; it may best be judged by the phys-
ical therapist who has the opportunity to see and
work with the child regularly. The occupational
therapist can be of significant help in evaluating
upper-extremity function. The speech therapist can
provide suggestions to improve sucking, swallow-
ing, and speech, as well as reduce drooling. Intel-
lectual level should be ascertained by careful psy-
chological evaluation repeated two or three times
at 6- to 12-month intervals. The proper selection
of psychological testing materials is as important
as the examination procedure itself— the numerical
intelligence quotient is very often given unjustifi-
able importance, with the result that the educa-
tional opportunities provided throughout the
years of a child’s development may be inappro-
priate and unproductive.

With this background information the physician
is ready to set tentative goals for locomotion, self-
care, and communication. The means of attaining
these goals involve combinations of physical, occu-
pational, and speech therapy, drugs, bracing, spe-
cial education, social work, and parent counselling.
The approach is holistic, including the parents
and the community— a concept well described by
Weiss and Betts (1967) . The specifications for this
manifold regimen and the coordination of the
therapies involved are the responsibility of the
physician. Only after becoming thoroughly famil-

MICHIGAN MEDICINE FEBRUARY 1972 109

SPASTIC DPI LEGI A/ Continued

Fig. 1. Misalignment of the brace
axis results in undesirable pressures
when the knee is flexed. When the
brace axis is located posterior to the
knee axis in extension, flexion causes
excessive pressure on the posterior
thigh and calf. When the brace axis is
misaligned superiorly, flexion causes
excessive pressure on the posterior
thigh and anterior shin.

Figure 1 is reproduced with permission from
Orthotics Etcetera, ed 1, New Haven, Conn.
Elizabeth Licht, Publisher, 1966, chap 2, pp.
44, 45.

iar with the principles and often the techniques of
these therapies can he prescribe correctly.

Physical therapy must be properly prescribed.
Too often a prescription is written for “physical
therapy” and the decisions concerning goals and
methods of treatment are left to the therapist.
This is a responsibility no therapist should be
asked to assume and which most therapists do not
want to assume. The prescription should state
what parts of the body are to be treated, how they
are to be treated, and for how long. Some of the
techniques used by the therapist can be taught to
the parents and carried out by them at home. The
therapist should report his patient’s progress and
his observations to the physician at a stated time,
when a new prescription can be written.

Rehabilitation clinics in general use rather con-
ventional programs of therapy involving: (1)

stretching specific areas of soft-tissue tightness
manually, by proper positioning, and with braces;
(2) encouraging development of motor skills
through repetition of movements and proper posi-
tioning for sitting, creeping, crawling, standing,
and finally walking; (3) strengthening key mus-
cles; (4) facilitation techniques to make use of
reflex activity and encourage active voluntary func-
tion; and (5) inhibitory techniques to suppress
unwanted reflex activity. Various techniques of
neuromuscular facilitation have become popular
at one time and then discredited at another time.

Reduction of activity in spastic muscles has
been sought in a variety of ways including drugs,

surgery, and most recently, injections of dilute
solutions of phenol or alcohol into peripheral
nerves or motor endplate areas of muscles. In
carefully selected cases, we at The University of
Michigan have been impressed with the effective-
ness of phenol injections.

‘‘Operant conditioning” is a technique which
has been used to control animal behavior and
may be applicable to human subjects. The “oper-
ant” is the existing movement, either voluntary
or involuntary, that is to be brought under ex-
perimental control. Through a series of positive
and negative reinforcements (rewards and punish-
ments) the animal learns to perform a required
maneuver. With human subjects, Hefferline (Foss
1966) has been able to control twitches of the
masseter and thenar muscles so that EMG re-
sponses of a desired amplitude could be produced
voluntarily. Brenner (Foss 1966) has shown that
the heart rate can be controlled, without medica-
tion or voluntary changes in breathing rate, by
giving negative reinforcement when the pulse rate
fell within previously specified limits. The pos-
sibility that this technique might be used to
control movements in the spastic child warrants
investigation.

The management frequently includes assistive
devices. The leg braces used in spastic diplegia
either provide support, correct deformity, or assist
function. They vary from night splints for pre-
vention or correction of tight heelcords to long
double uprights with a pelvic band, for standing

110 MICHIGAN MEDICINE FEBRUARY 1972

and walking. In each instance the device applies
forces which affect movement about skeletal joints.

Only recently have the forces at work in normal
and abnormal musculoskeletal systems begun to
be studied. The alignment of brace and skeletal
joint axes is extremely important (Figure 1); sheer
forces created by straps and cuffs (e.g., at the thigh,
calf and knee) are another important considera-
tion. Principles of alignment and placement of
forces have been described by Smith and Juvinall
in a chapter of the book Orthotics Etcetera
(1966) .

It behooves each of us involved in the use of
braces to consider these points; otherwise, the
forces created by malalignment may well prevent
the action we are trying to assist or support.
Brace fit, function, and alignment should be re-
checked every 3 to 6 months; as the child grows
the brace must be lengthened, the cuffs deepened,
and the shoes changed. All leg braces for these
children should be adjustable in height. We cus-
tomarily have the cuffs covered with plastisol in-
stead of leather (Harden, et al., 1967); other ortho-
tists should explore the advantages of this non-
absorbent, resilient, easily applied material.

Shoes may be regular, orthopedic or surgical,
low-quarter or high-quarter. The surgical shoe
is particularly useful when the patient has poor
control of the toes and has difficulty placing his
foot correctly in the shoe.

In addition to prescribing the braces and shoes
and checking their fit periodically, the physician
should specify the length of time the brace is
to be worn. If it is designed to correct tight heel-
cords and hamstrings, much benefit may be gained
by wearing it all or part of the night— this too
should be specified. When a detachable caliper
has been used, a shoe with a vamp cut out may
be used at night on the brace instead of the regu-
lar walking shoe. Frequently there is a lack of
anticipated improvement because the parents or
other attendants did not understand when, why
and how long the braces should be worn.

Wheelchairs are used when walking is impos-
sible or impractical with crutches and/or braces.
The prescription for a wheelchair should be as
specific as those for braces or medication, and
again, the amount of time to be spent in it should
be specified, as well as the time out of it— for
exercise on mats or floor.

While the child is on an exercise mat, toys can
help the therapist induce the desired positions and
body movements. Large beach balls and cylindrical
stuffed animals provide support in the prone po-
sition or can be used for gross arm coordination.
Small blocks, nests of boxes, rings on a peg, and
wheeled vehicles encourage bimanual coordination.

Perusal of current literature reveals great varia-
tion in management of spastic diplegia. The
philosophy of treatment varies from treatment by
a team of specialists including speech, physical,
occupational and recreational therapists, and re-
habilitation nurse, to treatment by one person
who' has been specially trained in the various
therapies involved in cerebral palsy (Cotton 1965) .
Some clinics stress inhibition of patholgic re-
flexes, while others encourage and attempt to make
positive use of such reflexes. Some centers use
braces extensively while others shun them. One
thing is clear— there is no one effective method
of management of spastic diplegia.

Surgery should be considered whenever soft-
tissue contractures are worsening in spite of ade-
quate therapy, or when function can be improved
by tendon transfer or arthrodesis. But bear in
mind that postoperative disturbances lasting three
to four months have been observed (Reynell
1965) ; these include diminished response to ther-
apy, emotional disturbances, increased fatigue,
and fearfulness. The patient should be psycho-
logically prepared for surgery, not merely operated
upon like a defective robot.

As the patient matures, aptitude and prevo-
cational testing assumes greater importance than
therapy. Vocational training under the auspices
of special education programs may be indicated.

All the while the patient is being treated and
evaluated, his parents will benefit from counsel-
ling. Through group sessions they learn that other
parents have similar problems; they can share
their grief as well as their solutions to common
problems. Sometimes groups of parents form or-
ganizations for the common good; parents of ce-
rebral palsied children in the United States form
the backbone of United Cerebral Palsy. Together
and with proper guidance they can approach the
problems involved in planning for long-term care
—problems of where to live, what to do during
the day, how to provide protective supervision,
and how to pay for care.

There is tremendous room for improvement in
the vocational, avocational, and housing programs
for cerebral palsy patients who are essentially
wheelchair-bound. During the patient's growing
years we may have been able to minimize de-
formity and optimize mobility, manipulative skill,
and communication, only to come to the end of a
blind alley vocationally. Much work remains to be
done in this area of rehabilitation.

Summary

Proper management of spastic diplegia is based
on an accurate evaluation of the abnormal physio-
logic states associated with brain damage. The role
of pathologic reflexes and spasticity must be ascer-

MICHIGAN MEDICINE FEBRUARY 1972 111

SPASTIC Dl PLEGI A/ Continued

tainecl so that desirable effects can be counteracted
by appropriate therapy while helpful effects are
reinforced and utilized. Assessment of muscle
strength and tone and joint range of motion helps
the physician outline a program of exercise de-
signed to minimize contractures, strengthen weak
muscles, and increase functional capacity.

Attainable goals should be set for locomotion,
self care, and communication. Where appropriate,
vocational plans are made and avocational ac-
tivities encouraged.

The means of attaining these goals entail com-
binations of physical, occupational, and speech
therapy, drugs, bracing, social work, education,
and parent counselling. The specifications for the
manifold regimen and the appropriate inter-
digitation of the therapies involved are the re-
sponsibility of the physician.

Periodic reassessment of the patient is essential,
to ensure that the goals and the program of man-
agement will be altered as necessary to maintain
optimum progress.

Bibliography

Cotton, E.: The Institute for Movement Therapy and
School for ‘Conductors’— A Report of a Study. De-
velop Med Child Neurol 7:437-446 (Aug.) 1965.

Foss, B.M.: Operant Conditioning in the Control of
Movements. Develop Med Child Neurol 8:339-340,
1966.

Fuldner, R.: Personal Communication.

Harden, D. H., and Koch, R. D.: Plastisol Coatings
and Application Techniques. Dept, of Physical Med-
icine and Rehabilitation, Orthetics Research Project,
Technical Report #8, February 1967.

Reynell, J. K.: Post-operative Disturbance Observed in
Children with Cerebral Palsy. Develop Med Child
Neurol 7:360-376 (Aug.) 1965.

Sinclair, f. C., and Coldiron, J. S.: Low Birth Weight
and Post-natal Physical Development. Develop Med
Child Neurol 11:314-329 (June) 1969.

Smith, E. M., and Juvinall, R. C.: “Mechanics of
Bracing” in Licht, S. (ed) Orthotics Etcetera ed 1,
New Haven, Conn.: Elizabeth Licht, Publisher, 1966,
chap 2, pp. 32-62.

Weiss, H., and Betts, H. B.: Methods of Rehabilitation
in Children with Neuromuscular Disorders. Ped Clin
N Amer 14:1009-1016 (Nov.) 1967.

112 MICHIGAN MEDICINE FEBRUARY 1972

1

The effect of a nursing bottle
on the teeth of a young child

By Harvey A. Beaver, DDS, MS
Harper Woods

One of the most extensive oral pathological
disorders may be initially diagnosed in a phy-
sician’s office when the child is between the ages
of 30 months and 36 months. The unsuspecting
parents of these children are unaware of the
destruction slowly progressing on all surfaces of
the developing teeth. Usually the pain is uncom-
municative to the parents, therefore increasing the
carious breakdown of the dentition. When the
lesions can be readily seen, the disorder has spread
to a most agonizing and rampant condition. The
upper anterior teeth are either abscessed or totally
destroyed, while the remaining teeth manifest
some degree of carious involvement (Fig. 1).

This syndrome causing massive dental pathology
in the maxillary anterior region has been noted
for some time, but within the last ten years the
causative agents have been thoroughly investi-
gated. The condition has been termed as “nursing
or baby bottle syndrome” and is easy to detect and
diagnose but challenging to treat since we are
dealing with uncooperative on non-communicative
patients (Fig. 2).

The parents are quite shocked when presented
with the problem and told the extent of the
damage. Upon investigation the parents reveal a
history of putting the child to sleep with a bottle
containing milk formula, milk, juice, or sweetened
water.

The child lies in bed with the nursing bottle in
the mouth. The nipple rests against the palate
w'hile the tongue with the cheeks aid in the ex-
pulsion of the liquid from the bottle into the oral
cavity. This process enables the tongue to contact
the lips at the same time covering the mandibular
anterior teeth. The sucking at first is rapid, but
as the child falls off to sleep the rate of swallow-
ing decreases along with salivary secretion and
liquid ingestion. The liquid now present in the
mouth emerses the oral cavity, thus permitting

Doctor Beaver’s article was provided to Michi-
gan Medicine by the Michigan Dental Associa-
tion which felt that pediatricians and family
physicians especially would be interested. Its
appearance coincides with Children’s Dental
Health Week Feb. 6-12, 1972.

Fig. 1 A two year old who had been placed
to bed each evening with a milk bottle. Note
complete destruction of the upper anterior teeth.

the carbohydrates to remain in contact with the
teeth in the presence of microorganisms for a pro-
longed time period. The bottle remains in the
mouth during most of the time the child is asleep
with the liquid oozing into the oral cavity.

The problems which may be associated with
this malady are pain, infection, tongue thrusting
and abnormal swallowing habits with conconnnit-
tant speech difficulties.

Dental decay is a progressive destruction of the
calcified tissues of the teeth initiated by bacterially
produced acids on the tooth surface. It is an ir-
reversible disease characterized by a demineraliza-
tion of the inorganic portion and a destruction of
the organic substance of the tooth.1

The exact etiology of dental disease is still
unknown. What is known is that the carious pro-
cess is dependent on many factors. These factors
are, fermentable carbohydrates, oral microbial or-

MICHIGAN MEDICINE FEBRUARY 1972 113

3

NURSING BOTTLE/Continued

Fig. 2 A three year old who was given a
bottle of juice during her afternoon nap time.
The extent of the carious involvement is not
as destructive as in Fig. 1.

ganisms, plaque material, tooth morphology and
the oral clearance of carbohydrates.4

The acids involved in the caries process are
derived from the carbohydrate substances which
have been degraded by microbial enzymes. The
enzymes are produced by the microorganisms in
the plaque material, which is a thin gelatinous
material adhering to the surface of the tooth. If
the acid produced is maintained in contact with
the tooth for a prolonged period of time the outer
surface of the tooth will become decalcified thus
initiating the carious process.9

One of the first pediatricians in this country,
A. Jacobi in 1862, 6 suggested that milk may be a
cariogenic agent. He observed a massive destruc-
tion of the primary teeth when an infant was
given milk or water sweetened with sugar when
going to sleep.

Weiss and Bibby15 found that milk is a modify-
ing element on enamel solubility. Their research
concluded that regardless of whether is was raw,
pasteurized, whole or skim milk, it reduced enamel
solubility by 20 per cent.

In 1966, Jenkins and Ferguson7 demonstrated
from clinical data that milk has no local cario-
genic effect and it is not an important factor in
promoting caries. 1 he laboratory experiments of
this study suggested that milk possibly may have
a local cariogenic effect on the teeth when as-
sociated with other foods. The authors suggested
that the calcium and phosphate in milk are largely

114 MICHIGAN MEDICINE FEBRUARY 1972

responsible for the reductions in the amount of
enamel dissolved. Since the effect of milk was
still detectable after it had been washed from the
teeth, some substance must contribute to this effect.
This substance has yet to be identified by these
researchers. Weiss and Bibby15 have speculated
that this protective agent may be due to protein
absorption on the tooth.

Sperling and associates13 found that feeding
milk and milk containing 10 j>er cent dissolved
sucrose to rats during their entire life span did
not produce dental caries. Those animals who
had milk with free access to either a water solu-
tion of sucrose or dry sucrose developed very se-
vere caries according to Sperling. It seems that
milk consumed directly with sucrose in solution
and in a limited proportion, seemed to protect
the teeth.

Elliott and Pigman2 found caries increased in
hamsters on a typical infant’s diet. Steinman and
Haley14 reported a study of the effect of; 20 per
cent sucrose, 20 per cent lactose, and 20 per cent
glucose and fructose on rats from birth until
weaning at 21 days. Sucrose solutions caused the
most carious lesions with the least being evident
with lactose.

Vianna, in 1970, 17 tested four milk solutions
during a six week period; bovine milk, human
milk, bovine milk plus honey, and an infant for-
mula. After six weeks, all milk solution groups
showed signs of tooth decalcification. The milk and
honey group had the highest decalcification rate
while the least was plain bovine milk. The author
suggests that time of contact and stagnation are
important factors which determine the effect of
decalcification on the tooth. Again it is stated
that bovine milk is non-conductive to caries.

High milk consumption related to a high decay
rate was observed in 864 children, age 10-16 years.
An oral examination, along with a diet survey
was conducted by Potgieber and associates.11

Pitts,10 in a London Hospital study of 70 cases
of extensive carious lesions in children three years
or under, found that the upper incisors and the
upper and lower molars, seldom the lower incisors,
were the teeth most involved. The author after
careful study observed that the incidence of caries
did not appear to be affected by either breast or
artificial feeding. Pitts noted that these children
had been weaned on a dummy dipped in honey
milk or sugar for an extensive period of time.

Robinson and Nylor12 again indicated that milk
bottle fluid heavily saturated writh sugar is cario-
genic if placed in the oral cavity of an infant
during his sleep time. They also noted that de-
cayed teeth could be associated with a slower
gain in weight after the age of 2y2 to 3 years.

Fass3 investigated the prevalence of rampant
caries in children under four years of age. He
found that the common element among all these
patients was that they were put to bed with a
milk bottle from which they drank lying down. As
the milk from the bottle continues to flow into
the mouth while the child sleeps, all the factors
necessary for the carious process to occur are
present in the child’s mouth which are the follow-
ing:

1. Milk, sugar content of 3.8 per cent.

2. Oral microorganisms capable of producing
acids.

3. Very slow clearance of the oral contents.

4. Decreased salivary secretion and decreased
salivary flow.

Kroll and Stone8 undertook a statistical analysis
comparing the relationship between the occurrence
of rampant dental caries and nocturnal nursing
bottle feeding. The authors also analysed those
patients with rampant caries to see if there might
be a relationship between the pattern of decay and
bottle feeding. From the analysis they found that
nocturnal bottle feeding can contribute to ramp-
ant caries.

The prevalence of dental decay as related to
a nursing bottle has been studied in England by
Goose,5 who found in a study of 309 children
one to two years of age, 6.8 per cent showed the
typical nursing bottle mouth.

Winter and associates16 in a recent study in
England of 602 children, ages 12-60 months, found
8 per cent with rampant caries. The etiological
factors were the prolonged use of sweetened com-
forters and bottle feeding.

From the accumulated data and information it
is evident that liquids enriched with carbohydrates
that are consumed during the sleeping hours from
a nursing bottle or other devices can produce
extensive carious lesions in the infant.

It behooves the family physician and pedia-
trician to advise parents of the ill-effects of pro-
longed nocturnal bottle feeding. If for psycho-
logical reasons it is found necessary to use the
nursing bottle, water should be recommended. In
cases where there is a history of prolonged use of
the night-time bottle the physician should advise
the parents to seek dental treatment immediately.

Bibliography

1. Boucher, C. O. Current clinical dental terminology,
St. Louis, C. V. Mosby. 1963.

2. Elliott, H. C., Jr., and Pigman, W. A. A study of
the effect of a typical infant’s diet on the caries
incidence of the Syrian Hamster. J. Dent., Res.,
32:698, Oct. 1953.

3. Fass, E. N. Is bottle feeding of milk a factor in
dental caries? J. Dent. Child., 29:245-51, 4th Quar.
1962.

4. Finn, S. B. Clinical pedodontics. Philadelphia, W.
B. Saunders. 1967. 753p. (p. 634-655).

5. Goose, D. H., and Gittus, E. Infant feeding
methods and dental caries. Public Health, 82:72-6,
1967.

6. Jacobi, A. Dentition and its derangements: a
course of lectures delivered in New York Medical
College. New York, Bailliere Brothers. 1862. VII+
172 p. (p. 27, 33) .

7. Jenkins, G. N., and Ferguson, D. B. Milk and
dental caries. Brit. Dent. J., 120:472-7, May 17,
1966.

8. Kroll, R. G., and Stone, J. H. Nocturnal bottle-
feeding as a contributory cause of rampant dental
caries in the infant and young child. J. Dent.
Child., 34:454-7, Nov. 1967.

9. McDonald, R. E. Dentistry for the child and ado-
lescent. St. Louis, C. V. Mosby. 1969. 539 p. (p.
112-141).

10. Pitts, A. T. Some observations on the occurrence
of caries in very young children. Brit. Dent. J.,
48:197-206, Feb. 1927.

11. Potgieber, M„ et al. The foods, habits and dental
status of some Connecticut children. J. Dent. Res.
35: 638-44, 1956.

12. Robinson, Seymour, and Naylor, S. R. The effects
of late weaning on the deciduous incisor teeth.
Brit. Dent. J., 115:250-2, Sept. 17, 1963.

13. Sperling, Gladys, et al. Effect of long time feeding
of whole milk diets to white rats. J. Nutr., 55:399-
414, March 1955.

14. Steinman, R. R., and Haley, M. I. The biological
effect of various carbohydrates ingested during the
calcification of the teeth. J. Dent. Child. 24:211-24,
4th Quar. 1957.

15. Weiss, H. E. and Bibby, B. G. Effects of milk on
enamel solubility. Arch. Oral Biol., 11:49-57, Jan.
1966.

16. Winter, G. B., et al. The prevalence of dental
caries in pre-school children aged 1 to 4 years.
Brit. Dent. J., 130:271-7, April 6, 1971.

17. Vianna, R. B. D. The cariogenic potential of milk.
Indianapolis, Indiana University-Purdue University
School of Dentistry, 1971. 68p. typed thesis.

On the following pages is a chart on emergency
treatment for the effects of commonly abused
drugs. The chart is prepared by Edward J. Lynn,
MD, assistant professor of psychology in the
Michigan State University College of Human
Medicine. It was produced for the Governor’s
Office of Drug Abuse, which also distributes
guides to talking down a bad tripper, resource
materials on drug abuse, a drug-abuse teaching
kit and audio-video tapes. Doctor Lynn wishes
to acknowledge Charles Maclean of the Governor’s
Office for his library research assistance.

MICHIGAN MEDICINE FEBRUARY 1972 115

Effects qf Commonly ^Abused Drugs

Qroup

DRUG

HOW USED

USUAL

EFFECTS SOUGHT

USUAL

DURATION OF EFFECTS

Heroin

(Diacetylmorphine)

Sniffed or injected
Dose varies

4 6 hrs.

Opiates

Morphine
(Morphine sulfate)

Swallowed or injected
Dose varies

Euphoria, pain relief,
prevention of withdrawal
symptoms, etc.

4 6 hrs.

Methadone

(Dolophine, Amidone)

Swallowed or injected
Dose varies

4 6 hrs.

Barbiturates

(Phenobarbital, Nembutal,
Seconal, Amytal, etc.)

Swallowed or injected
Dose varies

CNS

Depressaips

Alcohol

(Ethanol, Ethyl alcohol)

Swallowed
Dose varies

Euphoria, intoxication,
anxiety reduction, and
prevention of withdrawal
symptoms

Depends on route
and preparation

Minor tranquilizers
(Meprobamate, Librium, etc.)

Swallowed
Dose varies

ton

Dellqdonnn

cAlKaloids

Belladonna

Scopolamine

Hyoscyamine

Stramonium

Atropine

Various over-the-counter
sleep preparations

Swallowed or injected
Dose varies

Euphoria, hallucinations

Varies

I.S1

Cocaine

(Benzoylmethylecgonine)

Sniffed or injected
Dose varies

CNS

§timulqnts

Amphetamines
(Benzedrine, Dexedrine,
Dezoxin, Methamphetamine)

Swallowed or injected

Euphoria

Ritalin

(Methylphenidate)

Swallowed or injected

Varies based on
route and type of
preparation (capsule,
spansule, IV, etc.)

A

I m

I ill):

LSD

(d-lysergic acid diethylemide)

Swallowed
Dose varies

Mescaline

(3, 4, 5— trimethoxy- phenethyl
amine, or naturally from Peyote)

Swallowed
Occasionally injected

DMT

(Dimethyltriptamine)

Smoked or injected

Hallucinogens

"STP"

(DOM, Dimethoxy-
methylamphetamine)

Swallowed

Psilocybin

(3 [2-dimethyl amino]
ethylindol— 4 oldihydrogen
phosphate), or naturally
from mushrooms

Euphoria, perceptual
intensification, illusions
and hallucinations

Swallowed

PCP

(Phencyclidene HCI, Sernylan)

Swallowed

8 - 12 hrs.

1 2 hrs.

1 - 3 hrs.

Up to 2 - 4 days

5 - 8 hrs.

Varies

A,

Cai\r$bii\ols

Marihuana
(Cannabis sativa)

Swallowed or smoked

Hashish

(same as marihuana, has more
T etrahydrocannabinol)

Euphoria, perceptual
intensification; illusions
and hallucinations (in
high doses)

Variable (2 -4 hrs.
if smoked, may last
longer if swallowed)

A.

*

Emergency Treatment qf Their Ejects

“Prepared by0 Edward Pyn^TVIfD.

A. INTOXICATION
CITY B. WITHDRAWAL

MANAGEMENT OF ACUTE TOXIC EFFECTS

MANAGEMENT OF WITHDRAWAL

int pupils (dilated with anoxia),
atory depression, areflexia, coma,

1 = anxiety, craving, yawning,

/mation, rhinorrhea and restlessness !

2 = fixed dilated pupils,

ection, cramps and muscle twitching

3 = insomnia, elevated pulse, blood
re, temperature; nausea and vomiting

1. Establish airway, support respiration, cardiac
massage for arrest, usual regimen for pulmonary
edema if necessary, vasopressors as indicated

2. Levallorphan tartrate (Lorfan) 1 mg. or
Nallorphine HCI (Nalline) 5 10 mg. IV,

1 - 3 times q 15 minutes as indicated

(It is advisable not to exceed 40 mg. of
Nalline.) DO NOT reduce vigilance after
the patient becomes responsive.

Wait until stage 2 withdrawal and in the young,
healthy patient give methadone 10 mg. p.o., t.i.d.
and decrease dosage by 5 mg. daily for six days.

In the elderly or debilitated give methadone
until tolerance level is achieved, then withdraw
slowly over 2 - 3 weeks.

Another approach to managing the abstinence
syndrome, especially if mild, involves symptomatic
treatment with antiemetics (Compazine), analgesics
I (Darvon), and antihistamines (Benadryl) for sleep.

fine lateral nystagmus,
ssed reflexes

nediate = ataxia, dysarthria
= coarse nystagmus, Romberg sign,
ataxia, somnolence
e = CNS depression, mydriasis,

, death

ness, restlessness, tremulousness,
nia, blepharoclonus, postural
ension, anxiety, fever, delirium, ;

Isions, status epilepticus, psychosis
visual hallucinations, and formication
ulsions may occur 16 hrs. after abrupt
rawal and psychosis after 36 hrs.)

Induced vomiting or gastric lavage, keep
moving and observation for mild cases

More severely depressed patients may
require mechanical assistance of respiration,
IV fluids and electrolytes, and vasopressors.
Some cases may require dialysis or exchange
resins.

In any case where the ingestion is possibly
self destructive or suicidal, psychiatric
evaluation should be obtained before the
patient is discharged.

Determine tolerance level with a test dose of
200 mg. of pentobarbital and examine the
patient in one hour. If no toxicity is seen, he
will tolerate more than 800 mg. Estimate
tolerance as follows:

Nystagmus = 700 - 800 mg. /day

Mild Ataxia and Dysarthria = 500 - 600 mg. /day

Gross Ataxia = 400 mg. or less/day

Give pentobarbital in divided doses and withdraw
by 100 mg./day. There are many other reasonable
regimens for treating D.T.— like withdrawal and
may be found in most texts.

louth and throat, dilated pupils, twitching,
ulty swallowing, elevated temperature and
pressure, slow pulse which may become
and weak, respiratory depression,
sis and urinary retention

ness, giddiness, thirst, blurred vision,
ment and confusion with hallucinations,
jm, stupor, coma

Supportive as indicated

Phenothiazines are to be AVOIDED for
they may cause cardiovascular collapse in
combination with this group of drugs. Small
doses of short acting barbiturates are indicated
for the control of excitement.

or, dry mouth, tachycardia and
tension (may be absent in chronic use),
ng, dilated pupils, hyperreflexia, palpi-
s, convulsions, circulatory collapse

may be extremely high and may lead
th. A panic reaction or a psychosis
r to acute paranoid schizophreniza
)e seen.

Supportive j

Induced vomiting and gastric lavage if orally
ingested. Sedation with short acting barbit- ;

urates or Valium (diazepam). Phenothiazines
are useful in cases where psychosis needs to
be managed— only if it is certain that no
contaminants are involved.

Hypothermia if indicated

Although these drugs are not technically
physically addicting, depression and suicidal
behavior have been observed in a number of
amphetamine users who have stopped taking ,

the drug (this may be a manifestation of
underlying depression or a withdrawal
phenomenon). Care must be exercised to
evaluate these entities.

reactions (more from set and setting
rom drug), depersonalization, illusions,
:inations (commonly visual) and delusions

may be dilated, incoordination, mild
ion in pulse rate and blood pressure

Usually emotional support ("talking down")
is sufficient. Thorazine and barbiturates are
contraindicated unless LSD is certainly the
only drug taken— fatalities may occur if the
drug taken is STP or PCP or if contaminants
such as strychnine or belladonna are involved.
Valium (Diazepam) 20 - 50 mg. IM is thought
by many to be the treatment of choice if
sedation is necessary.

It should be noted that a significant number
of individuals who have psychotic episodes
while under the influence of these drugs have
been in emotional difficulties in the past.
Follow-up evaluation is recommended. An
acute episode while "tripping" may serve as
case finding for some individuals.

ientation, excitement; disturbances in
h, proprioception and coordination;
ased salivation

drug may also exacerbate psychotic
toms.

Supportive management— medically and
psychologically, avoid drugs if possible
in treatment

tly elevated pulse, conjunctival
tion, dried mucous membranes

rse reactions are uncommon.

75 percent are panic ractions and
ot pharmacologic. Of the remainder
are depression (in the chronically
assed— similar to "crying in your beer").

c psychosis (overdose) is uncommon and
last 12 -48 hrs. Occasionally a prolonged
lotic episode may be seen in a borderline
idual or someone who has been psychotic
e past unrelated to drugs.

Supportive psychotherapy is usually
sufficient for most cases of panic.

Toxic psychosis may be treated with short
acting barbiturates or Valium for sedation.
The individual can generally sleep if off in
a hospital setting. Chronic psychotic reactions
are treated supportively on psychiatric units.

Produced for and distributed by

Office of Drug Abuse
State of Michigan
414 Hollister Bldg.

Lansing, Mich. 48913
Tel. (157) 373-1728

Four television screens strategically located
around the auditorium of E. W. Sparrow Hospital,
Lansing, helped bring the message to mid-Mich-
igan physicians attending a recent Gynecological-

Surgical Clinic. Co-sponsors were the hospital,
the Michigan Society of Obstetricians and Gy-
necologists and the Lansing Ob/Gyn Society.

Both clinic panels were chaired by Thomas
Kirschbaum, MD, center, professor and chair-
man, Department of Ob/Gyn at MSU’s College
of Human Medicine. With him on one panel,
from left, were Thomas DePuydt, College of Hu-
man Medicine senior; J. A. Caruso, MD, Lansing;
Ray Hansen, College of Human Medicine senior,
and W. E. Maldonado, MD, director of labora-
tories at Sparrow Hospital.

Key persons at the clinic, which presented live
televised medical procedures and panel discus-
sions, were, from left, E. B. Leverich, MD, panel-
ist; F. W. Tamblyn, MD, clinic chairman, and
Henry Malcolm, MD, panelist. All are members
of the Lansing Ob/Gyn Society, and Doctor Tam-
blyn is president.

118 MICHIGAN MEDICINE FEBRUARY 1972

Campbell’s Soups...

wide variety... for limited appetites

Many people lose interest in food as they grow
older. Some of them are fussy eaters — with only
a few favorite foods. Others become indifferent
to foods — because planning and preparing meals
becomes a chore. Here Campbell’s Soups can help
— for these four very good reasons:

Appeal With a variety of tastes, textures,
aromas, and colors, Campbell’s Soups can
add interest and appetite appeal. And they’re
easy to eat — ingredients are tender, bite-size.

Even patients on special diets will find soups
they can enjoy among the more than 50 dif-
ferent varieties available.

Nourishment Campbell’s Soups contain selected
meats and sea foods, best garden vegetables —
carefully processed to help retain their natural
flavors and nutritive values.

Convenience Within 4 minutes a bowl of deli-
cious soup is heated and ready to eat.

Economy Campbell’s Soups are inexpen-
sive— an important consideration to those
whose budgets are limited.

Recommend Campbell’s Soups . . . and,
of course, enjoy them yourself. Remember,
there’s a soup for almost every patient and
diet . . . and for every meal.

Most women* with a balanced hormone profile and j
normal menses do best on a middle-of-the-road pill |
that is neither estrogen dominant nor strongly
progestogen dominant.

(*Typical clues — normal body build and breasts,
feminine appearance, healthy skin and hair. Vaginal
cytology slide — balanced “pink and blue’.’)

Some women having problems on other O.C.s
might do well on Ovulen.

Ovulen has a distinctive hormonal balance that
combines moderate estrogenic activity with a slight]
progestogen dominance. It has an excellent record
of patient acceptance.

Ovulen

Each white tablet contains: ethynodiol diacetate 1 mg./mestranol 0.1 mg.

Ml women are not equal in their endogenous
hormonal output. And, while all oral contraceptives
are fundamentally effective, they exhibit differences
n their activity levels and estrogen-progestogen
"atios that affect different women differently— in
aoth short and long-term use. Some brands
nay be insufficient for the woman's needs or else
nay exceed them.

Searle offers a family of O.C. products that covers
:he range of women’s needs to help you provide
:he right pill for the right woman at the right time.

References 1. Editorial Oral Contraceptives Which Pill for Which Patient7 Patient Care 5:90-115
Feb.) 1969 and 4:135145 (June 15)1970 2. Greenblatt, R B • Progestational Agents in Clinical
Practice. Med. Sci. 78 3749 (May) 1967 3. Kistner, R W Gynecology: Principles and Practice, ed. 2,
Chicago, Year Book Medical Publishers, 1971 4. Kistner, R. W The Pill Facts and Fallacies About
Today's Oral Contraceptives, New York, Delacorte Press. 1968 5. Nelson, J H Clinical Evaluation of
side Effects of Current Oral Contraceptives, J Reprod. Med 6 50-55 (Feb ) 1971 6. Orr, G W. Oral
Progestational Agents Therapy and Complications, S. Dakota J Med 2211-17 (Jan.) 1969

the

3 phases
of Eve

SEARLE

-

For brief summary of prescribing informatic
see following page.

the Demulen phase

Many women* who secrete more estrogen than most
do well on a pill with lower estrogen activity and an
increased progestogen overbalance.

("Typical clues— shorter, plumper, full-breasted,
with glowing skin and no wrinkles. Vaginal cytology
slide “pink’.’)

Some women with special conditions that may
be aggravated by higher estrogen-activity products
may do better on this ratio.

Demulen combines minimal estrogenic activity
with a moderate ratio of progestogen overbalance.

It is particularly well suited to the young when
low-dose (activity) is preferred. Demulen offers
little risk of the most potent progestogen side
effects; early breakthrough bleeding is often
transient.

Demulen

the Enovid-E phase

Some women* who secrete less estrogen than me
do best on a pill with a moderate estrogen
overbalance.

('Typical clues— oily complexion, acne, hirsutisr
masculinity, flat chest. Vaginal cytology slide —
“blue'.’)

Patients with estrogen deficiency may show:
premenopausal syndrome intermittent depressii
early-cycle bleeding increased appetite

scanty menses steady weight gain

vaginal candidiasis

Enovid-E not only provides increased estrogeni
activity with low progestogen activity, but also
contains the only progestogen that is not
antiestrogenic. Therefore it offers less risk of high
dose progestogen side effects.

Enovid-E

Each white tablet contains: ethynodiol diacetate 1 mg./ethinyl estradiol 50 meg
Each pink tablet in Ovulen-28,and Demulen'-28 is a placebo,
containing no active ingredients.

Both Ovulen and Demulen are available in 21- and 28-pill schedules.

Each tablet contains: norethynodrel 2.5 mg./mestranol 01 mg.

Oral contraceptives are complex medications and, after
reference to the prescribing information, should be prescribed
with discriminating care.

i

for the 3 phases of Eve:

a family of O.C. products

Ovulen' Demulen'

Each white tablet contains: Each white tablet contains:

ethynodiol diacetate 1 mg./mestranol 0.1 mg. ethynodiol diacetate 1 mg./ethinyl estradiol 50 meg.

Each pink tablet in Ovulen-28”and Demulerf-28 is a placebo, containing no active ingredients.

I

I

A

i

3

r

r;

o

t

T

9f

F.

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re

Si

Pi

[

Actions-Ovulen and Demulen act to prevent ovulation by inhibiting the out-
put of gonadotropins from the pituitary gland. Ovulen and Demulen depress
the output of both the follicle-stimulating hormone (FSH) and the luteinizing
hormone (LH).

Special note -Oral contraceptives have been marketed in the United
States since 1960. Reported pregnancy rates vary from product to product.
The effectiveness of the sequential products appears to be somewhat lower
than that of the combination products. Both types provide almost completely
effective contraception.

An increased risk of thromboembolic disease associated with the use of
hormonal contraceptives has now been shown in studies conducted in both
Great Britain and the United States. Other risks, such as those of elevated blood
pressure, liver disease and reduced tolerance to carbohydrates, have not been
quantitated with precision.

Long-term administration of both natural and synthetic estrogens in sub-
primate animal species in multiples of the human dose increases the frequency
of some animal carcinomas. These data cannot be transposed directly to man.
The possible carcinogenicity due to the estrogens can be neither affirmed nor
refuted at this time. Close clinical surveillance of all women taking oral contra-
ceptives must be continued.

Indication -Ovulen and Demulen are indicated for oral contraception.

Contraindications-Patients with thrombophlebitis, thromboembolic
disorders, cerebral apoplexy or a past history of these conditions, markedly im-
paired liver function, known or suspected carcinoma of the breast, known or
suspected estrogen-dependent neoplasia and undiagnosed abnormal genital
bleeding

Warnings-The physician should be alert to the earliest manifestations of
thrombotic disorders (thrombophlebitis, cerebrovascular disorders, pulmonary
embolism and retinal thrombosis). Should any of these occur or be suspected
the drug should be discontinued immediately.

Retrospective studies of morbidity and mortality conducted in Great Britain
and studiesof morbidity in the United States have shown a statistically significant
association between thrombophlebitis, pulmonary embolism, and cerebral
thrombosis and embolism and the use of oral contraceptives. There have been
three principal studies in Britain13 leading to this conclusion, and one4 in this
country. The estimate of the relative risk of thromboembolism in the study by
Vessey and Doll3 was about sevenfold; while Sartwell and associates4 in the
United States found a relative risk of 4.4, meaning that the users are several
times as likely to undergo thromboembolic disease without evident cause as
nonusers. The American study also indicated that the risk did not persist after
discontinuation of administration and that it was not enhanced by long-
continued administration. The American study was not designed to evaluate
a difference between products. However, the study suggested that there might
be an increased risk of thromboembolic disease in users of sequential prod-
ucts. This risk cannot be quantitated, and further studies to confirm this finding
are desirable.

Discontinue medication pending examination if there is sudden partial or
complete loss of vision, or if there is a sudden onset of proptosis, diplopia or
migraine. If examination reveals papilledema or retinal vascular lesions medica-
tion should be withdrawn.

Since the safety of Ovulen and Demulen in pregnancy has not been demon-
strated, it is recommended that for any patient who has missed two consecutive
periods pregnancy should be ruled out before continuing the contraceptive
regimen. If the patient has not adhered to the prescribed schedule the possi-
bility of pregnancy should be considered at the time of the first missed period.

A small fraction of the hormonal agents in oral contraceptives has been
identified in the milk of mothers receiving these drugs. The long-range effect to
the nursing infant cannot be determined at this time.

Precautions-The pretreatment and periodic physical examinations
should include special reference to the breasts and pelvic organs, including a
Papanicolaou smear since estrogens have been known to produce tumors,
some of them malignant, in five species of subprimate animals. Endocrine and
possibly liver function tests may be affected by treatment with Ovulen or Demu-
len. Therefore, if such tests are abnormal in a patient taking Ovulen or Demulen,
it is recommended that they be repeated after the drug has been withdrawn for
two months. Under the influence of progestogen-estrogen preparations pre-
existing uterine fibromyomas may increase in size. Because these agents may
cause some degree of fluid retention, conditions which might be influenced by
this factor, such as epilepsy, migraine, asthma, cardiac or renal dysfunction,
require careful observation. In breakthrough bleeding, and in all cases of irregular
bleeding per vaginam, nonfunctional causes should be borne in mind. In un-
diagnosed bleeding per vaginam adequate diagnostic measures are indicated.
Patients with a history of psychic depression should be carefully observed and

the drug discontinued if the depression recurs to a serious degree. Any possible
influence of prolonged Ovulen or Demulen therapy on pituitary, ovarian, adrenal,
hepatic or uterine function awaits further study. A decrease in glucose tolerance
has been observed in a significant percentage of patients on oral contracep-
tives. The mechanism of this decrease is obscure. For this reason, diabetic pa-
tients should be carefully observed while receiving Ovulen or Demulen therapy.
Theageofthe patient constitutes no absolute limitingfactor, although treatment
with Ovulen or Demulen may mask the onset of the climacteric. The pathologist
should be advised of Ovulen or Demulen therapy when relevant specimens are
submitted. Susceptible women may experience an increase in blood pressure
following administration of contraceptive steroids.

Adversereactionsobserved in patients receivingoral contracep-
tives A statistically significant association has been demonstrated between
use of oral contraceptives and the following serious adverse reactions: thrombo-
phlebitis, pulmonary embolism and cerebral thrombosis.

Although available evidence is suggestive of an association, such a relation-
ship has been neither confirmed nor refuted for the following serious adverse
reactions: neuro-ocular lesions, e g, retinal thrombosis and optic neuritis.

The following adverse reactions are known to occur in patients receiving oral
contraceptives: nausea, vomiting, gastrointestinal symptoms (such as abdom-
inal crampsand bloating), breakthrough bleeding, spotting, change in menstrual
flow, amenorrhea during and after treatment, edema, chloasma or melasma,
breast changes (tenderness, enlargement and secretion), change in weight
(increase or decrease), changes in cervical erosion and cervical secretions, sup-
pression of lactation when given immediately post partum, cholestatic jaundice,
migraine, rash (allergic), rise in blood pressure in susceptible individuals and
mental depression.

Although the following adverse reactions have been reported in users of
oral contraceptives, an association has been neither confirmed nor refuted:
anovulation post treatment, premenstrual-like syndrome, changes in libido,
changes in appetite, cystitis-like syndrome, headache, nervousness, dizzi-
ness, fatigue, backache, hirsutism, loss of scalp hair, erythema multiforme,
erythema nodosum, hemorrhagic eruption and itching.

The following laboratory results may be altered by the use of oral contra-
ceptives: hepatic function: increased sulfobromophthalein retention and other
tests; coagulation tests: increase in prothrombin, Factors VII, VIII, IX and X;
thyroid function: increase in PBI and butanol extractable protein bound iodine,
and decrease in T3 uptake values; metyrapone test and pregnanediol deter-
mination.

References: 1. Royal College of General Practitioners: Oral Contracep-
tion and Thrombo-Embolic Disease, J. Coll. Gen. Pract. 13:267-279 (May) 1967.
2. Inman, W. H. W„ and Vessey, M. P.: Investigation of Deaths from Pulmonary,
Coronary, and Cerebral Thrombosis and Embolism in Women of Child-Bearing
Age, Brit. Med. J. 2:193-199 (April 27) 1968. 3. Vessey, M. P, and Doll, R.: Investi-
gation of Relation Between Use of Oral Contraceptives and Thromboembolic
Disease. A Further Report, Brit. Med. J. 2:651-65/ (June 14) 1969. 4. Sartwell,
P. E , Masi, A. T.; Arthes, F. G.; Greene, G. R., and Smith, H. E.: Thromboem-
bolism and Oral Contraceptives: An Epidemiologic Case-Control Study, Amer.
J. Epidem. 90365-380(Nov.) 1969.

Products of SEARLE & CO.

San Juan, Puerto Rico 00936

Enovid-E

norethynodrel 2.5 mg./mestranol 01 mg.

Actions -Enovid-E acts to prevent ovulation by inhibiting the output of
gonadotropins from the pituitary gland. Enovid-E depresses the output of both
the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH).

Indication -Enovid-E is indicated for oral contraception.

The Special Note, Contraindications, Warnings, Precautions and Adverse
Reactions listed above for Ovulen and Demulen are applicable to Enovid-E and
should be observed when prescribing Enovid-E.

Enovid-E

brand of norethynodrel with mestranol

SEARLE

SEARLE

Co

k

Fn

Lc

m:

to:

Product of G. D. Searle & Co.

P.O. Box 5110, Chicago, Illinois 60680
Where “The Pill" Began

Try Eutrorron a stubborn diastolic

pargyline hydrochloride 25 mg. and methyclothiazide 5 mg.

When you're not satisfied with your patient's diastolic
“end point ” under present treatment , consider a trial of Eutron.
It will often bring further reduction of blood pressure ,
even in severe diastolic hypertension .

Special Characteristics of Eutron :

Course of therapy usually is smooth, with
blood pressure reducing gradually over one to
three weeks.

Around-the-clock effect from a single daily dose.

Provides diuresis when edema accompanies
hypertension.

Free of central depressant action.

Lower doses of pargyline hydrochloride are
made possible because of the methyclothiazide
component.

TM— Trademark

Special Restrictions (see back of page) :

Tyramine-containing foods (e.g. aged cheese)
should be avoided. (For further listing of foods,
see back of page.)

If alcohol is used, it should be used cautiously
and in reduced amounts.

Patients should be warned against the concurrent
use of non-prescription medications (particularly
cold preparations and antihistamines), or
prescription drugs without physician’s consent.

Discontinue Eutron at least two weeks prior to
elective surgery.

Before prescribing Eutron, see prescribing

information in package insert. A brief
summary appears on next page. 201363

Brief Summary
EUTRON™

pargyline hydrochloride and methyclothiazide

Filmtab"’

INDICATIONS. EUTRON (pargyline hydrochloride and methyclothiazide) is indicated in the
treatment of patients with moderate to severe hypertension, especially those with severe
diastolic hypertension, /f is nor recommended for use m patients with mild or labile hypertension
amenable to therapy w th sedatives and/or thiazide diuretics alone.

Because of the potent diuretic properties of methyclothiazide, the combination is particularly
suited for use when congestive heart failure or other conditions requiring diuretic therapy
coexist with hypertension, or when edema attributable to antihypertensive therapy develops.

As discussed in regard to dosage and administration, it is desirable to establish the dosage
requirements for EUTRON by the administration of Eutonyl and Enduron separately.

CONTRAINDICATIONS. 1. Pargyline therapy is contraindicated in patients with pheo-
chromocytoma, paranoid schizophrenia, hyperthyroidism and advanced renal failure.

2. Pargyline should not be administered to those with malignant hypertension, or to children
under twelve years of age because significant clinical information concerning the use of the
drug in these conditions is not available.

3. In general, the following drugs or agents are contraindicated in patients receiving pargyline
hydrochloride:

a. Centrally acting sympathomimetic amines such as amphetamine and its derivatives (also
found in anorectic preparations).

Peripherally acting sympathomimetic drugs such as ephedrme and its derivatives (also
found in nasal decongestants, hay fever preparations and cold remedies).

b. Aged and natural cheese (e g., Cheddar, Camembert, and Stilton), and other foods (e g ,
pickled herring, Chianti wine, pods of broad beans, chicken livers, chocolate and yeast
products), which require the action of bacteria or molds for their preparation or preserva-
tion, because of the presence of pressor substances such as tyramine. Banana peels are
also contraindicated. Cream cheese, processed cheese, and cottage cheese can be allowed
in the diet during EUTRON therapy, since their tyramine content is inconsequential.

In some patients receiving EUTRON, tyramine may precipitate an abrupt rise in blood
pressure accompanied by some or all of the following : severe headache, chest pain, profuse
sweating, palpitation, tachycardia or bradycardia, visual disturbances, stertorous breath-
ing, coma, and intracranial bleeding (which could be fatal) A phenothiazine derivative or
phentolamine may be administered parenterally for treatment of such an acute hyper-
tensive reaction.

c. Parenteral administration of reserpine or guanethidine may cause hypertensive reactions
from sudden release of catecholamines Parenteral use of these drugs is contraindicated
during, and for at least one week following, treatment with EUTRON.

d. Imipramme, amitriptyline, desipramine, nortriptyline, or their analogues should not be
used with pargyline. The use of these drugs with monoamine oxidase inhibitors has been
reported to cause vascular collapse and hyperthermia which may be fatal A drug-free
interval (about two weeks) should separate therapy with EUTRON and use of these agents.

e. Methyldopa or dopamine, which may cause hyperexcitability in patients receiving pargyline,
should not be given.

f. Other monoamine oxidase inhibitors should not be added to a EUTRON regimen since
they may augment the effects of pargyline.

4. Methyclothiazide is contraindicated in patients with a known sensitivity to methyclothiazide
and/or other thiazide diuretics. It should not be used in patients with severe renal disease
(except nephrosis) or complete renal shutdown. Thiazide diuretics should not be used in the
presence of severe liver disease and/or impending hepatic coma Hepatic coma has been
reported as a consequence of hypokalemia in patients receiving thiazide diuretics.

WARNINGS

A PATIENTS

1. PATIENTS SHOULD BE WARNED AGAINST THE USE OF ANY OVER-THE-COUNTER
PREPARATIONS, PARTICULARLY "COLD PREPARATIONS” AND ANTIHISTAMINES
OR PRESCRIPTION DRUGS WITHOUT THE KNOWLEDGE AND CONSENT OF THE
PHYSICIAN.

2. PATIENTS SHOULD BE CAUTIONED ON THE USE OF CHEESE (SEE CONTRAINDICA-
TIONS) AND ALCOHOLIC BEVERAGES IN ANY FORM.

3. PATIENTS SHOULD BE WARNED ABOUT THE LIKELIHOOD OF THE OCCURRENCE OF
ORTHOSTATIC HYPOTENSION

4. PATIENTS SHOULD BE INSTRUCTED TO REPORT PROMPTLY THE OCCURRENCE OF
SEVERE HEADACHE OR OTHER UNUSUAL SYMPTOMS

5. PATIENTS WITH ANGINA PECTORIS OR CORONARY ARTERY DISEASE SHOULD
BE ESPECIALLY WARNED NOT TO INCREASE THEIR PHYSICAL ACTIVITIES IN
RESPONSE TO A DIMINUTION IN ANGINAL SYMPTOMS OR AN INCREASE IN WELL-
BEING OCCURRING DURING TREATMENT WITH EUTRON.

B, PHYSICIANS

1. WHEN INDICATED THE FOLLOWING SHOULD BE CAUTIOUSLY PRESCRIBED IN
REDUCED DOSAGES:

a. ANTIHISTAMINES

b. HYPNOTICS, SEDATIVES OR TRANQUILIZERS

c. NARCOTICS (MEPERIDINE SHOULD NOT BE USED)

2. DISCONTINUE EUTRON AT LEAST TWO WEEKS PRIOR TO ELECTIVE SURGERY,

3. IN EMERGENCY SURGERY THE DOSE OF NARCOTICS OR OTHER PREMEDICATIONS
SHOULD BE REDUCED TO 1/4 TO 1/5 THE USUAL AMOUNT. CLINICAL EXPERIENCE
HAS SHOWN THAT RESPONSE TO ALL ANESTHETIC AGENTS CAN BE EXAGGERATED
IN PATIENTS RECEIVING EUTRON. THEREFORE THE DOSE OF THE ANESTHETIC
SHOULD BE CAREFULLY ADJUSTED.

4. PARGYLINE HYDROCHLORIDE MAY INDUCE HYPOGLYCEMIA.

5. CARE SHOULD BE EXERCISED IN USING EUTRON IN PATIENTS WITH ADVANCED
RENAL FAILURE.

The possibility of sensitivity reactions to methyclothiazide or pargyline should be considered
in patients with a history of allergy or bronchial asthma.

There have been several reports published and unpublished, concerning nonspecific small
bowel lesions consisting of stenosis with or without ulceration, associated with the administra-
tion of enteric-coated thiazides with potassium salts. These lesions may occur with enteric-
coated potassium tablets alone or when they are used with nonenteric-coated thiazides, or
certain other oral diuretics.

These small bowel lesions have caused obstruction, hemorrhage and perforation. Surgery
was frequently required and deaths have occurred.

Available information tends to implicate enteric-coated potassium salts although lesions
of this type also occur spontaneously. Therefore, coated potassium-containing formulations
should be administered only when adequate dietary supplementation is not practical, and
should be discontinued immedizo 'y if abdominal pain, distention, nausea, vomiting or gas-
trointestinal bleeding occurs.

The possibility of exacerbation or activation of systemic lupus erythematosus has been
reported for sulfonamide derivatives, including thiazides.

EUTRON does not contain added potassium.

USE IN PREGNANCY

Pargyline Hydrochloride. Safe use of pargyline during pregnancy or lactation has not yet
been established. Before prescribing pargyline in pregnancy, in lactation, or in women of
childbearing age, the potential benefits of the drug should be weighed against its possible
hazaid to mother and child.

Methyclothiazide. Thiazides should be used with caution in pregnant women and nursing
mothers since they cross the placental barrier and appear in cord blood and in breast milk.
The use of thiazides may result in fetal or neonatal jaundice, bone marrow depression and
thrombocytopenia, altered carbohydrate metabolism in newborn infants of mothers showing
decreased glucose tolerance, and possible other adverse reactions which have occurred in
the adult. When the drug is used in women of childbearing age, the potential benefits of the
drug should be weighed against the possible hazards to the fetus.

PRECAUTIONS

Pargyline Hydrochloride. The therapeutic response to a variety of drugs may be changed,
or exaggerated, in patients receiving a monoamine oxidase inhibitor such as pargyline hydro-
chloride. Caffeine, alcohol, antihistamines, barbiturates, chloral hydrate, and other hypnotics,
sedatives, tranquilizers and narcotics (meperidine should not be used), should be used
cautiously and at reduced dosage in patients who are taking pargyline.

Pargyline has not been shown to damage the kidney or liver. However, laboratory studies
including complete blood counts, urinalyses, and liver function tests should be performed
periodically. The drug should be used with caution in the presence of liver disease. All patients
with impaired circulation to vital organs from any cause including those with angina pectoris,
coronary artery disease, and cerebral arteriosclerosis should be closely observed for symptoms
of orthostatic hypotension. If hypotension develops in these patients, EUTRON dosage should
be reduced or therapy discontinued since severe and/or prolonged hypotension may precipitate
cerebral or coronary vessel thromboses.

The hypotensive effect of pargyline may be augmented by febrile illnesses. It may be advisa-
ble to withdraw the drug during such diseases.

Since pargyline is excreted primarily in the urine, patients with impaired renal function
may experience cumulative drug effects. Such patients should also be watched for elevations
of blood urea nitrogen and other evidence of progressive renal failure. If such alterations
should persist and progress, the drug should be discontinued.

An increased response to central depressants may be manifested by acute hypotension
and increased sedative effect. Pargyline also may augment the hypotensive effects of anesthetic
agents and surgery. For this reason, the drug should be discontinued from at least two weeks
prior to surgery.

In the event of emergency surgery smaller than usual doses (1/4 to 1/5) of narcotics,
analgesics, sedatives, and other premedications should be used. If severe hypotension should
occur, this can be controlled by small doses of a vasopressor agent such as levarterenol.

Pargyline therapy should not be used in individuals with hyperactive or hyperexcitable
personalities, as some of these patients show an undesirable increase in motor activity with
restlessness, confusion, agitation and disorientation. Clinical studies have shown that par-
gyline may unmask severe psychotic symptoms such as hallucinations or paranoid delusions
in some patients with pre-existing serious emotional problems. This can usually be controlled
by judicious administration of chlorpromazine intramuscularly, or other phenothiazines, the
patient remaining supine for one hour after administration.

Pargyline should be used with caution in patients with Parkinsonism, as it may increase
symptoms. In addition, great care is required if pargyline is administered in conjunction with
anti-parkinsonian agents.

In experience to date, pargyline has not been associated with eye changes or optic atrophy
as reported with the use of some hydrazine monoamine oxidase inhibitors. However, patients
receiving this drug for prolonged periods should be examined for any changes in color per-
ception, visual fields, fundi, and visual acuity.

Clinical reports state that certain individuals receiving pargyline for a prolonged period of
time are refractory to the nerve-blocking effects of local anesthetics, e g., lidocaine.
Methyclothiazide. Thiazide therapy should be used with caution in patients with severely
impaired renal function because of the possibility of cumulative effects. Caution is also nec-
essary in patients with severely impaired hepatic function or progressive liver disease.

Thiazide drugs may reduce response to levarterenol Accordingly, the dosage of vasopressor
agents may need to be modified in surgical patients who have been receiving thiazide therapy.

Thiazide drugs may increase the responsiveness to tubocurarine.

The antihypertensive effect of the drug may be enhanced in the svmpathectomized patient.

All patients should be observed for clinical signs of fluid or electrolyte imbalance, including
hyponatremia ("low-salt” syndrome). These include thirst, dryness of the mouth, lethargy
and drowsiness.

Hypokalemia may occur during therapy with methyclothiazide. In such cases supplemental
potassium may be indicated. Potassium depletion can be hazardous in patients taking digitalis.
Myocardial sensitivity to digitalis is increased in the presence of reduced serum potassium
and signs of digitalis intoxication may be produced by formerly tolerated doses of digitalis.
Hypochloremic alkalosis may occur following intensive or prolonged thiazide therapy. Re-
placement of chloride may be indicated in such cases.

Thiazides may decrease serum P.B.I. levels without signs of thyroid disturbance.
ADVERSE REACTIONS. Generally side effects should not be severe or serious when the
recommended dosages are used, and necessary precautions are observed. If side effects
are severe or persist in spite of symptomatic treatment, the dosage should be reduced or the
drug withdrawn. See also Warnings and Precautions.

Pargyline Hydrochloride. The most frequently occurring side effects are those associated
with orthostatic hypotension (dizziness, weakness, palpitation, or fainting). These usually
respond to a reduction of dosage. Patients should be warned against rising to a standing
position too quickly, especially when getting out of bed. Severe and persistent orthostatic
hypotension should be avoided by reduction in dosage and/or discontinuation of therapy.

Mild constipation, fluid retention with or without edema, dry mouth, sweating, increased
appetite, arthralgia, nausea and vomiting, headache, insomnia, difficulty in micturition night-
mares, impotence and delayed ejaculation, rash and purpura, have also been encountered.
Hyperexcitability, increased neuromuscular activity (muscle twitching) and other extra-pyra-
midal symptoms have been reported. Gain in weight may be due either to edema or increased
appetite. Drug fever is extremely rare. In some patients reduction of blood sugar has been
noted. Although the significance of this has not been elucidated, the possibility of hypo-
glycemic effects should be borne in mind. Congestive heart failure has been reported in patients
with reduced cardiac reserve.

Methyclothiazide. Side effects that may accompany thiazide therapy include anorexia,
nausea, vomiting, diarrhea, headache, dizziness, paresthesias, weakness, skin rash, photo-
sensitivity. Jaundice and pancreatitis also have been reported.

Blood dyscrasias, including thrombocytopenia with purpura, agranulocytosis and aplastic
anemia, have been reported with thiazide drugs.

Thiazides have been reported, on rare occasions, to have elevated serum calcium to hyper-
calcemic levels. The serum calcium levels have returned to normal when the medication has
been stopped. This phenomenon may be related to the ability of the thiazide diuretics to
lower the amount of calcium excreted in the urine.

Elevations of blood urea nitrogen, serum uric acid, and blood sugar have occurred with the
use of thiazide drugs. Symptomatic gout mayTre induced.

Although not established as an adverse effect of methyclothiazide, it has been reported that
thiazide diuretics may produce a cutaneous vasculitis in elderly patients.

®>FILMTAB— Film-sealed tablets, Abbott. TM— Trademark 204364

cSMSmS ill actiori

New MSMS committee structure
works this way:

After more than a year of study, the MSMS com-
mittee structure and reporting system was re-
vamped by the Planning and Priorities Committee
and adopted by The Council.

Brooker L. Masters, MD, chairman, announced
the new procedure in October, noting that all the
innovations would be meshed into the system by
mid-1972.

Doctor Masters praised the staff which had la-
bored over committee revisions for many months
in consultation with the Planning and Priorities
Committee.

Following is the final amended report as recom-
mended by the Planning and Priorities Committee
and adopted by The Council:

Up-Dating of Committees

The majority of the committees of the Michigan
State Medical Society were established many,
many years ago— when the concerns were much
different than today.

To bring the committee structure in line with pres-
ent-day goals and objectives, all the committees
should be studied to determine if some of them
can be dropped or combined, etc. The purposes
must be reviewed and redefined.

Committee System

1. Terms

Under the present system, the committees begin
their year after the Annual Session and end it in
the spring, when they are asked to submit their
summaries of activities. Then they are re-appointed
for the following year.

This procedure limits the actual working time of
the committees to about six months.

So the committees can function on a year-round
basis, the chairmen and members could be ap-
pointed to serve two-year terms, with the expira-
tion dates staggered. No member could serve for
more than three terms — thus assuring that the
committees would periodically have new people
added.

2. Appointment of Committees

Since appointments would be made for two-year
terms, it is recommended that the officers who will

be serving during that period should jointly select,
with the consent of The Council, the doctors who
are to be invited to serve on the committees —
namely, the President, the President-Elect, the
Chairman of The Council, and the Vice Chairman
of The Council.

Recommendations for appointments would come
from the committees, MSMS officers and council-
ors, the county societies, etc.

Appointments would be made in June or July for
the ensuing MSMS fiscal year.

In addition, each year the Society would send out
a questionnaire to the entire membership of MSMS
(this could be a tear-out in Michigan Medicine) giv-
ing them an opportunity to let the Society know
they would be interested in serving on a committee.

When making their appointments, the appointing
officers should give consideration to appointing one
or two delegates to each committee. This would
involve our delegates in more committee activities.
Few now serve. The appointment of councilors and
officers to selected committees also should be con-
sidered.

As a guideline, the committees should be com-
posed of not less than eleven or not more than
twenty-one members. This size is for optimum ef-
fectiveness. Exceptions would be made in the case
of committees with unique functions.

In general, it is recommended that no vice-chair-
men be appointed.

Operation of the Committees

Annually, the committees shall develop objectives
for the coming year, based on (1) referrals from
The Council, (2) assignments from the Planning and
Priorities Committee, (3) ideas from the members
of the committee, and (4) charges from the House
of Delegates.

This plan of activities would be presented to The
Council for its information and review and subse-
quently, along with a proposed budget, submitted
to the Finance Committee of The Council so that
appropriate funds can be allocated for the imple-
mentation of the committee’s program and projects.

To carry out these projects, the committees will
have the privilege of appointing study groups to
work on an informal basis and report back to the
main committee.

(Continued on Page 128)

MICHIGAN MEDICINE FEBRUARY 1972 125

I

I

A

1

a

i

rl

cl

i

i

?

F

[

t4 is the

PREDICTABLE
HORMONE BECAUSE
IT LOVES PROTEIN.

ALL THYROID-
FUNCTION TESTS ARE
USEFUL IN
MONITORING
SYNTHROID THERAPY

TWO GOOD REASONS
WHY THE ROAD TO
NORMALIZED
THYROID STATUS IS
SO SMOOTH FOR THE
SYNTHROID PATIENT.

HY1

SYNTHROID® (sodium
levothyroxine) is pure synthetic T4,
the major circulating thyroid
hormone. It is reliable to use
because of its affinity for protein-
binding sites in the blood. T3 is
more fickle. Sometimes it binds.
Sometimes it doesn’t. T4 more
predictably binds to protein.

No calculations are needed, test
interpretation is simple.

Any of the commonly used T4
thyroid function tests (P.B.I., T4 By
Column, Murphy-Pattee, Free
Thyroxine) are useful in monitoring
patients on T4 because they all
measure T4. Patients on
SYNTHROID are thereby easy to
monitor because their results will
fall within predictable, elevated
test ranges. Of course, clinical
assessment is the best criterion of
the thyroid status of the drug-
treated patient.

TEST

HYPOTHYROID

SYNTHROID

THERAPEUTIC

NORMAL

P.B.I.

Less than 4 meg %

6-10 meg %

T4 By Column

Less than 3 meg %

7-9 meg %

T 3 (Resin)

Less than 25%

27-35%

T 3 (Red Cell)

Less than 11%

11.5-18%

Free Thyroxine

Less than 0.7
nanograms %

0.7-2.5

nanograms %

Murphy-Pattee

Less than 2.9
meg %

4-1 1 meg %

Gtjoose

rnootfi

(1) The onset of action of T4 is
gradual. It has a long in vivo
“half-life” of over six days.
(Occasional missed doses or
accidental double-doses are of less
concern because of this factor)’;

(2) since SYNTHROID contains only
T4, the potential for metabolic
surges traceable to more potent
iodides (T3) is eliminated.

• r

"

AS WITH ANY
THYROID
PREPARATION,
CAUTIOUS

OBSERVATION OF THE
PATIENT DURING THE
BEGINNING OF
THERAPY WILL ALERT
THE PHYSICIAN TO
ANY UNTOWARD
EFFECTS.

.:s;

■ ■

a

Side effects, when they do occur,
are related to excessive dosage.
Caution should be exercised in
administering the drug to patients
with cardiovascular disease. Read is
the accompanying prescribing
information for additional data or
write Flint Laboratories.

tfiyroid replacement tljerapy "*

inti

i :

ONE

WAY

TOLL

AHEAD

ATIENTS CAN BE
LTCCESSFULLY
[AINTAINED ON A
RUG CONTAINING
HYROXINE ALONE.

yroxine (T4) is, as you know,

3 major circulating hormone
educed by the thyroid gland,
is also produced, in smaller
lounts, and is active at the
ilular level. For years it has been
working hypothesis among
docrinologists that T4 is
averted by the body to T3. In
70 this process, called
eiodination,” was demonstrated
Braverman, Ingbar, and Sterling2,
does convert to T3, though the
ecise quantities are still being
jdied.

The conversion has been
nically demonstrated during the
ministration of T4 to athyrotic
tients. Their thyroid status is
rmalized on SYNTHROID alone,
t the presence of T3 in these
tients has been clearly shown.

WHY DOES SYNTHROID
COST LESS THAN
SYNTHETIC DRUGS
CONTAINING T3?

Very simple. T3 costs more to make
synthetically than does T4. So it is
economically necessary for a
synthetic thyroid medication
containing T3 to cost more than
one containing T4 alone. Synthetic
combinations cost patients nearly
50% more than SYNTHROID3
because the T3 costs more to start
with; also there is the additional
expense of formulating a tablet
containing two active ingredients.

1. Latiolais, C. J., and Berry, C. C.: Misuse of
Prescription Medications by Outpatients,

Drug Intelligence S Clin. Pharm. 3:270-7, 1969.

2. Braverman, L. E., Ingbar, S. H., and
Sterling, K.: Conversion of Thyroxine (T4) to
Triiodothyronine (T3) in Athyreotic Human
Subjects, J. Clin. Invest. 49:855-64, 1970.

3. American Druggist BLUEBOOK, March, 1971.

Synthroid

sodium levothyroxine)

HE FACTS ARE
LEAR AND HERE
3 OUR OFFER.

\CTS:

mthetic thyroid drugs are an
iprovement over animal gland
oducts. Patients, even athyrotic
les, can be completely
aintained on SYNTHROID (T4)
one. Thyroid function tests are
isy to interpret since they are
edictably elevated when the
itient adheres to SYNTHROID.

: all synthetic thyroid drugs,
fNTHROID is the most
onomical to the patient.

| n

;| OFFER:

j Free TAB-MINDER medication
dispensers to start or convert all
your hypothyroid patients to
| SYNTHROID. Free information to
physicians on role of thyroid
ll function tests in a new booklet
titled: “Guideposts to Thyroid

Therapy.” Ask us. ;;

Name S'

Address •!

City State Zip |

Indications: SYNTHROID (sodium levothyroxine) is spe-
cific replacement therapy for diminished or absent
thyroid function resulting from primary or secondary
atrophy of the gland, congenital defect, surgery, ex-
cessive radiation, or antithyroid drugs. Indications for I
SYNTHROID (sodium levothyr >xine) Tablets include ,
myxedema, hypothyroidism without myxedema, hypo-
thyroidism in pregnancy, pediatric and geriatric hypo-
thyroidism, hypopituitary hypothyroidism, simple
(nontoxic) goiter, and reproductive disorders asso-
ciated with hypothyroidism. SYNTHROID (sodium levo-
thyroxine) for Injection is indicated for intravenous
use in myxedematous coma and other thyroid dysfunc-
tions where rapid replacement of the hormone is re-
quired.The injection is also indicated for intramuscular
use in cases where the oral route is suspect or con-
traindicated due to existing conditions or to absorp-
tion defects, and when a rapid onset of effect is not
desired.

Precautions: As with other thyroid preparations, an
overdosage may cause diarrhea or cramps, nervous-
ness, tremors, tachycardia, vomiting and continued
weight loss. These effects may begin after four or five
days or may not become apparent for one to three
weeks. Patients receiving the drug should be observed
closely for signs of thyrotoxicosis. If indications of
overdosage appear, discontinue medication for 2-6
days, then resume at a lower dosage level. In patients
with diabetes mellitus, careful observations should be
made for changes in insulin or other antidiabetic drug :
dosage requirements. If hypothyroidism is accom-
panied by adrenal insufficiency, as Addison’s Disease
(chronic subcortical insufficiency), Simmonds’s Dis-
ease (panhypopituitarism) or Cushing’s syndrome (hy-
peradrenalism), these dysfunctions must be corrected
prior to and during SYNTHROID (sodium levothyroxine)
administration. The drug should be administered with
caution to patients with cardiovascular disease; devel-
opment of chest pains or other aggravations of cardio-
vascular disease requires a reduction in dosage.
Contraindications: Thyrotoxicosis, acute myocardial
infarction. Side effects: The effects of SYNTHROID
(sodium levothyroxine) therapy are slow in being mani-
fested. Side effects, when they do occur, are secondary 1
to increased rates of body metabolism; sweating, h'eart
palpitations with or without pain, leg cramps, and
weight loss. Diarrhea, vomiting, and nervousness have
also been observed. Myxedematous patients with heart
disease have died from abrupt increases in dosage of
thyroid drugs. Careful observation of the patient during
the beginning of any thyroid therapy will alert the
physician to any untoward effects.

In most cases with side effects, a reduction of dos-
age followed by a more gradual adjustment upward
will result in a more accurate indication of the pa-
tient’s dosage requirements without the appearance
of side effects.

Dosage and Administration: The activity of a 0.1 mg.
SYNTHROID (sodium levothyroxine) TABLET is equiva-
lent to approximately one grain thyroid, U.S.P. Admin-
ister SYNTHROID tablets as a single daily dose,
preferably after breakfast. In hypothyroidism without
myxedema, the usual initial adult dose is 0.1 mg. daily,
and may be increased by 0.1 mg. every 30 days until
proper metabolic balance is attained. Clinical evalua-
tion should be made monthly and PB1 measurements
about every 90 days. Final maintenance dosage will
usually range from 0.2-0.4 mg. daily. In adult myx-
edema, starting dose should be 0.025 mg. daily. The
dose may be increased to 0.05 mg. after two weeks
and to 0.1 mg. at the end of a second two weeks. The
daily dose may be further increased at two-month in-
tervals by 0.1 mg. until the optimum maintenance dose
is reached (0. 1-1.0 mg. daily).

Supplied: Tablets: 0.025 mg., 0.05 mg., 0.1 mg., 0.15
mg., 0.2 mg., 0.3 mg., 0.5 mg., scored and color-coded,
in bottles of 100, 500, and 1000. Injection: 500 meg.
lyophilized active ingredient and 10 mg. of Mannitol,

N.F., in 10 ml. single-dose vial, with 5 ml. vial of So-
dium Chloride Injection, U.S.P., as a diluent.
SYNTHROID (sodium levothyroxine) for Injection may
be administered intravenously utilizing 200-400 meg.
of a solution containing 100 meg. per ml. If significant
improvement is not shown the following day, a repeat
injection of 100-200 meg. may be given.

FLINT LABORATORIES

DIVISION OF TRAVENOL LABORATORIES. INC
Morton Grove, Illinois 60053

NEW COMMITTEE STRUCTURE/Continued

Generally, we would look with disfavor on sub-
committees.

Also, the chairman of the committee will have the
privilege of inviting guests, advisors, or consultants
to meet with this committee as he feels they are
needed.

Reporting to The Council

Currently, only committee recommendations are
acted upon (approved, amended, or disapproved)
by The Council, yet it must review all of the com-
mittee minutes whether or not recommendations
are contained therein.

To reduce the volume of work by The Council, it
is proposed that committee minutes become only a

Welcome

Members of the Michigan State Medical Society
join in welcoming the following new members into
a progressive state medical organization. MSMS is
dedicated to promoting the science and art of
medicine, the protection of the public health, and
the betterment of the medical profession. Each new
member is encouraged to join with other MSMS
members at both the local and the state levels in
achieving these goals.

Russell B. Dieterich, MD, 1846 Kreiser, S.E., Grand
Rapids 49506

Joseph J. Gadbaw, MD, 33925 Oakland Ave., Far-
mington 48024

Heland Garapetian-Salmasi, MD, 308 N. Mead St.,
St. Johns 48879

George W. Greenman, MD, 2311 E. Stadium Blvd.,

Ann Arbor 48104

Syed M. Jalit, MD, 27634 Five Mile Rd., Detroit
48239

Joseph R. Noveilo MD, University of Michigan,
Ann Arbor 48103

Ismaii D. Yanga, MD, 600 County Farm Rd., Howell
48843

record of committee activities and be sent as in-
formation only to The Council and MSMS leader-
ship. Any recommendations of the committee will
be written as a Special Report with explanation,
arguments, and background leading to a committee
recommendation to The Council for formal Council
action.

Special Reports of committee recommendations
should be submitted for Council approval when the
committee wishes to recommend (1) establishing a
new MSMS policy, or changing existing MSMS pol-
icy, (2) inaugurating liaison with outside agencies
which involve the committee acting as spokesman
for the Michigan State Medical Society, (3) begin-
ning new projects of major importance, especially
those involving expenditure of funds not previously
budgeted, or (4) other major decisions of similar
importance.

Internal decisions for committee action which sim-
ply involve the implementation of ongoing projects
need not be submitted as recommendations. These
would be simply indicated as motions in the com-
mittee’s minutes.

These Special Reports would be referred to the
three standing committees of The Council, which
would be:

1. Finance Committee

2. Legislative Policy Committee

3. Scientific and Educational Affairs Committee
(this name is suggested for the present
“County Societies” name which does not ap-
propriately reflect its role in reviewing min-
utes which deal primarily with scientific and
educational activities.)

After the standing committees have reviewed the
Special Reports of the committees, they will sub-
mit their committee reports to The Council.

After The Council has rendered its opinion, the
committee is to be immediately notified so it can
proceed with its work. The report is then appended
to the appropriate committee minutes, with the ac-
tion of The Council noted, and placed in the per-
manent minute book of the committee.

Each year, for the record, the committee would
prepare a summary of activities, based on its min-
utes and special reports, for distribution as infor-
mation to The Council and the House of Delegates.
A copy of the final report would be filed in the per-
manent minute book.

Planning and Priorities Committee

The purpose of the Planning and Priorities Com-
mittee is to develop a plan for the activities of
MSMS, recommend priorities according to the rela-
tive importance of each, taking into consideration
the available resources of MSMS.

The Planning and Priorities Committee is to be ap-
pointed by The Council and be composed of repre-
sentation from The Council, the House of Dele-
gates, the Council of Specialty Societies, and other
members of MSMS.

'MARY 1972

128 MICHIGAN MEDICINE

if skin is infected,
or open to infection <

choose the topicals
that give your patient™

*« broad antibacterial activity against
susceptible skin invaders
i? lowallergenic risk— prompt clinical response

Special Petrolatum Base

Neosporin* Ointment

(polymyxin B-bacitracin-neomycin)

Each gram contains: Aerosporin® brand polymyxin B sulfate, 5000 units;
zinc bacitracin, 400 units; neomycin sulfate 5 mg. (equivalent to 3.5 mg.
neomycin base); special white petrolatum q. s.

In tubes of 1 oz. and Vz oz. for topical use only.

\anishinii Cream Base

Neospormf-G Cream

(polymyxin B-neomycin-gramicidin)

Each gram contains: Aerosporin® brand polymyxin B sulfate, 10,000 j
units; neomycin sulfate, 5 mg. (equivalent to 3.5 mg. neomycin base);
gramicidin, 0.25 mg., in a smooth, white, water-washable vanishing
cream base with a pH of approximately 5.0. Inactive ingredients: liquid
petrolatum, white petrolatum, propylene glycol, polyoxyethylene
polyoxypropylene compound, emulsifying wax, purified water, and 0,25%
methyl paraben as preservative,
in tubes of 15 g.

NEOSPORIN for topical infections due to susceptible organisms, as in
impetigo, surgical after-care, and pyogenic dermatoses.

Precaution: As with other antibiotic preparations, prolonged use may
resuit in overgrowth of nonsusceptible organisms and/or fungi. Appropriate
measures should be taken if this occurs. Articles in the current medical
literature indicate an increase in the prevalence of persons allergic to
neomycin. The possibility of such a reaction should be borne in mind.
Contraindications: Not for use in the external ear canal if the eardrum is .
perforated. These products are contraindicated in those individuals who
have shown hypersensitivity to any of the components.

Complete literature available on request from Professional Services
Dept. PML.

itn

When irritable colon feels like this

. . .in the presence of spasm or hypermotility,
gas distension and discomfort, KINESED®
provides more complete relief :

□ belladonna alkaloids— for the hyperactive bowel

n simethicone— for accompanying distension and pain due to gas

□ phenobarbital— for associated anxiety and tension

Composition: Each chewable, fruit-flavored, scored tab-
let contains: 16 mg. phenobarbital (warning: may be
habit-forming); 0.1 mg. hyoscyamine sulfate; 0.02 mg.
atropine sulfate; 0.007 mg. scopolamine hydrobromide;
40 mg. simethicone.

Contraindications: Hypersensitivity to barbiturates or
belladonna alkaloids, glaucoma, advanced renal or he-
patic disease.

Precautions: Administer with caution to patients with
incipient glaucoma, bladder neck obstruction or uri-

nary bladder atony. Prolonged use of barbiturates may
be habit-forming.

Side effects: Blurred vision, dry mouth, dysuria, and
other atropine-like side effects may occur at high doses,
but are only rarely noted at recommended dosages.
Dosage: Adults: One or two tablets three or four times
daily. Dosage can be adjusted depending on diagnosis
and severity of symptoms. Children 2 to 12 years: One
half or one tablet three or four times daily. Tablets may
be chewed or swallowed with liquids.

STUART PHARMACEUTICALS I Pasadena, California 91109 | Division of ATLAS CHEMICAL INDUSTRIES, INC.

(from the Greek kinetikos,
to move,

and the Latin sedatus,
to calm)

KINESED*

antispasmodic/sedative/antiflatulent

Spring peeper (tree frog, Hyla crucifer ):
this small amphibian can expand
its throat membrane with air until it is
twice the size of its head.

MICHIGAN MEDICINE FEBRUARY 1972 131

< ^Mictiigari medisceqe

Feb. 7-10 — Advances in Internal Medicine, post-
graduate course, Towsley Center for Continuing
Medical Education, University Medical Center,
Ann Arbor, contact: Chairman, Department of
Postgraduate Medical Education, Towsley Center,
Ann Arbor, 48104

Feb. 9 — Michigan Committee on Trauma, American
College of Physicians, 6:30 p.m., MSMS Head-
quarters, contact: Thomas C. Blair, MD, 1322 E.
Michigan Ave., Lansing, 48912

Feb. 10 — Interim session, Michigan State Pharma-
ceutical Association, House of Delegates, Lans-
ing, contact: Louis M. Sesti, RPh, MSPA director,
1812 Michigan National Tower, Lansing, 48933

Feb. 12 — Annual seminar, Michigan Society of
Pathologists, “The Role of the Laboratory in
Clinical Immunology,” 1:30 p.m. Henry Ford
Hospital Auditorium, Detroit

March 12 — Michigan Academy of Family Physicians,
board meeting, MSMS Headquarters, contact:'
Louis R. Zako, MD, MAFP president, 7720 Allen
Road, Allen Park, 48101

March 19 — The Council, Sheraton Cadillac Hotel,
Detroit, contact: Warren F. Tryloff, MSMS Head-
quarters

March 20-21 — Spring Session, MSMS House of
Delegates, Detroit Hilton Hotel, contact: Richard
Campau, MSMS Headquarters

March 26 — Michigan State Medical Assistants So-
ciety, board meeting, 11 a.m., MSMS Head-
quarters, contact: Mrs. Betty L. Boers, president,
MSMAS, 1116 Sheridan, Kalamazoo, 49001

March 29 — Muskegon Trauma Day, Holiday Inn,
Muskegon, contact: Guida Anessa, MD, 205 Medi-
cal Center, Muskegon

March 29-30 — Annual Michigan Conference on Ma-
ternal and Perinatal Health, Olds Plaza Hotel,
Lansing, contact: Joseph L. Sheets, MD, 2909 E.
Grand River, Lansing, or Helen Schulte, MSMS
Headquarters

April 3 — Annual Beaumont Lecture — Wayne County
Medical Society, Detroit, contact: William Blod-
gett, MD, Wayne County Medical Society, 1010
Antietam, Detroit, 48207

April 5-8 — 49th Annual Meeting, American Ortho-
psychiatric Association, Cobo Hall, Detroit, con-
tact: Sylvia F. Gruggett, AOA, 1790 Broadway,
New York, N.Y., 10019

April 8 — Health Careers Day, Michigan State Uni-
versity, sponsored by MSU and Michigan Health

Council, contact: John A. Doherty, MHC, 712
Abbott, East Lansing, 48823
April 13-15 — Michigan Heart Association Heart
Days, Cobo Hall, Detroit, contact: Harold Arnow,
publicity director, MHA, 13100 Puritan, Detroit,
48227

April 19 — Woman’s Auxiliary to MSMS, Legislative
Day, Olds Plaza, Lansing, contact: Mrs. R. J.
Westerhoff, 2458 Maplewood, SE, Grand Rapids,
49506

April 19-20 — Woman's Auxiliary to MSMS, spring
conference, Hospitality Inn, Lansing, contact:
Mrs. Charles Schoff, 5209 Sunset Drive, Midland,
48640

April 26 — The Council, MSMS Headquarters, con-
tact: Warren F. Tryloff, MSMS Headquarters
April 27-30 — Annual Convention, Michigan State
Medical Assistants Society, Holiday Inn, Cross-
town Parkway, Kalamazoo, contact: Mrs. Betty
Boers, 1116 Sheridan, Kalamazoo, 49001
April 30-May 5 — American Nurses Association Bi-
ennial Convention, Cobo Hall, Detroit, contact:
Miss Virginia Stone, executive director, Detroit
District, Michigan Nurses Association, 316 Fisher
Building, Detroit, 48202

May 18-19 — Annual Gull Lake meeting, MSMS Com-
mittee on Maternal and Perinatal Health, Kellogg
Biological Station, Gull Lake, contact: Helen
Schulte, MSMS Headquarters
May 20-27 — Michigan Week

May 22-23 — Michigan Chapter meeting and scien-
tific session of the American College of Emer-
gency Physicians, Shanty Creek, Bellaire, con-
tact: Gaius Clark, MD, 865 Pebblebrook Lane,
East Lansing, 48823

June 2-3 — Gaylord Trauma Day, Hidden Valley Ot-
sego Ski Club, Gaylord, contact: Benjamin Henig,
MD, Keyport Clinic, 308 Michigan Ave., Grayling,
49738

June 5-7 — Initial Management of the Acutely III and
Injured Patient, Ann Arbor, contact: Charles F.
Frey, MD, Department of Surgery, University of
Michigan Medical Center, Ann Arbor, 48104
June 7 — The Council, MSMS Headquarters, contact:
Warren F. Tryloff, MSMS Headquarters
June 18-22 — Many Michigan physicians will attend
AMA Annual Convention in San Francisco
June 23-24— Annual Meeting, Upper Peninsula
Medical Society, Holiday Inn, Marquette, contact:
Thomas B. Bolitho, MD, UPMS president, 1414
W. Fair Ave., Marquette, 49855
July 27-28 — Coller-Penberthy-Thirlby Conference,
Park Place Motor Inn, Traverse City, contact: L.
P. Skendzel, MD, Traverse City, chairman
Oct. 1 and 4 — The Council, Sheraton-Cadillac Ho-
tel, Detroit, contact: Warren F. Tryloff, MSMS
Headquarters

Oct. 7-5— 107th Annual Session of the Michigan
State Medical Society, Sheraton-Cadillac Hotel,
Detroit, contact: Richard Campau, MSMS Head-
quarters, 120 W. Saginaw, East Lansing, 48823
Nov. 8 — The Council, special meeting, noon, MSMS
Headquarters, contact: Warren F. Tryloff, MSMS
Headquarters

Dec. 6 — The Council, MSMS Headquarters, contact:
Warren F. Tryloff, MSMS Headquarters

132 MICHIGAN MEDICINE FEBRUARY 1972

Note

from Jim Imboden
about ‘your opinion please’

James Imboden, AM A Field representative for
Michigan, recently sent the following note to his
boss, R. G. Layton, director of the AMA field serv-
ice department:

“Attached are the opinions of several Michigan
physicians regarding prepaid group practice, from
the November, 1971 issue of Michigan Medicine,
‘Your opinion please’ section.

“There is some really outstandingly clear thinking
on the part of these fellows and I knew that you
would be interested in what they have to say.

“Incidentally, Dick, this portion of the journal,
‘Your opinion please,’ is one which appears reg-
ularly in Michigan Medicine and I have found it
one of the most interesting segments to be found
in any medical journal anywhere. ... It really gives
you that grass roots thinking and it’s for sure it
doesn’t pay to ever get too far away from ‘what
the doctor is thinking.’ ”

These Michigan doctors
took part

in AMA convention

Eleven Michigan physicians were on the program
of the 1971 AMA Clinical (Convention Nov. 28-Dec.
1 in New Orleans.

Richard W. Schneider, MD, Ann Arbor, presided
over a meeting on “Innovations in Sports Medicine
through State Medical Societies”; while James P.
Muldoon, MD, Grand Rapids, made a presentation
on “The Management of Acute Diverticulitis of the
Colon.”

Franklin V. Wade, MD, Flint, as a member of
the Special Exhibit Committee on Fractures, took
part in continuous demonstrations of the manage-
ment of fractures of the hand, ankle and knee in
the exhibit center.

Doctors Robert E. Burns, Joseph P. Abraham and
Thomas A. Chapel of Detroit represented Henry
Ford Hospital with an exhibit on “Visible Evidence
of Red Cell Disease”; while a display entitled “Can
Oral Penicillin Be Malabsorbed?” was presented
by Evelyn J. Fisher, MD, E. L. Quinn, MD, Frank
Cox, MD, W. Haubrich, MD, and J. Ponka, MD,
also of Henry Ford Hospital.

Doctor Furlong

Doctor Heidenreich

Doctor Harris

Doctor Leader

Four MSMS members
end dedicated service
as AMA delegates

Four Michigan physicians have retired after giv-
ing long and dedicated service to MSMS as dele-
gates to the AMA. They are Harold Furlong, MD,
Pontiac, and Bradley Harris, MD, Ann Arbor, who
were alternate delegates, and John R. Heidenreich,
MD, Menominee, and Luther R. Leader, MD, Pon-
tiac, who were full MSMS delegates.

The four doctors’ terms of office ended Dec. 31.

Taking their places at the next AMA meeting
June 18-22 in San Francisco will be John W.
Moses, MD, Detroit, and Paul T. Lahti, MD, Royal
Oak, who were moved from the position of alternate
delegate to full delegate at the MSMS Annual
Session Oct. 3-7 in Grand Rapids. Four new alter-
nate delegates were elected at the Annual Session
to replace the retiring Doctor Harris and Doctor
Furlong and the promoted Doctor Moses and
Doctor Lahti. The new alternates are Frank B.
Walker II, MD, Grosse Pointe; Donald T. Anderson,
MD, Kingsford; Richard McMurray, MD, Flint, and
Brooker L. Masters, MD, Fremont.

MICHIGAN MEDICINE FEBRUARY 1972 133

°Iil small doses

Mario M. Chaves, MD, of Brazil,

is the new program director for the Latin Ameri-
can interests of the W. K. Kellogg Foundation.
Doctor Chaves holds both dentistry and medicine
degrees and most recently was associate direc-
tor of the Pan American Federation of Associa-
tions of Medical Schools and of the Latin Ameri-
can Association of Dental Schools.

Julio C. Davila, MD, of San Francisco,

is new chief of the Thoracic Surgery Division
at Henry Ford Hospital, Detroit.

Andrew D. Hunt, Jr., MD, East Lansing,

dean of the MSU College of Human Medicine,
is new president of the board of directors of the
Michigan Association for Regional Medical Pro-
grams. New vice president is John Gronvall, MD,
dean of the U-M Medical School, and new secre-
tary-treasurer is D. Bonta Hiscoe, MD, Lansing,
past president, Ingham County Medical Society.

Fernando Leon, MD, Detroit,

is the winner for the second time of the semi-
annual Semmes Awards at Bon Secours Hospital,
Grosse Pointe, for displaying genuine interest in
and sympathetic attitude toward patients and
their families.

Donald F. Moore, MD, formerly of Kalamazoo,

is new president of the Central Neuropsychiatric
Association. The association serves neurologists,
neurosurgeons and psychiatrists for the central,
southern and western states. Doctor Moore is
now professor of psychiatry at Indiana University
School of Medicine.

Harry A. Towsley, MD, Ann Arbor,

who retired in June as chairman of the Depart-
ment of Postgraduate Medical Education at the
University of Michigan, was honored recently
by the Midland County Medical Society at a din-
ner and reception. The event was staged in con-
junction with the MSMS Fall PG course in Mid-
land, which is to be renamed locally the Harry
Towsley Clinic Day. Doctor Towsley, who is still
with the U-M Medical Center as editor of the
Medical Center Journal, is a native Midlander.

Gerald S. Wilson, MD, Detroit,

is new chairman of the board of the Michigan
Cancer Foundation. Doctor Wilson is joined by
new board member Ethelene J. Crockett, MD.
Doctor Wilson is chief of surgery at The Grace
Hospital and Doctor Crockett is vice chairman
of the board of the Regional Medical Programs
and board member of the Comprehensive Health
Planning Council, the Health Council of New
Detroit, Inc., and the United Community Services.

134 MICHIGAN MEDICINE FEBRUARY 1972

Pre-Sate

(chlorphentermine hydrochloride)

Caution: Federal law prohibits dispensing without prescrip-
tion.

Indications

Pre-Sate (chlorphentermine hydrochloride) is indicated in
exogenous obesity, as a short term (i.e. several weeks) adjunct
in a regimen of weight reduction based upon caloric restriction.

Contraindications

Glaucoma, hyperthyroidism, pheochromocytoma, hypersen-
sitivity to sympathomimetic amines, and agitated states. Pre-
Sate (chlorphentermine hydrochloride) is also contraindicated
in patients with a history of drug abuse or symptomatic cardio-
vascular disease of the following types advanced arterio-
sclerosis, severe coronary artery disease, moderate to severe
hypertension, or cardiac conduction abnormalities with danger
of arrhythmias. The drug is also contraindicated during or
within 14 days following administration of monamine oxidase
inhibitors, since hypertensive crises may result.

Warnings

When weight loss is unsatisfactory the recommended dosage
should not be increased in an attempt to obtain increased ano-
rexigenic effect; discontinue the drug Tolerance to the anorectic
effect may develop. Drowsiness or stimulation may occur and
may impair ability to engage in potentially hazardous activities
such as operating machinery, driving a motor vehicle, or per-
forming tasks requiring precision work or critical judgment.
Therefore, such patients should be cautioned accordingly.
Caution must be exercised if Pre-Sate (chlorphentermine hydro-
chloride) is used concomitantly with other central nervous
system stimulants There have been reports of pulmonary hyper-
tension in patients who received related drugs
Drug Dependence Drugs of this type have a potential for abuse.
Patients have been known to increase the intake of drugs of
this type to many times the dosages recommended. In long-
term controlled studies with the high dosages of Pre-Sate,
abrupt cessation did not result in symptoms of withdrawal.
Usage In Pregnancy The safety of Pre-Sate (chlorphentermine
hydrochloride) in human pregnancy has not yet been clearly
established. The use of anorectic agents by women who are or
who may become pregnant, and especially those in the first
trimester of pregnancy, requires that the potential benefit be
weighed against the possible hazard to mother and child Use
of the drug during lactation is not recommended Mammalian
reproductive and teratogenic studies with high multiples of the
human dose have been negative

Usage In Children Not recommended for use in children under
12 years of age.

Precautions

In patients with diabetes mellitus there may be alteration of in-
sulin requirements due to dietary restrictions and weight loss.
Pre-Sate (chlorphentermine hydrochloride) should be used with
caution when obesity complicates the management of patients
with mild to moderate cardiovascular disease or diabetes mel-
litus, and only when dietary restriction alone has been unsuc-
cessful in achieving desired weight reduction In prescribing
this drug for obese patients in whom it is undesirable to intro-
duce CNS stimulation or pressor effect, the physician should
be alert to the individual who may be overly sensitive to this
drug. Psychologic disturbances have been reported in patients
who concomitantly receive an anorectic agent and a restrictive
dietary regimen
Adverse Reactions

Central Nervous System: When CNS side effects occur, they
are most often manifested as drowsiness or sedation or over-
stimulation and restlessness. Insomnia, dizziness, headache,
euphoria, dysphoria, and tremor may also occur Psychotic
episodes, although rare, have been noted even at recommended
doses. Cardiovascular: tachycardia, palpitation, elevation of
blood pressure Gastrointestinal: nausea and vomiting, diar-
rhea. unpleasant taste, constipation Endocrine: changes in
libido, impotence. Autonomic: dryness of mouth, sweating,
mydriasis Allergic: urticaria Genitourinary: diuresis and,
rarely, difficulty in initiating micturition. Others: Paresthesias,
sural spasms

Dosage and Administration

The recommended adult daily dose of Pre-Sate (chlorphen-
termine hydrochloride) is one tablet (equivalent to 65 mg chlor-
phentermine base) taken after the first meal of the day. Use in
children under 12 not recommended.

Overdosage

Manifestations: Restlessness, confusion, assaultiveness, hal-
lucinations, panic states, and hyperpyrexia may be manifesta-
tions of acute intoxication with anorectic agents. Fatigue and
depression usually follow the central stimulation. Cardiovas-
cular effects include arrhythmias, hypertension, or hypotension
and circulatory collapse Gastrointestinal symptoms include
nausea, vomiting, diarrhea, and abdominal cramps. Fatal
poisoning usually terminates in convulsions and coma
Management: Management of acute intoxication with sym-
pathomimetic amines is largely symptomatic and supportive
and often includes sedation with a barbiturate. If hypertension is
marked, the use of a nitrate or rapidly acting alpha-receptor
blocking agent should be considered Experience with hemo-
dialysis or peritoneal dialysis is inadequate to permit recom-
mendations in this regard.

How Supplied

Each Pre-Sate (chlorphentermine hydrochloride) tablet con-
tains the equivalent of 65 mg chlorphentermine base; bottles of
100 and 1000 tablets.

the increasingly practical
appetite suppressant^^

When you select this familiar antibiotic for
IV infusion you have available a broad dosage range
that hospitalized patients may neea.

Intravenous Lincocin (lincomycin
hydrochloride, Upjohn), with its 1.2 to
8 grams/ day dosage range, covers many
serious and even life-threatening
infections. Lincocin is effective in
infections due to susceptible strains of
streptococci, pneumococci, and
staphylococci. Lincocin IV therefore
can be as useful in your hospitalized
patients as its IM use has proved to be in
your office patients. As with all
antibiotics, in vitro susceptibility studies
should be performed.

In life-threatening situations as much
as 8 grams/ day has been administered
intravenously to adults.

1.2 to 8 grams/ day IV dosage range:

Most hospitalized patients with
uncomplicated pneumonias respond
satisfactorily to 1.2 to 1.8 grams/ day of
Lincocin IV. These doses may have to
be increased for more serious infections.

In usual IV doses, Lincocin (lincomycin
hydrochloride, Upjohn ) should be
diluted in 250 ml or more of normal
saline solution or 5% glucose in water.
But when 4 grams or more per day is
given, Lincocin should be diluted in not
less than 500 ml of either solution,
and the rate of administration should
not exceed 1 00 ml/hour. Too rapid
intravenous administration of doses
exceeding 4 grams may result in
hypotension or, in rare instances,
cardiopulmonary arrest.

Effective gram-positive antibiotic:

Lincocin IV is effective in respiratory
tract, skin and soft-tissue, and bone

led

.

nfections caused by susceptible strains
>f pneumococci, streptococci, and
taphylococci, including penicillin-
esistant strains. Staphylococcal strains
esistantto Lincocin (lincomycin
lydrochloride, Upjohn) have been
ecovered. Before initiating therapy,
ulture and susceptibility studies should
>e performed. Lincocin has proved
aluable in treating patients hyper-
ensitive to penicillin or cephalosporins,
ince Lincocin does not share
ntigenicity with these compounds,
lowever, hypersensitivity reactions
ave been reported, some of these in
iatients known to be sensitive to
enicillin.

Veil tolerated at infusion site: Lincocin
itravenous infusions have not
roduced local irritation or phlebitis,
'hen given as recommended. Lincocin
; usually well tolerated in patients who
re hypersensitive to other drugs.
Nevertheless, Lincocin should be used
autiously in patients with asthma or
ignificant allergies.

n patients with impaired renal function,
le recommended dose of Lincocin
hould be reduced to 25—30% of
le dose for patients with normal
idney function. Its safety in
regnant patients and in infants
;ss than one month of age has
otbeen established.

/incocin may be used with other
ntimicrobial agents: Since Lincocin

i stable over a wide pH range, it is
aitable for incorporation in
itravenous infusions; it

administered concomitantly with other
antimicrobial agents when indicated.
However, Lincocin should not be used
with erythromycin, as in vitro antagonism
has been reported.

Uncocirr

Sterile Solution (300 mg per ml)

(lincomycin hydrochloride, Upjohn)

For further prescribing information, please see following page.

(lincomycin hydrochloride, Upjohn) =

Up to 8 grams per day by IV infusion for
hospitalized patients with life-threatening infections.
Lincocin is effective in infections due to
susceptible strains of streptococci, pneumococci,
and staphylococci. As with all antibiotics,
in vitro susceptibility studies should be performed.

Each Lincomycin

preparation hydrochloride

contains: monohydrate

equivalent to
lincomycin base

250 mg Pediatric Capsule 250 mg

500 mg Capsule 500 mg

*Sterile Solution per 1 ml 300 mg

Syrup per 5 ml 250 mg

’"Contains also: Benzyl Alcohol 9 mg; and,
Water for Injection — q.s.

Lincocin (lincomycin hydrochloride) is in-
dicated in'infections due to susceptible strains
of staphylococci, pneumococci, and strepto-
cocci. In vitro susceptibility studies should
be performed. Cross resistance has not been
demonstrated with penicillin, ampicillin,
cephalosporins, chloramphenicol or the tet-
racyclines. Some cross resistance with eryth-
romycin has been reported. Studies indicate
that Lincocin does not share antigenicity
with penicillin compounds.

CONTRAINDICATIONS: History of prior
hypersensitivity to lincomycin or clindamy-
cin. Not indicated in the treatment of viral
or minor bacterial infections.

WARNINGS: CASES OF SEVERE AND
PERSISTENT DIARRHEA HAVE BEEN
REPORTED ND HAVE AT TIMES
N ECESSIT A TED DISCONTINUANCE
OF THE DRUG THIS DIARRHEA HAS
BEEN OCCASIONALLY ASSOCIATED
WITH BLOOD AND ’ IN THE

STOOLS AND HAS AT TIMES RE-
SULTED IN AN ACUTE COLITIS. THIS
SIDE EFFECT USUALLY HAS BEEN
ASSOCIATED WITH THI ORAL DOS-
AGE FORM BUT OCCASION \ f.Y HAS

BEEN REPORTED FOLLOWING PA-
RENTERAL THERAPY . A careful inquiry
should be made concerning previous sensi-
tivities to drugs or other allergens. Safety
for use in pregnancy has not been estab-
lished and Lincocin (lincomycin hydrochlo-
ride) is not indicated in the newborn. Reduce
dose 25 to 30% in patients with severe im-
pairment of renal function.

PRECAUTIONS: Like any drug, Lincocin
should be used with caution in patients
having a history of asthma or significant
allergies. Overgrowth of nonsusceptible or-
ganisms, particularly yeasts, may occur and
require appropriate measures. Patients with
pre-existing mondial infections requiring
Lincocin therapy should be given concomi-
tant antimoniHal treatment. During pro-
longed Lincocin therapy, periodic liver
function studies and blood counts should be
performed. Not recommended (inadequate
data) in patients with pre-existing liver dis-
ease unless special clinical circumstances in-
dicate. Continue treatment of /3-hemolytic
streptococci infections for 10 days to
diminish likelihood of rheumatic fever or
glomerulonephritis.

ADVERSE REACTIONS: Gastrointestinal
—Glossitis, stomatitis, nausea, vomiting. Per-
sistent diarrhea, enterocolitis, and pruritus
ani. Hemopoietic— Neutropenia, leukopenia,
agranulocytosis, and thrombocytopenic pur-
pura have been reported. Hypersensitivity
reactions— Hypersensitivity reactions such
as angioneurotic edema, serum sickness, and
anaphylaxis have been reported, sometimes
in patients sensitive to penicillin. If allergic
reaction occurs, discontinue drug. Have
epinephrine, corticosteroids, and antihista-

mines available for emergency treatment.
Skin and mucous membranes— Skin rashes
urticaria, vaginitis, and rare instances of ex
foliative and vesiculobullous dermatitis have
been reported. Liver— Although no direct re
lationship to liver dysfunction is established,
jaundice and abnormal liver function test'
(particularly serum transaminase) have beer
observed in a few instances. Cardiovasculai
—Instances of hypotension following paren
teral administration have been reported,
particularly after too rapid IV administra-
tion. Rare instances of cardiopulmonary ar-
rest have been reported after too rapid IV
administration. If 4.0 grams or more admin-
istered IV, dilute in 500 ml of fluid and
administer no faster than 100 ml per hour
Special senses—' Tinnitus and vertigo have ,
been reported occasionally. Local reaction t \
—Excellent local tolerance demonstrated tc
intramuscularly administered Lincocin
(lincomycin hydrochloride). Reports of pair
following injection have been infrequent
Intravenous administration of Lincocin ir
250 to 500 ml of 5% glucose in distilled
water or normal saline has produced nc
local irritation or phlebitis.

HOW SUPPLIED: 250 mg and 500 mt
Capsules— bottles of 24 and 100. Sterile
Solution, 300 mg per ml— 2 and 10 ml vial;
and 2 ml syringe. Syrup, 250 mg per 5 m
—60 ml and pint bottles.

For additional product information, consult
the package insert or see your Upjohi
representative.

MED B-6-S (K.ZL-7) JA71-1631

The Upjohn Company
Kalamazoo, Michigan 49001

Upjohn

On the next two pages:
An important announcement
for you and your patients.

New from Colgate:

Superior Gram negative

P3DQ

ANTI -BACTERIAL DEODORANT SOAP

Effective against Gram positive bacteria

and Gram negative bacteria.

As mild as any other toilet soap.
With unsurpassed substantivity for
long-lasting antibacterial action.

Active ingredients: 3, 4', 5-tribromosalicylanilide and 4, 2',4'-trichloro-2-hydroxy diphenyl ether.
Together these agents produce a synergistic effect that provides broad spectrum protection
against skin bacteria. (P-300 does not contain hexachlorophene.)

The new all-purpose soap for homes, offices, hospitals, schools,
restaurants, food processing plants, laboratories, etc.

P‘300: Superior protectior

o

)acteriostasis in a bar soap.

P-300 -superior to other antibacterial bar soaps. Proven
effective against 25 of 31 cultures representing bacteria of
major concern in nosocomial infections and cross-infections.*

A.T.C.C.

BACTERIA

No.

P-300

Soap “D”

Soap “S”

Gram Positive

Staphylococcus aureus

8094

0 ••

0

Staphylococcus aureus

11371

• ••

®

•

Staphylococcus aureus

8096

• ••

0

0

Staphylococcus aureus

10390

• ••

0

0

Staphylococcus aureus

6342

• ••

©

0

Staphylococcus epidermidis

17917

• ••

0

0

Staphylococcus sp.

13565

• ••

0

0®

Mycobacterium smegmatis

19420

• ••

0 0

• 0

Listeria monocytogenes

13932

0 00

# 0

0*0

Streptococcus pyogenes

7958

#

0

•

Streptococcus mitis

903

•

0

•

Streptococcus sp.

12403

•

®

•

Bacillus anthracis

14578

•

0 0

Gram Negative

Alcaligenes tolerans

19359

00 0

00

0 90

Neisseria gonorrhoeae

19424

mm

0

•

Neisseria menigitidis

13077

• mm

0

0

Proteus vulgaris

8427

• ••

0

O

Escherichia coli

10536

•

O

o

Escherichia coli

11229

•

O

o

Escherichia coli

11698

•

o

o

Klebsiella pneumoniae

12833

•

o

o

Salmonella typhi

9993

«

o

o

Salmonella typhi

6539

#

o

o

Salmonella typhimurium

13311

0

o

o

Herellea sp.

11959

0

o

o

Pseudomonas aeruginosa

10145

°

o

o

Pseudomonas aeruginosa

7700

"o

o

o

Pseudomonas aeruginosa

9027

o

o

o

Pseudomonas aeruginosa

14210

o

o

o

Proteus rettgeri

9250

o

o

o

Proteus morganii

9237

o

o

o

KEY: ZONE OF INHIBITION

• • = 18.0 mm or larger

• = 12.0 mm to 17.9 mm

• = Less than 1 1 .9 mm
O _ No Inhibition

V

Test Method; The three antibacterial soaps were evaluated by
means.i,QptjT@ ^ndatJdgProtein Adsorption Test, conducted by a
recognized independent* laboratory, using A.T.C.C. organisms.

‘The bacteria were those most frequently named in a nationwide
survey of 334 hospitals.

or you

samples of P~300 and product literature,

please write:

Professional Services Department
COLGATE-PALMOLIVE COMPANY
740 North Rush Street
Chicago, Illinois 6061 1

or generations my family has insisted on Donnagel -PG," says active young matron Mrs. T.
Farnsworth Lipp (of the Upper Lipps), shown here with her charming son. "All the benefits of
paregoric— without the unpleasant taste, don't you know? And Junior thinks Donnagel-PG tastes so
much like bananas that I never worry about a slip between spoon and Lipp.”

With or without a silver spoon, a most tasteful solution in treating acute, non-specific
diarrheas: all the benefits of paregoric, without the unpleasant taste. Donnagel -PG treats
iccompanying cramping, tenesmus, and nausea as well as the diarrhea itself. Instead of
rnpleasant-tasting paregoric, it contains the therapeutic equivalent, powdered opium,

:o promote the production of formed stools and lessen the urge. And it provides the
demulcent- detoxicant effects of kaolin and pectin, plus the antispasmodic benefits of
belladonna alkaloids. And a good banana flavor to baby any taste.

Donnagel-PG

Donnagel with paregoric equivalent
(S. Available on oral prescription or without prescription
under limited circumstances as modified by applicable state law.

Each 30 cc. contains: Kaolin, 6.0 g.; Pectin, 142.8 mg.; Hyoscyamine sulfate, 0.1037 mg.;
Atropine sulfate, 0.0194 mg.; Hyoscine hydrobromide, 0.0065 mg.; Powdered opium, USP, 24.0 mg.
equivalent to paregoric 6 ml.) (Warning: may be habit forming); Sodium benzoate (preservative),
60.0 mg.; Alcohol, 5%. A.H. Robins Company, Richmond, Virginia 23220

X4H70BINS

[RobitussmA-C

|Robituss*n-Fs

ibitussinOV,

Cough Calmers

•J litUoK rf tof*

i

with the

The coughing season is here again.
Time to rely on the four Robitussins
and Cough Calmers to help clear the
lower respiratory tract. All contain
glyceryl guaiacolate, the efficient ex-
pectorant that works systemically to
help increase the output of lower
respiratory tract fluid. The enhanced
flow of less viscid secretions soothes
the tracheobronchial mucosa, pro-
motes ciliary action, and makes
thick, inspissated mucus less viscid
and easier to raise. Available on your
prescription or recommendation.

For coughs of colds and “flu”

Robitussin®

Each 5 cc. contains:

Glyceryl guaiacolate 100.0 mg.

Alcohol, 3.5%

For unproductive allergic coughs

Robitussin A-C®

Each 5 cc. contains:

Glyceryl guaiacolate 100.0 mg.

Pheniramine maleate 7.5 mg.

Codeine phosphate 10.0 mg.

(warning: may be habit forming)
Alcohol, 3.5%

Non-narcotic for 6-8 hr. cough control

Robitussin-DM®

Each 5 cc. contains:

Glyceryl guaiacolate 100.0 mg.

Dextromethorphan

hydrobromide 15.0 mg.

Alcohol, 1.4%

Clears sinuses and nasal
stuffiness as it relieves cough

Robitussin-PE®

Each 5 cc. contains:

Glyceryl guaiacolate 100.0 mg.

Phenylephrine

hydrochloride 10.0 mg.

Alcohol, 1.4%

Robitussin-DM in solid form
for “coughs on the go”

Cough Calmers®

Each Cough Calmer contains:

Glyceryl guaiacolate 50.0 mg.

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MICHIGAN MEDICINE FEBRUARY 1972 145

"How medical students are taught”
— a revolution is in progress

This article was developed for MICHIGAN
MEDICINE to help interpret to MSMS mem-
bers and the public some of the many changes
and improvements in medical schools and med-
ical education. The article is based on a recent
report of the AMA Council on Medical Educa-
tion entitled, “How Medical Students Are Be-
ing Taught.” The suggestion that this infor-
mation be presented to MSMS members was
made by Donald N. Sweeny, Jr., MD, chair-
man of the MSMS delegation to the AMA
House of Delegates in his report to the 1971
MSMS House of Delegates. This article ivas
written by Herbert A. Auer, staff assistant to
the MSMS Education Liaison Committee and
manager of the MSMS Department of Commu-
nications.

The changes in medical schools since 1950
“add up to a revolution in medical education only
slightly less significant than the revolution that
followed the Flexner Report.”

That assessment is made by the AMA Council
on Medical Education.

The Council, in a report accepted by the AMA
House of Delegates, observes that “These changes
in medical education have resulted from many in-
fluences, some arising within the medical schools,
some outside them. It is believed that neither the
general public nor the medical profession fully
appreciates the magnitude and the significance of
these changes.”

Since 1950, medical schools have been seriously
concerned about their curricula and their teaching
methods. Perhaps the first major break with the
traditional undergraduate medical school curriculum
came with the introduction of a new curriculum at
Western Reserve University School of Medicine in
1952. As time went on, revision of the curricula
involved more and more medical schools, and the
changes became greater and more significant.

“Now it is virtually impossible to find in any
medical school what would have been considered
in 1950 an orthodox curriculum,” the AMA Council
observes.

Perhaps the greatest change in the medical
school curricula . has been the early introduction
of significant contact with patients. This certainly
is true at the three Michigan medical schools.

There has been an increase in electives for the
students and a reduction in the number of required
courses. Now, typically, about one-quarter of the
curricular time is given over to electives distributed
more or less evenly throughout the curriculum, al-
though tending to be concentrated toward the latter

part. In a number of schools, the entire fourth year
is elective.

Some schools have developed so-called “tracks.”
For example, a student may choose a family prac-
tice track, a medical or surgical specialty track,
a behavioral track, or a medical science track. For
the first year or year and one-half of the curriculum,
the students are all exposed to a basic core of
material mostly composed of the basic sciences.
After this core is completed, each student may
choose one track to pursue.

In some schools the fourth year is spent in what
essentially is a straight internship in a teaching
hospital.

Another general change has been the increasing
use of clinical facilities of community hospitals,
neighborhood health centers, and other types of
community facilities, exposing the student to a
variety of patterns of delivery of medical care,
rather than restricting his exposure to medicine as
practiced in the teaching hospital. This involves
an increase in the use of part-time and volunteer
faculty members.

The AMA Council reports a decrease in the
total amount of scheduled classroom time. Where-
as, formerly, medical students in the basic science
years might actually be in classes as many as
44 hours weekly, now, 25 to 30 hours is more
typical. This reduction in time has been accom-
plished mainly through reducing laboratory in-
struction. Basic science teaching now occupies
about a year instead of the former two years.

A growing number of medical schools encourage
students to progress through the curriculum at
different rates, accompanied by efforts to devise
better methods of assessing competence that there
may be more emphasis on mastery of material
and less emphasis on the amount of time spent
in school.

Among other curricula changes have been the
involvement of university departments outside the
medical school in the teaching of the basic medical
sciences; an increase in the use of visual aids and
self-instruction methods of various sorts; more
widespread involvement of the social sciences in
the medical school curricula; and the organization
of Departments of Research in Medical Education
with new faculty members with doctor’s degrees
in education.

“There has been a tendency,” the AMA Council
observes, “for the medical school to assume re-
sponsibility for the development and operation of
programs involving the provision of medical care
to certain population groups in order to provide

146 MICHIGAN MEDICINE FEBRUARY 1972

clinical experience for the student under conditions
that would not otherwise be available to him.”

A growing number of medical schools have
started or are considering programs to train family
physicians.

The AMA Council also reports a decrease in the
total duration of undergraduate medical education.
In some schools, it has long been possible for a
few exceptional students to obtain the MD degree
in three years. This is becoming more common.

The AMA Council points to these three major
developments in medical education:

“1. Expansion of enrollment, encouraged and,
in part, made possible by some of the curricular
changes mentioned.

“2. Attention to increasing enrollment of stu-
dents from groups seriously under-represented in
the American medical profession. This involves
changes in admission standards, provision of re-
medial programs, arrangements for students to pro-
gress through the curriculum at different rates,
and augmentation of financial aid.

“3. The assumption by students of a substantial
role in the operation and governance of the medi-
cal school, in part, through membership on various
committees including, in some instances, the ex-
ecutive committee.”

These three developments along with changes
in teaching “represent an effort to relate the edu-
cation of medical students more directly to the
provision of medical care and to the health prob-
lems of society,” the AMA Council told the House
of Delegates.

1972

SAMA-MECO project
already underway

Work has started on the 1972 Student American
Medical Association-Medical Education and Com-
munity Orientation (SAMA-MECO) summer project
which will place medical students in community
hospitals throughout Michigan. Fifty students par-
ticipated in the 10-week 1971 program. Both the
students and officials of the hospitals involved re-
ported enthusiastically on success of the program,
designed to provide valuable experience for the
students and to encourage them to consider com-
munity medical practice.

John Bruder, a junior medical student at Wayne
State University, is coordinating the program among
SAMA members in Michigan, with the Michigan
State Medical Society handling overall coordination.
For additional information, contact the MSMS Edu-
cation Liaison Committee, MSMS, Box 950, East
Lansing, Mich. 48823.

44 Physician assistant
programs in USA now;
WMU "developing"

The Survey of Operational Physician Assistant
Programs published in March, 1971 by HEW re-
ports that the following schools will graduate the
following numbers of graduates in June 1972:

148 Graduates — Marine Physician’s Assistant Pro-
gram, U.S. Public Health Service Hospital,
Staten Island, N.Y., (one-year program)

74 physician’s associates, Duke University (two
years)

46 ophthalmic assistants, Baylor University (14
months)

35 cardiopulmonary technicians, Spokane, Wash.,
Community College (two years)

33 physician assistants, Medex, U. of Washing-
ton (15 months)

22 physician assistants, Medex, U. of Alabama
(one year)

22 physicians assistants, Medex, Dartmouth (one
year)

There are 39 operational programs now training
physician’s assistants. Nineteen of these are train-
ing generalists; 15 are training specialists; 5 are
training both specialists and generalists. There are
five additional programs, including Western Michi-
gan University’s, which are classified as “develop-
ing programs.”

The AMA has assumed a new leadership role
in developing and sponsoring a national certifica-
tion program for the assistant to the primary care
physician. The Association's Council on Health
Manpower will develop a blueprint for carrying
out a certification program and present it to the
House of Delegates at its June’s annual conven-
tion.

60% of applicants
rejected by med schools,
says NABSP

The National Association of Blue Shield Plans
reports that despite record U.S. medical school en-
rollments this fall, preliminary statistics indicate
that 60 percent of all applicants for admission were
rejected.

As the 1971-72 academic year opened first-year
classes totaled an estimated 11,858, an increase of
498 from the estimated 11,360 first-year class last
year. Total enrollment climbed to an estimated
43,063, compared with 40,185 last year. The 11,858
new students were accepted from approximately
25,000 applicants. Five new medical schools were
opened, bringing the total number of U. S. medical
schools to 108.

MICHIGAN MEDICINE FEBRUARY 1972 147

I /

£ Medical cafe programs

Is there an HMO
in your future?

By Herbert Mehler

Chief, Research and Analysis

Government Medical Programs

The issue is here. Physicians are faced with al-
ternatives to traditional solo, partnership or cor-
porate practice of medicine: The HMO is one of
the alternatives.

Interest, diverse reaction and broad speculation
have been provoked about health maintenance or-
ganizations.

An HMO has been described as an aggregate of
four constituent parts: a group of providers, appro-
priate facilities, a method of financing medical care
through prepayment, and a population enrolled for
the services.

The debate in Congress and in Michigan is now
enjoined as to what direction we will take and how
rapidly we will move for new kinds of incentives to >
deliver health care in the 1970’s. These incentives
range from HMOs, as supported by the national
administration, to “comprehensive health services
organizations,” “health care corporations,” and
“health services and health education corpora-
tions.”

The Department of Health, Education, and Wel-
fare, which probably would have responsibility for
HMOs, has enunciated the following basic require-
ments:

1. For a new, free-standing HMO, a minimum
initial enrollment of 10,000, with prospects for
25,000 to 30,000 within two years.

2. Strong administrative leadership in existence
and well accepted by all participants by the
time of the design and implementation stage.

3. Compatibility with and access to portions of
the existing health care system of the area
as a back-up resource.

4. Demonstration that the HMO has complied
with, or is satisfactorily in the process of
complying with, all of the applicable cor-
porate practice laws, licensure laws, hospital
certification regulations, professional regula-
tions and other legal considerations.

5. Demonstration that the HMO can manage
anticipated fiscal deficits during the initial
operating period.

6. The modern business management mechan-
ism (which has been found so necessary by
groups who have operated prepaid capitation
health care systems) that can produce the
specific accounting and data information
which will be required of HMOs.

7. An understanding of the need for community
outreach and active consumer participation in
its organization and operation.

The MSMS Committee on Governmental Medical
Care Programs has been authorized by The Coun-
cil to seek a federal grant “to study the practicing
physician's attitudes toward HMOs and similar
types of health care delivery in his own county or
region.”

Succeeding issues of Michigan Medicine will pro-
vide detailed, pertinent information you must have
about HMOs in order that you can determine the
type of practice best suited to you and your pa-
tients.

Ingham doctors

explore ‘this thing

called prepaid group practice’

Public pressure to find new ways to finance
health care is leading to more exploration of pre-
paid group practices, Ingham County physicians
were told recently.

William Flaherty of Detroit, a Michigan Blue
Cross vice president, told the doctors that in the
past three years, “noise of increasing loudness”
also has come from Washington for prepaid group
practice as a way to lead the health profession out
of its problems. He cited statistics showing less use
of hospitals through prepaid programs than in tra-
ditional coverage. He also noted that the Commu-
nity Health Association of Detroit, one example of
a PPGP, was “a moneymaker,” with a profit of ap-
proximately $830,000 on $11 million revenue.

Pressures to change the financing of health care
are coming from employers who foot the entire in-
surance bill, and are warily eyeing rate increases,
and from the employe, who is looking at the in-
creasing premiums slicing into his wage package,
said Mr. Flaherty.

Berrien doctors
sponsor seminar
on health care delivery

The Berrien County Medical Society was a co-
sponsor recently of a seminar on health care de-
livery systems, which presented varying views of
medical care and resources. On the panel were
Peter Maraveleas, president, Medical Ancillary Serv-
ices, Inc.; Clinton Wilson, MD, Benton Harbor phy-
sician; Edward J. Connors, administrator, Univer-
sity Hospital, Ann Arbor, and Sidney Katz, MD,
head of the Department of Community Medicine,
Michigan State University College of Human Med-
icine.

148 MICHIGAN MEDICINE FEBRUARY 1972

INTRODUCING

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Boyne City
finds a doctor!

The successful end to Boyne City’s six-year
search for a new medical doctor has delighted the
citizens of that community and the Michigan Health
Council.

Atherosclerosis
major topic
of MHA Heart Days

Distinguished physicians and researchers will
be speakers at the annual Heart Days Sessions
of the Michigan Heart Association April 13-15 at
Cobo Hall and the Ponchartrain Hotel in Detroit.

The Scientific Sessions on Friday and Saturday
will be preceded by a program on stroke, all day
Thursday.

Franz W. Jordan, MD, of Saginaw, began a fam-
ily practice in Boyne in early November. He found
the city and its need for a medical doctor through
the Health Council’s Physician Placement Service.

Topic of the five talks and one panel discussion
on Friday will be “Atherosclerosis and Its Compli-
cations.” Saturday’s program will concentrate on
coronary artery disease.

Boyne City was the first Michigan community to
obtain a doctor when the Health Council estab-
lished its free MD Placement Service in 1953 under
the guidance of the MSMS and the financial assist-
ance of the Upjohn Company. The Health Council
has since placed nearly 1,100 physicians in Mich-
igan practices.

Doctor Jordan’s placement was a result of a joint
effort between the health council and the Boyne
Community. A citizens’ committee was organized
to find an “MD for BC,” billboards were erected
along nearby state highways, newspaper articles
advertised the need for a doctor and the Chamber
of Commerce assisted.

There is a particular need for family doctors like
Doctor Jordan, who are interested in going to
smaller, rural Michigan communities, reports John
A. Doherty, executive vice president of the MHC.

The Physician Placement Service has openings,
however, for over 2,000 physicians in all special-
ties, he says. The service can be reached at MHC
headquarters, 712 Abbott St., East Lansing, Mich.
48823.

Doctor Franz Jordan at home in his
new Boyne City office.

Speakers include Charles K. Friedberg, MD, edi-
tor of Circulation and author of the definitive text
on cardiovascular disease; William B. Kannel, MD,
medical director, Framingham Heart Disease Study;
Norman E. Shumway, MD, transplant surgeon at
Stanford University School of Medicine, and Her-
bert L. Abrams, MD, chairman, Department of Radi-
ology, Harvard Medical School.

Transgrow service
for detecting gonorrhea
now available

With the beginning of 1972, the Bureau of
Laboratories of the Michigan Department of Public
Health is making available a new service for diag-
nosing gonorrhea, utilizing the Transgrow medium,
Maurice S. Reizen, MD, director of the department,
has announced. Transgrow is used for sending
specimens to a central laboratory.

Transgrow is available either through local health
departments, the nearest branch of the Bureau of
Laboratories, or the Division of Laboratory Services,
Michigan Department of Public Health, 3500 N.
Logan St., Lansing, Mich. 48914.

Interns, residents
may join AMA
at special rate

The AMA House of Delegates has approved a
special $20 membership dues rate for all hospital
interns and residents who wish to join the AMA
directly or through a state society.

Interns and residents are not eligible for 1972
AMA membership dues exemption or special asso-
ciate membership. For their dues payment, the in-
terns and residents will receive the same AMA
publications which are given to the regular dues-
paying members.

Representing the views of Michigan physicians on the health care needs of
the state was Brooker L. Masters, MD, far right, MSMS Council chairman,
when he testified before the national Democratic Policy Council’s Subcom-
mittee on Health Jan. 12 in Detroit. Doctor Masters was accompanied by
Donald N. Sweeny, Jr., MD, second from left, chairman, Michigan’s AMA
delegation. The two met with, from left, James McNeely, chairman Michigan
State Democratic Party; Leonard Woodcock, president of the UAW and The
Hon. Martha W. Griffiths, Detroit congresswoman. Mrs. Griffiths and Mr.
Woodcock are co-chairmen of the policy council’s subcommittee. (See re-
lated article on page 81)

New assistant
in Dep’t of Education
aids deaf-blind children

Michigan physicians who see children with the
dual impairment of deafness and blindness may
refer such children to the Michigan Department of
Education’s new Project Assistant for Services to
Deaf-Blind Children.

Mrs. Sandra G. Skubick holds the new MDE post,
which became effective Aug. 30 and is funded
through the Midwest Regional Center for Services
to Deaf-Blind Children.

She may be reached by dialing (517) 373-3730,
and will be visiting each county and intermediate
school district. She also will speak at medical so-
ciety meetings.

Hutzel Hospital
training physicians
in Xeroradiography

Hutzel Hospital has a training program to teach
doctors to read Xerox prints as a new diagnostic
technique. Called Xeroradiography, the new proc-
ess is being promoted as better than the X-ray.

The XR provides much better detail for the de-
tection of breast cancer, as reported in a January,
1969, Michigan Medicine article by John N. Wolfe,
MD, chief of radiology at Hutzel, and a pioneer in
the use of the XR.

The new process, which produces a dry, blue-
tinted, positive print in about 90 seconds, also can
be used for examining bone fractures; the larynx,
cervical spine and neck; tumors, and abnormal
conditions of the breast.

MICHIGAN MEDICINE FEBRUARY 1972 151

/

I

I

t

■

Doctor Swartz

Doctor Swartz optimistic
after conference on aging

Older Americans can look forward to government
action in their behalf over the next year as the re-
sult of the 1971 White House Conference on Aging,
according to Frederick C. Swartz, MD, of Lansing,
chairman of the American Medical Association
Committee on Aging. He spoke to reporters at a
news conference held in East Lansing by the Mich-
igan State Medical Society at the conclusion of
the White House Conference.

Doctor Swartz, a member of the MSMS Ad Hoc
Committee for the White House Conference, said
he is optimistic about results of the conference be-
cause of the mandate given leaders who will stay
on in the federal government to carry out programs
approved by the conference.

President Nixon’s expression of interest and
promise of additional funds for the Administration
on Aging were greeted warmly by conferees, Doc-
tor Swartz said.

“I don’t think Nixon promised anything more
than he thought he could possibly do,” the doctor
added. “He seemed to offer a well-thought-out an-
swer to many of the problems he thinks he can
help with.”

Older persons should be integrated into the
mainstream of medicine and treated as any other
patient, Doctor Swartz told reporters.

“Age is no bar to good medical or surgical treat-
ment and today a surgeon will not ask the age of
a patient but inquire about his physical condition,”
he said.

Doctor Swartz told reporters that not age itself
but compulsory retirement, idleness, lack of motiva-
tion and segregation from other parts of society
contribute most to health problems of older Amer-
icans.

There are no problems of the aging except those
imposed by retirement — they are the same as those
of every other age group, he said. “Age actually
does nothing to the human body — it is not a matter
of age, but a matter of the patient's trials and trib-
ulations and how he overcomes them.”

Ideally, he said, an individual should have satis-
fying employment, in the amount suited to his abil-
ity, outside interests and the same medical treat-
ment and preventive health care as the population
generally.

152 MICHIGAN MEDICINE FEBRUARY 1972

PFIZERPEN
DOSAGE FORMS

Orange-flavored

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(potassium phenoxymethyl penicillin)

125 mg. (200,000 units)/ 5 cc.:
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250 mg. (400,000 units)/ 5 cc.:
bottles of 1 00 cc. and 1 50 cc.

Pfizerpen VK Tablets

(potassium phenoxymethyl penicillin)

250 mg. (400,000 units): bottles of 100.
500 mg. (800,000 units): bottles of 100.

Pfizerpen G

Butterscotch-caramel-flavored
Pfizerpen G Powder for Syrup
(potassium penicillin G)

400.000 units/ 5 cc.:

bottles of 1 00 cc. and 200 cc.

Pfizerpen G Tablets
(potassium penicillin G)

200.000 units: bottles of 100 and 500.

250.000 units: bottles of 100.

400.000 units: bottles of 100 and 1000,
and unit-dose pack of 100 (10 x 10's).

800.000 units-, bottles of 1 00.

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GORVK. JUST
MAKE SURE IT’S PFIZERPEN.

Michigan Board of Education
includes health interests in new goals

Various references to health are made in the
recently-adopted “Common goals of Michigan Edu-
cation” by the Michigan Board of Education. The
goals were originally formulated by a special 21-
member task force and refined after 28 public
meetings across the state.

“Adoption of these goals helps to build account-
ability into the Michigan education system,”
stresses John W. Porter, state superintendent of
public instruction.

The three goals deal with (1) citizenship and
morality, (2) democracy and equal education, (3)
student learning. Grouped under these three head-
ings are 22 specific goals.

Among the 22 specific goals are these:

“Physical and Mental Well-Being: Michigan edu-
cation must promote the acquisition of good health
and safety habits and an understanding of the
conditions necessary for physical and mental well-
being.”

“Preparation for Family Life: Michigan education
must provide an atmosphere in which each indi-
vidual will grow in his understanding of and re-
sponsiveness to the needs and responsibilities in-
herent in family life. Joint efforts must be made
by school, parents, and community to bring to-

Grand Rapids hospitals

strengthen ties

with U-M , MSU med schools

Three major hospitals in Grand Rapids are un-
dertaking an arrangement with Michigan’s medical
schools that gives Grand Rapids the clinical pro-
grams of a medical school.

Blodgett, Butterworth and St. Mary’s hospitals
officially formed the Grand Rapids Area Medical
Education Center (GRAMEC) on Nov. 29 at a con-
tract-signing ceremony chaired by the president of
the new corporation, Craig Booher, MD, director of
medical education at Blodgett Hospital.

Over the past four years, the three hospitals
gradually have increased their cooperative educa-
tional efforts in collaboration with Michigan State
University and the University of Michigan.

Other medical schools also may send students
to Grand Rapids to take part in undergraduate
medical programs. Similarly, the organization is
open to other area hospitals and educational in-
stitutions that train health manpower.

The cooperative effort includes the training not
only of medical students but also of interns and
residents and eventually will include continuing
education programs for community physicians.

gether the human resources necessary in this
endeavor.”

“Education of the Exceptional Person: Michigan
education must recognize and provide for the
special educational needs of exceptional persons.
This recognition must extend to those who are
academically talented and to those who are con-
sidered physically, mentally, or emotionally handi-
capped. Regarding the handicapped, Michigan edu-
cation must further assure that its procedures con-
cerning the testing and evaluation of children tenta-
tively identified as being mentally or emotionally
handicapped do not unduly penalize minority or
low socioeconomic status children by precipitous
referral and placement into special classes. Every
effort must be made to achieve the maximum
progress possible for exceptional individuals by
facilitating their movement into and/or out of spe-
cial classes.”

Interested physicians may obtain a copy of the
goals booklet by writing to Michigan Department
of Education, Michigan National Bank Tower,
Lansing, Michigan 48902.

79% of patients
from out-of-state
at one NY abortion clinic

The Eastern Women’s Center of New York City
makes the following report on its experiences with
abortion during its first five months of operation,
June-October:

The center had over 4,000 patients, the majority
referred through Planned Parenthood, Problem
Pregnancy Services, Free Clinics and Zero Popula-
tion Growth agencies;

— 79% of the patients were from out-of-state;

— the greatest number of patients were 19 and
20; the average age was 22.5;

— 68% of the patients were single, 15% married,
12% separated and 5% divorced;

— 77% of those who terminated their pregnan-
cies had no children;

— 75% of the patients had used no method of
birth control.

New name

for psychiatrists’ organization

The Michigan Society of Psychiatry and Neu-
rology has changed its name to the Michigan
Psychiatric Society, according to Bruce L. Danto,
MD, of the Michigan Task Force of the society.

154 MICHIGAN MEDICINE FEBRUARY 1972

Specifically formulated with
vitamins and minerals important
in the treatment of anemia

PHASE 1

Enhanced Absorption

Each tablet provides 1 1 5 mg
elemental iron as the highly
absorbable ferrous fumarate plus 600
mg of Vitamin C.

PHASE 2

Erythrocyte Formation

Each tablet provides Vitamin Bn
(25 meg) and Folic Acid (1 mg) to
replace deficiencies.

PHASE 3

Premature Hemolysis

Each tablet provides Vitamin E, which
may be involved in lessening red
blood cell fragility.

For common anemias
as well as problem ones

HEMATINIC TABLETS

Tri-Phasic Hematinic with 600 mg Vitamin C PLUS Vitamin E

Each tablet contains:
Vitamin C (Ascorbic Acid)

600 mg.

Vitamin Em (Cobalamin
Concentrate, N.F.)

25 meg.

Intrinsic Factor Concentrate

75 mg.

Folic Acid

1 mg.

Vitamin EfcZ-AlphaTocopheryl
Acid Succinate)

30 Int. Units

Elemental Iron (as present in
350 mg. of
Ferrous Fumarate)

115 mg.

Dioctyl Sodium
Sulfosuccinate U.S.P.

50 mg.

Dosage: One Tablet Daily.
Available in Bottles of 30 Tablets.
On Your Prescription Only.

Precautions: Some patients affected with pernicious anemia may not respond to orally
administered Vitamin B12 with intrinsic factor concentrate and there is no known way to
predict which patients will respond or which patients may cease to respond. Periodic
examinations and laboratory studies of pernicious anemia patients are essential and
recommended. If any symptoms of intolerance occur, discontinue drug temporarily or
permanently. Folic acid, especially in doses above 1 mg. daily, may obscure pernipious
anemia, in that hematologic remission may occur while neurological manifestations re-
main progressive.

Adverse Reactions: G.I.: nausea, vomiting, diarrhea, abdominal pain. Skin rashes may
occur. Such reactions may necessitate temporary or permanent changes in dosage or
usage. Allergic sensitization has been reported following both oral and parenteral admin-
istration of folic acid.

HEMATINIC TABLETS

Tri-Phasic Hematinic with 600 mg Vitamin C PLUS Vitamin E

Specifically formulated with vitamins and minerals
important in the treatment of anemias, plus a stool
softener to counteract the constipating effects of iron.

LEDERLE LABORATORIES

^dBiSSs* A Division of American Cyanamid Company, Pearl River, New York 1 0965 421-1

MOVE-OUT STICKY MUCUS .

In asthma, bronchitis . . .

"Many physicians use iodides intravenously when they suspect that the main
reason for airway obstruction is sticky mucus but oral iodides are more
likely to exert an expectorant action.”1

"For the viscid sputum, potassium iodide (. . . preferable as enteric coated
tablets) may be best.”2

Provide tastefree, well-tolerated KI in convenient SLOSOL coated tablets —

IODO- NIACIN

Each SLOSOL coated tablet contains potassium
iodide 135 mg. and niacinamide hydroiodide 25 mg.

COLE

please see next page for prescribing information

Promote Productive Cough-

•j „

* 'b'

Cv

*«•

<■. *

"The productive cough
serves the necessary
purpose of removing
excess mucus from
the bronchial tree.”3

"... there is clear evidence
that the loosening of the bronchial mucus
blanket must begin from within the under-
lying mucus glands where it is anchored
and not from the surface. Complications
of iodides are too occasional to avoid the
use of this valuable medication.”3

Rx Information:

INDICATIONS: The primary indication for lodo-Niacin is in any clinical
condition where iodide therapy is desired. All of the usual indications for the
iodides apply to lodo-Niacin and include:

RESPIRATORY DISEASE: The use of lodo-Niacin is indicated whenever an
expectorant action is desired to increase the flow of bronchial secretion and
thin out tenacious mucus as seen in bronchial asthma, and other chronic
pulmonary disease. lodo-Niacin has also proven of value in sinusitis, bron-
chitis, bronchiectasis, and other chronic and acute respiratory diseases
where the expectorant action of iodide is desired.

THYROID DISEASE: lodo-Niacin is indicated in any thyroid disorder due to
iodine deficiency, such as endemic goiter or hypoplastic goiter, and where
hypothyroidism is secondary to iodine deficiency. lodo-Niacin will suppress
mild hyperthyroidism completely, and partially suppress more severe hyper-
thyroid states. lodo-Niacin is also of value in suppressing the symptoms of
hyperthyroidism and decreasing the size and vascularity of the thyroid gland
prior to thyroidectomy.

ARTERIOSCLEROSIS: Iodides have been reported as relieving some of the
symptoms associated with arteriosclerosis. The mechanism of action is un-
known, but the effects are documented.

OPHTHALMOLOGY: lodo Niacin has been reported to be of value in retinal and
vitreous hemorrhages. The mechanism of action is unknown, but absorption

of the hemorrhagic areas has been observed following use of this drug. It is
also reported to be of value in reducing or removing vitreous floaters.

SIDE EFFECTS: Serious adverse side effects from the use of lodo-Niacin are
rare Mild symptoms of lodism such as metallic taste, skin rash, mucous
memorane ulceration, salivary gland swelling, ana gastric distress have
occurred occasionally. These generally subside promptly when the drug is
discontinued. Pulmonary tuberculosis is considered a contraindication to
the use of iodides by some authorities, and the drug should be used with cau-
tion in such cases. Rare cases of goiter with hypothyroidism have been
reported in adults who had taken iodides over a prolonged period of time,
and in newborn infants whose mothers had taken iodides for prolonged
periods. The signs and symptoms regressed spontaneously after iodides were
discontinued. The causal relationship and exact mechanism of action of
iodides in this phenomenon are unknown. Appropriate precautions should be
followed in pregnancy and in individuals receiving lodo-Niacin for prolonged
periods.

DOSAGE: The oral dose for adults is two tablets after meals taken with a
glass of water. For children over eight years, one tablet after meals with
water. The dosage should be individualized according to the needs of the
patient on long-term therapy.

HOW SUPPLIED: Cole’s lodo Niacin tablets are available in bottles of 100,
500 and 1,000. Slosol coated pink. NDC 55-6458

IODO-NIACIN

Each SLOSOL tablet contains potassium iodide 135 mg. and
niacinamide hydroiodide 25 mg. Sig. fj tabs, t.i.d. p.c.

References: 1. Itkin, I. H., Am Fam Phys 4:83, 1971 2. Femberg, S. M., Consultant
Sept., 1971, pg. 32. 3. Bookman, R., Ann. Allerg. 29:367, 1971.

COLE

PHARMACAL CO. INC.

St. Louis, Mo. 63108

Presidents-elect and executive secretaries of
county medical societies were welcomed by
MSMS Director Warren F. Tryloff to a workshop
recently at MSMS headquarters in East Lansing.

The presidents-elect were introduced to the
MSMS staff and spent the afternoon discussing
MSMS procedures and projects and mutual
problems.

Challenges facing county medical societies were
expressed by Kenneth J. May, MD, new president
of the Kalamazoo Academy of Medicine, at the
opening session of the workshop.

Presidents-elect and executive secretaries of the
larger county medical societies held their own
session in the MSMS board room, led by Ken-
neth H. Johnson, MD, standing, MSMS secretary.

County Presidents-elect were taken on a walking
tour of the MSMS building by Herbert Mehler,
left, MSMS chief, Research and Analysis, Gov-
ernmental Medical Care Programs. Among the
future presidents clearly visible are, from left,
Richard H. Gascoigne, MD, Lenawee; William S.
Bowden, MD, St. Clair; Anthony Bartolo, MD,
Monroe; John E. Morovitz, MD, Shiawassee, and
Anthony M. Abruzzo, MD, Lapeer, foreground.

County presidents-elect
gain new insight
at MSMS workshop

MICHIGAN MEDICINE FEBRUARY 1972 161

County in the spotlight

Trying to recruit new doctors to your area?
Take some hints from Jackson

By Judith Marr
Managing Editor

Michigan’s leading county society in terms of
attracting new doctors to its area is undoubtedly,
Jackson.

The community’s doctor-business Committee for
Medical Opportunities, founded by the Jackson
County Medical Society in summer, 1968, has
brought 12 new physicians to Jackson. Among
them are internists, family physicians, surgeons,
an allergist, an oncologist and a pediatrician.

And there is much in the Jackson county so-
ciety’s recruitment technique that can be of help
to other county societies. Nathan Munro, MD, chair-
man of the committee, describes some of the
methods:

First, the Jackson society enlisted the services
of a professional public relations man from a large
local firm in planning their campaign.

His help resulted in the preparation of a large
packet of promotional materials about Jackson,
its health facilities and the physicians already
there. The packet is mailed to interesting phy-
sicians and was distributed to all U.S. Armed
Forces base hospitals to attract military doctors
when their service was over.

A major factor in the Jackson doctor’s recruit-
ment of new physicians has been their enlistment
of community support. The committee itself is com-
posed of varied community leaders including the
public relations men, who donate their time and
efforts.

The community support has also been monetary.
In the summer of ’68, Doctor Munro raised over
$11,000 to support the recruitment efforts. Half
came from community foundations and industry,
the other half from the county medical society.

The Jackson committee has worked closely with
the physician placement service of the Michigan
Health Council, which introduced the community
to nearly every new doctor brought to Jackson by
the committee.

“So many communities have the idea their doc-
tors don’t want any more physicians,” observes
John A. Doherty, executive vice president, Michigan
Health Council. “This isn't true. And in Jackson’s
case, the leadership for more doctors has come
from the county medical society.”

Mr. Doherty has high praise for the Jackson
efforts.

“The Jackson society has done a superior job
of developing materials. On the basis of obtaining
the cooperation of many people in the community,
it has done the best job in the state,” Mr. Doherty
says.

The Health Council has mailed the promotional
packet to all the physicians on its mailing list,
and also to other Michigan towns. Many have
copied the idea after seeing the materials inside.

When the Jackson committee first learns of a
doctor’s interest in Jackson, it sends him a week’s
copies of the local newspaper, “to give the doctor
some insight into Jackson,” says Robert Swartley,
JCMS executive director.

162 MICHIGAN MEDICINE FEBRUARY 1972

The Jackson society invites the doctor to town.
Mr. Swartley and community leaders drive the doc-
tor and family together on a tour of Jackson’s
highlights.

The county society assists the new physician,
once he’s agreed to come to Jackson, to find
housing, office space and personnel.

A major service of the society to the new doctor
is to list his telephone a month ahead of his ar-
rival and to begin to arrange appointments. Some
newly-settled Jackson doctors have walked into a
full month of appointments their first day of prac-
tice.

An important side-effect of the committee’s ac-
tivities, noted co-chairman Donald Huldin in 1969,
is that they stimulate Jackson physicians toward a
renewed interest in encouraging and seeking out
new doctors.

Their search is continuing.

“We hope to work directly with the family prac-
tice residency programs around the state, as our
need is greatest now for family doctors,” says
Doctor Munro. The committee also is looking for
good results from the local hospital’s clerkship
program with third and fourth-year medical stu-
dents from MSU.

Things to keep in mind
while recruiting new doctors

Is your county medical society trying to attract
new physicians to its area? Perhaps these sugges-
tions from Doctor Munro and Mr. Swartley will help:

1. Maintain congeniality while selling the pros-
pect on the advantages of your area. Let the physi-
cian, and his wife, also, know that they are sincere-
ly wanted.

The Jackson society:

2. Initiates contact with the physician with a
telephone call by a recruitment committee member
in the same specialty.

3. Takes the prospect to dinner with local physi-
cians and community business leaders and on a
tour of the area including private physician’s of-
fices and hospitals, assists him in locating office
space, employees, housing and bank loans, if nec-
essary.

“I personally believe convincing the prospective
physician of the need of his services to the entire
community is important,” says Mr. Swartley. “Show-
ing the physician’s wife the pleasant living accom-
modations available and the schools also helps
sell the prospect on our community.”

The treatment of

impotence

\ due to androgenic deficiency in the American male.
The concept of chemotherapy plus the
physician’s psychological support is confirmed
as effective therapy.

(4B>v

The Treatment of Impotence
with Methyltestosterone Thyroid
(100 patients — Double Blind Study)
T. Jakobovits

Fertility and Sterility, January 1970
Official Journal of the
American Fertility Society

Android

(thyroid-androgen) tablets

Choice of 4 strengths:

indroid Android-HP

Android-x Android-Pins

'ath yellow tablet contains:

lethyl Testosterone ..2.5 mg.
hyroid Ext. (1/6 gr.) ..10 mg.

lutamic Acid 50 mg.

hiamine HCL 10 mg.

)ose: 1 tablet 3 times daily.
ivailable:

Lotties of 100, 500, 1000.

HIGH POTENCY

Each red tablet contains:
Methyl Testosterone ..5.0 mg.
Thyroid Ext. [Vi gr.) ... 30 mg.

Glutamic Acid ..50 mg.

Thiamine HCL . ... 1 ... 10 mg.
Dose: 1 tablet 3 times daily.
Available:

Bottles of 100, 500, 1000.

EXTRA HIGH POTENCY

Each orange tablet contains:
Methyl Testosterone .12.5 mg.
Thyroid Ext. (1 gr.) ....64 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 or 2 tablets daily.
Available:

Bottles of 60, 500.

WITH HIGH POTENCY
B-COMPLEX AND VITAMIN C

Each white tablet contains:
Methyl Testosterone . 2.5 mg.
Thyroid Ext. («/4 gr.) .15 mg.
Ascorbic Acid (Vit. C) .250 mg.

Thiamine HCL 25 mg.

Glutamic Acid 100 mg.

Pyridoxine HCL 5 mg.

Niacinamide 75 mg.

Calcium Pantothenate .10 mg.

Vitamin B-12 2.5 meg.

Riboflavin 5 mg.

Dose: 2 tablets daily.
Available: Bottles of 60, 500.

Double-Blind Study and Type of Patient:

100 patients suffering from impotence. Of
the patients receiving the active medication
(Android) a favourable response was seen
in 78%. This compares with 40% on
placebo. Although psychotherapy is indi-
cated in patients suffering from functional
impotence the concomitant role of chemo-
therapy (Android) cannot be disputed.

Contraindications: Android is contraindicated in patients with prostatic carcinoma, severe cardiorenal
disease and severe persistent hypercalcemia, coronary heart disease and hyperthyroidism. Occasional
cases of jaundice with plugging biliary canaliculi have occurred with average doses of Methyl Testos-
terone. Thyroid is not to be used in heart disease and hypertension.

Warnings: Large dosages may cause anorexia, nausea, vomiting abdominal pain, diarrhea, headache,
dizziness, lethargy, paresthesia, skin eruptions, loss of libido in males, dysuria, edema, congestive heart
failure and mammary carcinoma in males.

Precautions: If hypothyroidism is accompanied by adrenal insufficiency the latter must be corrected prior
to and during thyroid administration.

Adverse Reactions: Since Androgens, in general, tend to promote retention of sodium and water, patients
receiving Methyl Testosterone, in particular elderly patients, should be observed for edema.

Hypercalcemia may occur, particularly in immobilized patients: use of Testosterone should be discontinued
as soon as hypercalcemia is detected.

References: 1. Montesano, P., and Evangelista, I. Methyltestosterone-thyroid treatment of sexual
impotence. Clin Med 12 69, 1966. 2. Dublin, M. F. Treatment of impotence with methyltestosterone-
thyroid compound. West Med 5:67, 1964. 3. Titeff, A. S. Methyltestosterone-thyroid in treating impotence
Gen Prac 25:6. 1962. 4. Heilman, L., Bradlow, H. L., Zumoff, B., Fukushima, D. K.,and Gallagher, T. F.
Thyroid-androgen interrelations and the hypocholesteremic effect of androsterone. J Clin Endocr 19:936,
1959. 5. Farris, E. J.. and Colton, S. W. Effects of L-thyroxine and liothyronine on spermatogenesis.
J Urol 79:863, 1958. 6. Osol, A., and Farrar, G. E. United States Dispensatory (ed. 25). Lippincott, Phila
delphia. 1955, p. 1432. 7. Wershub, L. P. Sexual Impotence in the Male. Thomas, Springfield.

III., 1959, pp. 79-99.

te lor literature and samples: TbR

THE BROWN PHARMACEUTICAL CO., INC. 2500 West 6th Street, Los Angeles, California 90057

MICHIGAN MEDICINE FEBRUARY 1972 163

Couqty" sceqes

Shiawassee doctors
aid youth program

Members of the Shiawassee County Medical So-
ciety are assisting in the efforts of Spearhead
Owosso, a nonprofit group organized last fall to
give young people a place to go and something to
do. The county society members accept young per-
sons referred to them by the center for aid in drug
addiction, alcoholism, venereal disease and preg-
nancy.

Van Buren doctors sponsor
diphtheria clinic

The Van Buren County Medical Society cospon-
sored a diphtheria immunization clinic in December
in the Covert Community Center, after a case of
diphtheria was reported in the South Haven area.

‘Talking Lady’
gift of Genesee MDs

A new “talking lady” exhibit has been provided
for the Flint Health Institute through a $25,000
donation by the Genesee County Medical Society.
The “talking lady” is a clear, life-size plexiglass
human form, whose lifelike internal organs light up
one by one as the Talking Lady describes how they
work.

Oceana doctors
cosponsor glaucoma clinic

A glaucoma screening clinic was cosponsored by
the Oceana County Medical Society and the Dis-
trict No. 5 Health Department in Hart in mid-De-
cember. The testing was done by three local physi-
cians.

County societies

with wage, price questions

to consult regional offices

County medical society officials seeking to raise
wages or prices for such items as blood bank
charges and society-operated telephone exchanges
are advised to contact regional headquarters of the
Office of Emergency Preparedness during the dura-
tion of the federally-imposed wage and price con-
trols.

Michigan is included in the Chicago region,
with its office at 33 East Congress Parkway, Room
204A, Chicago 60601. The telephone is (313) 591 -
5141.

Doctors should inform
emergency room patients
of full costs

The patient has the right to know just what he’ll
have to pay for his treatment before he leaves the
emergency room, says an Oakland County Medical
Society committee.

“It is the responsibility of the physician in the
emergency room to let the patient know,” declares
Joel I. Hamburger, MD, Southfield, chairman of the
OCMS Mediation Committee, in that committee’s
annual report. “And where possible, this should be
done in advance of the performance of the serv-
ice.”

“Even in the emergency room the patient’s free-
dom of choice to seek medical attention elsewhere
should be preserved,” says Doctor Hamburger.
“Since most emergency room patients are not
actually emergencies, advance agreement upon
fees seems not only possible, but proper.”

The responsibility of fully informing the patient
lies with the emergency room physician, says Doc-
tor Hamburger, “simply because no one else in an
emergency room setting can be expected to do the
job in a tactful and effective fashion.”

Doctor Hamburger's recommendations follow his
committee’s review of 22 complaints from July,
1970, to July, 1971. A sizeable proportion of the
complaints related to fees for emergency room
care.

Unexpected substantial bills (even though justifi-
able in terms of the services rendered) were the
bases upon which many complaints were made.
They were largely the result of lack of communi-
cation, reports Doctor Hamburger.

A common complaint was that the patient did
not realize he had seen a specialist, assuming “the
doctor worked for the hospital.”

“If these complaints, with their detrimental effect
upon the physician’s public image, are to be mini-
mized, a more effective effort must be made to in-
form the patient of the magnitude of his financial
responsibility,” urges Doctor Hamburger.

Calhoun doctors
recruit youngsters,
improve own knowledge

Calhoun County physicians have been active in
two important areas recently. Representatives of
the county medical society met with local high
school students during a “Night with the Profes-
sionals” at Kellogg Community College, Battle
Creek. Counseling sessions to encourage the stu-
dents to enter health careers were held as part of
the observance of Community Health Week.

164 MICHIGAN MEDICINE FEBRUARY 1972

Doctor Smathers
installed in January
as Wayne County president

Homer M. Smathers, MD, is the new president
of the Wayne County Medical Society, installed
at the January regular meeting when Sidney
Chapin, MD, was announced as the new president-
elect after a three-way contest.

Robert K. Whiteley, MD, was thanked for his
18 months of outstanding service. He served an
extra six months as president after a bylaws
change to the calendar year.

The WCMS elections committee also announced
that Ned I. Chalat, MD, had been returned as
secretary; and James D. Fryfogle, MD, chosen as
a new member of the board of trustees. WCMS
also elected officers for three sections and four
geographic positions, along with delegates and
alternates to the MSMS House.

Leaders of the Wayne County Medical Society,
gathered at the installation of new president
Homer M. Smathers, MD, center, include Robert
K. Whiteley, MD, left, immediate past president,
and Sidney Chapin, MD, president-elect, who will
become president in 1973.

Established 1924

MERCYWOOD HOSPITAL

4038 Jackson Road Conducted by Sisters of Mercy Ann Arbor, Michigan

Telephone — 313 663-8571

Mercywood Hospital is a private neuropsychiatric hospital
licensed by the Michigan Department of Mental Health.
Mercywood specializes in intensive, multi-disciplinary
treatment for emotional and mental disorders.

Accredited by the Joint Commission on Accreditation of
Hospitals and the National League of Nursing. A full Blue
Cross participating hospital.

Certified for: Medicare and M.A.A. programs

Robert J. Bahra, M.D.

Dean P. Carron, M.D.
Francis M. Daignault, M.D.
Gordon C. Dieterich, M.D.
James R. Driver, M.D.

(Active & Associate)

Robert L. Fransway, M.D.
Stuart M. Gould, Jr., M.D.
Sydney Joseph, M.D.
Hubert Miller, M.D.

Jacob J. Miller, M.D.
Rudolf E. Nobel, M.D.

Gerard M. Schmit, M.D.
Joseph J. Tiziani, M.D.
Prehlad S. Vachher, M.D.
Richard D. Watkins, M.D.
Robert M. Zimmerman, M.D.

MICHIGAN MEDICINE FEBRUARY 1972 165

Some county societies
have drug programs;
but they'd like more

By Judith Marr
Managing Editor

Twenty-one of the 55 MSMS component county
societies report that they work cooperatively with
local schools in lectures and counseling on drug
abuse.

Fifteen of the component societies work cooper-
atively with the police in lectures and counseling;
15 county societies urge their hospitals to provide
facilities for the diagnosis, treatment and rehabili-
tation of drug-dependent patients, and 14 have
active committees studying local drug abuse prob-
lems.

Ten county societies report active speakers
bureaus to serve schools, churches and community
clubs, and 10 have adopted action programs to
alleviate drug abuse conditions.

But 13 of the county societies do not have
trained speakers and 23 would like help from
MSMS to develop continuing medical education
programs for doctors about drug diagnosis, treat-
ment and rehabilitation. Sixteen would like help
from MSMS to bring community agencies together
to form a community-wide approach to education
and treatment.

These tabulations are the result of the question-
naire sent by the MSMS Committee on Alcohol and
Drug Dependence to MSMS’s 55 component so-
cieties on July 30. Forty of the societies responded.

Wayne County reported the most ambitious pro-
gram to combat the drug problem.

Its society has sponsored two workshops for
members, to discover the number of physicians
who would like to learn more about how to fight
drug abuse and what they would like to know. The
society has held two workshops with hospitals,
planned meetings with law enforcement agencies,
met with the Detroit Bar Association and school
representatives, and worked also with the Detroit
Health Department, Detroit Medical Association,
Greater Detroit Area Hospital Association, Wayne
County Osteopathic Association, and Metropolitan
Detroit Pharmaceutical Association, the state nar-
cotic bureau and the Food and Drug Administra-
tion.

Wayne County currently is encouraging 20 hos-
pitals to establish drug treatment centers and is
cooperating with the hospitals to provide emer-
gency care for drug addicts.

In other areas of the state, the Jackson County
doctors were instrumental in organizing the Jack-
son Area Drug Abuse Council three years ago; and
Kent County doctors are actively involved in Pro-
ject Rehab, a local organization combating drug
abuse. The Kent physicians introduced a resolution
for a moratorium on amphetamines in the 1971
MSMS House of Delegates.

Six or seven Lenawee County physicians spoke
with representatives of the county sheriff’s office
before school assemblies; the Midland County
Medical Society has an ad hoc committee on drug
abuse. Muskegon county has organized nightly
rotations of MDs and DOs to be “on call” for
acute drug problems and has held educational
meetings.

County medical society members throughout the
state have worked with church and youth groups,
mental health boards, county-wide mental health
advisory committees and concerned citizens groups,
as well as on an individual basis.

County medical society evaluations of the local
drug abuse problems range from the Houghton-
Baraga-Keweenaw assay that “drugs have not been
a problem in this area until recently,” and Oceana
County’s observation that the local problem is
“very minor, mostly from outsiders”; to Muskegon
county’s estimate that the problem is “increasing
and very serious,” and Lenawee county’s belief
that the problem is “increasing and getting into
junior high school.”

Detroit doctors
fighting for ecology

Dynamic Detroit-area physicians and scientists
are gathering under a new corporation to provide
consulting and laboratory services to fight prob-
lems of air and water pollution, waste disposal,
quality control of drugs, foods and beverages and
detection of contaminants.

“We all want to become involved. There’s an
awful lot of talent in this area and we might as
well use it,” says Edwin M. Knights, Jr., MD, presi-
dent of the new Life Science, Inc. Doctor Knights
is director of laboratories at Providence Hospital in
Southfield.

Each member of the corporation is a recognized
authority in his particular field and is giving his
time to help special groups to correct environ-
mental problems in the area.

The group plans to add specialists in all areas
of environmental problems. It is headquartered at
794 N. Woodward, Birmingham, in the Northland-
Oakland Medical Laboratories.

166 MICHIGAN MEDICINE FEBRUARY 1972

Flint, G. R. doctors
continuing to serve
in Fayette, Miss.

Physicians from Flint and Grand Rapids are con-
tinuing to provide free medical care in Fayette,
Miss., through a program begun in June, 1970,
by E. Marshall Goldberg, MD, director of medical
education at Hurley Hospital, Flint.

But the doctors now are going to Fayette on their
own, during vacations, since their original program
of assistance was discontinued at the request of
the administrative board of the privately-run Jeffer-
son County Hospital in Fayette.

During November, three Flint physicians, Roy
Diggs, MD, Anna Barg, MD, and Ron Chen, MD,
made the trip to Fayette, remaining for one week
each. Visits by the Michigan doctors will continue
on a sporadic basis.

Between June, 1970, and September, 1971, 130
Michigan physicians in three-man teams from Hurley
Hospital and Butterworth Hospital, Grand Rapids,
spent two weeks each working under the super-
vision of Charles Humphrey, MD, director of the
Medgar Evers Health Center in Fayette.

The doctors enabled the center to provide free

or low-cost medical care to surrounding Jefferson
County’s low-income population.

Some 6,000 patients were treated during the
first year from a total county population of less
than 10,000. Most are Negro and many had never
before received modern medical treatment.

The Michigan doctors also were attached to the
Jefferson County Hospital, publicly-owned, but
privately operated, in a teaching relationship be-
tween the Michigan institutions and the Fayette-
based hospital. The Michigan doctors provided the
county’s first 24-hour emergency medical coverage.

It was Doctor Goldberg’s desire, as reported in
a Michigan Medicine article in September, 1970,
to train his house staff in rural medicine, to show
Michigan physicians what poverty and poor de-
livery of health services are like in certain parts
of the country, and to expose them to the problems
of integration in the deep South. Doctor Goldberg
saw Fayette as most in need of his fellow phy-
sicians’ help.

Though the official program has been discon-
tinued, Doctor Goldberg is continuing his associa-
tion with the center.

He is a new member of the board of the Medgar
Evers Fund, which supports the center in Fayette.
As the only physician on the board, he joins such
distinguished directors as Leonard Woodcock,
Theodore Sorenson, Ramsey Clark, Carl B. Stokes,
Charles Evers and entertainers Sammy Davis Jr.,
and Shirley MacLaine.

ipecici

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MICHIGAN MEDICINE FEBRUARY 1972 167

Michigan’s
delegation
to the
AMA
Clinical
Convention

The AMA delegates laughed approval when a restraining jacket was present-
ed by the Michigan Delegation Chairman Donald N. Sweeny, Jr., MD, Detroit,
to the Ohio delegation for Buckeye Coach Woody Hayes. Doctor Sweeny indi-
cated that the “Michigan delegates would certainly be less than good neigh-
bors if we did not try to relieve the problems which faced the Ohio doctors
on a recent Saturday afternoon on the gridiron of the University of Mich-
igan” when Coach Hayes ranted and raved over some penalties. AMA Vice
Speaker Walker, at the upper podium, enjoyed the break in the serious dis-
cussions.

Herbert A. Raskin, MD, Detroit, left, chairman of
the AMA Committee on Alcoholism and Drug De-
pendence, held a news conference during the
AMA meeting with Jerome H. Jaffee, MD, direc-
tor of the national Special Action Office for Drug
Abuse Prevention.

Demonstrations in the treatment of fractures at-
tracted much attention at the AMA convention
in New Orleans. Franklin Wade, MD, Flint, not
shown in this demonstration team, participated
and was a member of the organizing committee
for the project.

MDPAC Chairman Louis R. Zako, MD,
Allen Park, marched across the plat-
form in New Orleans to place the
Michigan flag on the stage at the 10th
anniversary banquet for AMPAC. Vice
President Agnew was the featured
speaker. Michigan delegates and wives
occupied four tables at the banquet,
up close under the speaker’s table.

[diethylpropion hydrochloride, N.F.)

When girth gets out of control, TEPANIL can provide sound
support for the weight control program you recommend.
TEPANIL reduces the appetite — patients enjoy food but eat
less. Weight loss is significant— gradual— yet there is a rela-
tively low incidence of CNS stimulation.

Contraindications: Concurrently with MAO inhibitors, in patients hypersensitive to
this drug,- in emotionally unstable patients susceptible to drug abuse.

Warning: Although generally safer then the amphetamines, use with great caution in
patients with severe hypertension or severe cardiovascular disease. Do not use dur-
ing first trimester of pregnancy unless potential benefits outweigh potential risks.
Adverse Reactions: Rarely severe enough to require discontinuation of therapy, un-
pleasant symptoms with diethylpropion hydrochloride have been reported to occur
in relatively low incidence. As is characteristic of sympathomimetic agents, it may
occasionally cause CNS effects such as insomnia, nervousness, dizziness, anxiety,
and jitteriness. In contrast, CNS depression has been reported. In a few epileptics
an increase in convulsive episodes has been reported. Sympathomimetic cardio-
vascular effects reported include ones such as tachycardia, precordial pain,

arrhythmia, palpitation, and increased blood pressure. One published report
described T-wave changes in the ECG of a healthy young male after ingestion of
diethylpropion hydrochloride,- this was an isolated experience, which has not been
reported by others. Allergic phenomena reported include such conditions as rash,
urticaria, ecchymosis, and erythema. Gastrointestinal effects such as diarrhea,
constipation, nausea, vomiting, and abdominal discomfort have been reported.
Specific reports on the hematopoietic system include two each of bone marrow
depression, agranulocytosis, and leukopenia. A variety of miscellaneous adverse
reactions have been reported by physicians. These include complaints such as dry
mouth, headache, dyspnea, menstrual upset, hair loss, muscle pain, decreased
libido, dysuria, and polyuria.

Convenience of two dosage forms: TEPANIL Ten-tab tablets: One 75 mg. tablet
daily, swallowed whole, in midmorning (10 a.m.); TEPANIL: One 25 mg. tablet three
times daily, one hour before meals. If desired, an additional tablet may be given in
midevening to overcome night hunger. Use in children under 12 years of age is not
recommended. 1-3325 (2876 )

MMerrelM

MERRELL- NATIONAL LABORATORIES
Division of Richardson -Merrell Inc.
Cincinnati, Ohio 45215

Painful
night leg
cramps...

unwelcome bedfellow
for any patient-
including those with arthritis,
diabetes or PVD

□

□

Prevents painful night
leg cramps

Permits restful sleep

Provides simple
convenient dosage —
usually just one tablet
at bedtime

Prescribing Information — Composition: Each white, beveled, compressed tablet
contains: Quinine sulfate, 260 mg., Aminophylline, 195 mg. Indications: For the
prevention and treatment of nocturnal and recumbency leg muscle cramps, includ-
ing those associated with arthritis, diabetes, varicose veins, thrombophlebitis,
arteriosclerosis and static foot deformities. Contraindications: Quinamm is con-
traindicated in pregnancy because of its quinine content. Precautions/ Adverse
Reactions: Aminophylline may produce intestinal cramps in some instances, and
quinine may produce symptoms of cinchonism, such as tinnitus, dizziness, and gas-
trointestinal disturbance. Discontinue use if ringing in the ears, deafness, skin rash,
or visual disturbances occur. Dosage: One tablet upon retiring. Where necessary,
dosage may be increased to one tablet following the evening meal and one tablet
upon retiring. Supplied: Bottles of 100 and 500 tablets.
MERRELL-NATIONAL LABORATORIES

N MERR

Merrell ) Divisi

-r Cinci

1-3508(3050)

Quinamm

(quinine sulfate 260 mg., aminophylline 195 mg.)

ision of Richardson-Merrell Inc.
Cincinnati, Ohio 45215

Trademark: Quinamm

Specific therapy for night leg cramps.

ALLIN HIS HEAD: ALLIN'ORNADE*

Watery Eyes

Nasal

Congestion

Drying Agent — .

(isopropamide,
as the iodide —
2.5 mg.)

Decongestant — "
(phenylpropanol-
amine HC1 — 50 mg.)

Sneezing

Runny Nose

Antihistamine ^

(chlorpheniramine
maleate— 8 mg.)

THE COLD THE
SYMPTOMS INGREDIENTS
THAT HE NEEDS
MAKE HIM FOR PROLONGED
MISERABLE RELIEF

Before prescribing, see complete prescribing information in
SK&F literature or PDR.

Indications: Upper respiratory congestion and hypersecretion
associated with: the common cold; acute and chronic sinusitis;
vasomotor rhinitis; allergic rhinitis (hay fever, “rose fever,” etc.).
Contraindications: Hypersensitivity to any component;
concurrent MAO inhibitor therapy; severe hypertension;
bronchial asthma; coronary artery disease; stenosing peptic
ulcer; pyloroduodenal or bladder neck obstruction. Children
under 6.

Warnings: Advise vehicle or machine operators of possible
drowsiness Warn patients of possible additive effects with
alcohol and other CNS depressants.

Usage in Pregnancy: In pregnancy, nursing mothers and
women who might bear children, weigh potential benefits
against hazards. Inhibition of lactation may occur.

Trademark

Effect on PBI Determination and 7131 Uptake: Isopropamide
iodide may alter PBI test results and will suppress I131 uptake.
Substitute thyroid tests unaffected by exogenous iodides.
Precautions: Use cautiously in persons with cardiovascular
disease, glaucoma, prostatic hypertrophy, hyperthyroidism.
Adverse Reactions: Drowsiness, excessive dryness of nose,
throat or mouth; nervousness; or insomnia. Also, nausea,
vomiting, epigastric distress, diarrhea, rash, dizziness,
weakness, chest tightness, angina pain, abdominal pain,
irritability, palpitation, headache, incoordination, tremor,
dysuria, difficulty in urination, thrombocytopenia, leukopenia,
convulsions, hypertension, hypotension, anorexia, constipation,
visual disturbances, iodine toxicity (acne, parotitis).

Supplied: Bottles of 50 capsules.

SK&F Smith Kline & French Laboratories

OKNADE SPANSULE

©

Each capsule contains 8 mg. of Teidrin®(brand of
chlorpheniramine maleate); 50 mg. of phenylpropanolamine
hydrochloride; 2.5 mg. of isopropamide. as the iodide.

brand of sustained release capsules

UNCOMMON RELIEF FOR COLD SYMPTOMS

OR-203

Mylanta

24 million hours

a day.

Through the day, every day,
ulcer patients take
one million doses of Mylanta
for relief of ulcer pain.

aluminum and magnesium hydroxides plus simethicone

Good taste -patient acceptance

Relieves G.i gas distress*

Non-constipating

‘V'ith 1 ■ defoaming aclion of simethicone

Stuart |

Divi:

d i ARMACtUTICAlS Pasadena, Calif. 91 109

' ' '■ •_he.rr.ico1 hiduslries, Inc., Wilmington, Del. 19899

PR notebook

Start of new year
provides PR opportunities
for county societies

By Herbert A. Auer, Manager
M SMS Department of Communications

Every component county medical society must
constantly work to open and deepen good channels
of communications with the press, radio and tele-
vision.

The society committee on public relations should
be charged to find out what help the media need
to report and interpret the medical profession. The
committee also should know what the officers and
working medical committees expect in the way of
news coverage, editorial support.

The MSMS House of Delegates in 1971 adopted
a resolution urging component societies and phy-
sicians to cooperate with the media. The delegates
observed that “an out-of-date” code of ethics has
hindered the profession from being seen and
heard.”

The resolution states that “MSMS encourage
all physicians in the state to contact the local
outlets of the various communications media and
make arrangements to use these media for the
advancement of information on the present sys-
tem of delivery of medical services, its cost and
efficiency, as well as the progress medicine has
made in the past several decades in promoting
and improving the health care standards prevalent
today.” The resolution further states, “These mat-
ters to be accomplished with the consent of the
local medical society and in accord with its local
guidelines on the use of the media. Original and
innovative ideas in carrying out this resolution are
encouraged from all individual physicians, com-
ponent medical societies, and public relations
committees.”

Each year provides new opportunities for the
county society and public relations chairman to
call upon as many media leaders as possible. A
letter to the editor or station managers would be
appropriate seeking a conference.

In approaching a newspaper, for example, intro-
duce yourself to the editor, the managing editor,
or the city editor. Obviously, you more likely can
visit with the editor-in-chief in the smaller towns
than the larger ones. Here is an excellent oppor-
tunity to seek advice. The editor, or the reporter,
can give you some solid suggestions. And he will
have a keener interest in your group and its efforts,
if he has helped develop some workable pro-
cedures.

The editor will introduce you to the reporter
assigned to cover such groups as yours or such

activities as you have planned. Reporters generally
have “news beats,” such as the city hall, schools,
business, etc. You should make every effort to
build a business-like friendship with that reporter.
Keep him posted on your activities. Tip him off, too,
on other stories; he’ll appreciate your interest.

Your stories about local people and local efforts
are not likely to be tossed aside, but do not protest
if your pet articles are cut. News releases are sel-
dom printed just as they are turned in. It helps
to find out how the media would like news releases
prepared. Keep carbon copies of material that is
submitted and compare them with the actual ar-
ticle.

Develop the habit of telling what will be hap-
pening, rather than reporting old events. Look
ahead.

Newspapers have far more news, features and
photos every day than they can possibly print, so
medical news must compete with government,
sports, etc.

For a quick understanding about what is news,
here’s a broad, simple definition: “News is any-
thing and everything of interest to the public.” And
generally the news stories you will seek or the
feature stories you want to get into print will con-
nect if they are about something in the public in-
terest. Some insights into newspaper operation will
be valuable to you:

1. Newspapers have deadlines, which you must
respect.

2. News is news today only, not tomorrow.

3. Newspapers generally are shorthanded; your
help will be sincerely appreciated

4. Newspapers are always looking for human-
interest happenings and photos, so look for
the unusual and for chuckles.

Starting with this issue, MICH-
IGAN MEDICINE begins a new
series of articles about public rela-
tions for Michigan physicians. The
articles are designed to be torn out
and saved as a reference guide.

MICHIGAN MEDICINE FEBRUARY 1972 173

°Iil memortam

Ralph M. Burke, MD
Grosse Pointe

Ralph Martin Burke, MD, Detroit-area surgeon
and proctologist, died Dec. 12 at the age of 64.
He was affiliated with Providence, Jennings, St.
John and Bon Secours hospitals in Detroit.

Doctor Burke was a former chief of the Provi-
dence Hospital medical staff and had served as
chairman of the Committee on Education of the
American Proctologic Society.

Earl I. Carr, MD
Lansing

Earl I. Carr, MD, Lansing, a much-honored and
distinguished physician for his work in cancer con-
trol and as president of the Michigan Foundation
for Medical and Health Education, died Dec. 24,
1971, at the age of 85.

Doctor Carr had been a member of MSMS since
1914. He served as MSMS first vice president in
1927 and as liaison chairman with the University
of Michigan president from 1944-53. He was a past-
president of the Ingham County Medical Society.

He was chairman, trustee and president of the
founding committee of the Michigan Foundation.
He was trustee of the Michigan Health Council,
member of the board of directors of Michigan Med-
ical Service 17 years and on the Blue Shield fi-
nance, building and executive committees, as well
as chairman of the medical advisory board.

In 1951, Doctor Carr received the first Tiffany
Medal in Michigan of the American Cancer Society.
He was awarded a service citation from the ACS in
1961. He served on the Michigan board of directors
of the American Society for the Control of Cancer,
and on its executive committee.

Doctor Carr was chief consulting surgeon of the
Michigan Department of Public Health, and chief
surgeon of Michigan penal institutions from 1921-
26. He was on the Michigan executive committee
and Committee on Trauma of the American College
of Surgeons and past regent, chairman of the
board and vice president of the International Col-
lege of Surgeons.

Edwin F. Dittmer, MD
Grosse Pointe Park

Edwin F. Dittmer, MD, a Detroit obstetrician-
gynecologist, died Nov. 28 at the age of 62.

Doctor Dittmer was on the staffs of St. John,
Deaconess and Cottage hospitals in Detroit. He
was a graduate of Wayne State University School

of Medicine and was past treasurer of the WSU
Medical Alumni Association and a former member
of the WSU Board of Governors.

Doctor Dittmer was a fellow of the American
College of Obstetricians and Gynecologists and
was a member of the AMA Committee on Maternal
and Perinatal Health. He was a member of the
board of directors of Valparaiso University and a
member of the MacKenzie Honor Society of Wayne
State University.

Ellis R. Green, MD
Livonia

Ellis R. Green, MD, Livonia physician for 58
years, died Nov. 27 at the age of 82.

Doctor Green was a graduate of the Detroit
College of Medicine and was a life member of
MSMS. He was honored in 1962 by the Wayne
State Alumni Association when he was presented
with a certificate in honor of his 50 years of serv-
ice.

Edwin S. Hoffman, MD
Detroit

Edwin Sanford Hoffman, MD, retired Grace Hos-
pital staff physician, died Dec. 28 at the age of 66.

Doctor Hoffman was an instructor in gynecology
at Wayne State University school of medicine and
an assistant professor in the WSU graduate school.
He was a graduate of the University of Michigan
Medical School.

Doctor Hoffman was a fellow of the American
College, Central Association and Michigan Society
of Obstetricians and Gynecologists.

William C. Hubbard, MD
Flint

William C. Hubbard, MD, Flint ophthalmologist,
died Nov. 24 at the age of 40.

Doctor Hubbard, a graduate of the University of
Michigan Medical School, was affiliated with Gen-
esee Memorial, McLaren General, Hurley and St.
Joseph hospitals in Flint. He was a member of the
American Academy of Ophthalmology and Oto-
laryngology.

Herbert K. Kent, MD
Lansing

A life member of the Ingham, Michigan State and
American medical associations, Herbert K. Kent,
MD, Lansing, died Nov. 4 at the age of 77.

Doctor Kent was a graduate of Loyola University
medical school and practiced for a short while in
Oregon and North Dakota. He established a prac-
tice in Lansing in 1932 and was on the staffs of
E. W. Sparrow and Ingham Medical hospitals. He
retired in 1968.

174 MICHIGAN MEDICINE FEBRUARY 1972

David Kliger, MD
Detroit

Detroit pediatric allergist David Kliger, MD, died
Dec. 13 at the age of 69.

A graduate of Tufts College of Medicine, Doctor
Kliger was employed by the state as Wayne County
medical administrator for crippled and afflicted
children. He was on the staffs of Children’s, Mt.
Carmel-Mercy and Sinai hospitals in Detroit.

Doctor Kliger was a diplomat of the American
Board of Allergists and Immunologists and the
American Association for Clinical Immunology and
Allergy. He was a member of the Detroit Pediatric
Society, the Michigan Allergy Society and was an
associate fellow with the American College of Al-
lergy.

Richard S. Knox, MD
Royal Oak

Richard S. Knox, MD, the first psychiatric con-
sultant to the Wayne County Jail, died Dec. 27 at
the age of 48.

Doctor Knox was a graduate of the University of
Manitoba School of Medicine and maintained a pri-
vate practice in Royal Oak.

He also served as director of the adolescent de-
partment of Lafayette Clinic from 1959 to 1961 and

was consultant to the Sarah Fisher Home and the
Northwest Child Guidance Clinic.

He was an associate professor at Wayne State
University and was a member of the American Psy-
chiatric association, the Michigan Society of Neu-
rology and Psychiatry and the Royal Medico-Psy-
chological Association of Britain.

A. Herbert Naylor, MD
Milford

Arthur Herbert Naylor, MD, Milford, died Dec. 5
at the age of 78. Doctor Naylor had practiced med-
icine on the west side of Detroit for nearly 50
years.

Doctor Naylor was a graduate of the University
of Toronto medical school and was affiliated with
Mt. Carmel Mercy and Detroit General hospitals.

Alger A. Palmer, MD
Chelsea

Alger A. Palmer, MD, Chelsea generalist, died
Dec. 15 at the age of 80.

Doctor Palmer was a graduate of the University
of Michigan Medical School and was affiliated with
St. Joseph Mercy Hospital in Ann Arbor. He was
the recipient of two bronze battle stars for service
in World War II.

CONVENTION ’ll

combining the
Chicago Medical Society
MIDWEST CLINICAL CONFERENCE

and the

Illinois State Medical Society
ANNUAL MEETING
March 7-11, 1972 Conrad Hilton Hotel

• Specialized Workshops and •

Lectures

• Intensive 3-Day Postgraduate •

Course in Medicine

• 4 Accredited Instruction •

Courses

Programmed with the Cooperation of 14 Specialty Societies

Write for Full Details

Chicago Medical Society, 310 S. Michigan Avenue
Suite 1616

Chicago, Illinois 60604

Chicago

Continuous Medical Film
Program

Scientific and Technical
Exhibits

Renowned Trauma Session

MICHIGAN MEDICINE FEBRUARY 1972 175

Here's how to manage patients
under Blue Cross non -group contract

By Russell J. Burns
Physician Liaison
Michigan Blue Cross

Detroit

The following interpretation of the Mich-
igan Blue Cross NON-GROUP (under age 65)
CONTRACT exclusion is presented in an ef-
fort to assist the physician in his relation-
ships with his Blue Cross subscriber patients
having this particular contract.

The article was prepared in a continuing
effort by the Michigan Hospital Service to
maintain good relationships ivith Michigan
physicians and to assist physicians in their
relationships ivith patients. Subsequent articles
on other facets of the Blue Cross hospitaliza-
tion contract will follow in future issues of
MICHIGAN MEDICINE.

In Section VI (B-8) of the Blue Cross Non-Group
contract, the following statement appears: “Hos-
pital service is not available hereunder to any
member for a condition existing on the date mem-
bership becomes effective hereunder, whether or
not known to the member or diagnosed or treated
prior to that date, until membership has been
effective for at least 180 consecutive days im-
mediately preceding the date of admission to the>
hospital.”

In the Blue Cross application of this restriction
in its claims-handling procedures, our staff phy-
sicians consider objectively the entire medical pic-
ture, including the history of symptomatology and
the known natural pathogenesis of the disease
involved.

Any acute manifestation of a chronic condition,
disease or ailment which existed on the effective
date of the subscriber certificate must be con-
sidered a pre-existing condition and subject to
the 180-day waiting period.

The following are several examples which would
be ineligible for coverage under the pre-existing
condition exclusion and, consequently, benefits
would not be available in the event of hospitaliza-
tion during this waiting period.

1. Gallbladder disease with stones diagnosed in
the 180 day waiting period and symptoma-
tology dating back prior to the beginning
effective date of the contract.

2. An acute bladder obstruction from prostatism.
The acute obstruction obviously would not
have pre-existed but the prostatic enlarge-
ment symptomatology may have and if the
history is fairly specific on this point, benefts
would not be allowed.

3. Established and recognized diabetes sud-
denly going out of control during the waiting
period would be another example where
emphasis is placed on the total medical
entity — the diabetic state — even though con-
trolled at the time of the contract issuance.
In an acute episode, with such a pre-existing
diabetic condition, hospitalization benefits
would not be allowed.

4. A case of strangulated hernia in a patient
with pre-existing hernia.

5. An acute coronary attack in a case of es-
tablished cardiovascular disease.

6. Removal of cataracts when there is a history
of impaired vision.

7. Treatment or removal of hemorrhoids in a
patient with a history of pain or bleeding.

The subscription rates for this contract have
been established using the above exclusion inter-
pretation. The Blue Cross Non-Group subscriber,
therefore, is not paying for something he does
not receive.

The integrity of the patient and the lack of intent
to exploit Blue Cross by securing coverage after
the necessity of hospitalization is known are rea-
sons frequently offered as justification for Blue
Cross to accept liability. We can not, in 'airness
to all concerned, deviate from the policy of ad-
hering to the basic medical facts involved with
the case.

IN MEMOR I AM /Continued

Albert D. Ruedemann, MD
Grosse Pointe Park

Albert Darwin Ruedemann, MD, founder and for-
mer chief of the Kresge Eye Institute, Detroit, died
Dec. 30 at the age of 74.

Doctor Ruedemann was co-inventor of the first
moveable artificial eye in 1943, for which he re-
ceived the Gold Medal Award from the American
Academy of Ophthalmology and Otolaryngology. He
received a second Gold Medal Award for his work
in beta radiation and ophthalmology.

He was past president of the section in ophthal-
mology for the AMA, past president of the Amer-
ican Academy of Ophthalmology and Otolaryngol-
ogy and secretary for instruction of the latter so-
ciety for 25 years.

Doctor Ruedemann also was past president of
the Michigan Ophthalmology Society and served as
chief of ophthalmology at the Cleveland Clinic
from 1921 until 1947, when he came to Detroit. He
also was a professor of ophthalmology at Wayne
State University.

176 MICHIGAN MEDICINE FEBRUARY 1972

IN MEMORIAM/Continued

John J. Sauk, MD
Sterling Heights

John Joseph Sauk, MD, a surgeon affiliated with
Brent General Hospital in Detroit, died Dec. 10 at
the age of 59.

Doctor Sauk was a graduate of the University of
Michigan Medical School and was a member of the
American College of Surgeons. He had practiced
35 years in the Detroit area.

Norman Schkloven, MD
Detroit

Norman Schkloven, MD, psychiatrist and member
of the faculty of the Wayne State University School
of Medicine, died Dec. 24 at the age of 47.

Doctor Schkloven was affiliated with Receiving
and Sinai Hospitals of Detroit and was a graduate
of the University of Michigan Medical School. He
was a psychiatric consultant to the Mental Hygiene
Clinic of the VA Regional office in Detroit.

Doctor Schkloven was a member of the exec-
utive council of the American Psychoanalytical
Association and was a councillor for the Michigan
Association for Psycholanalysis. He also belonged
to the American Psychiatric Association and the
Michigan Society for Neurology and Phychiatry.

Archibald L. Seiferlein, MD
Grosse Pointe

Former City of Detroit Physician Archibald Seifer-
lein, MD, died Nov. 25 at the age of 68.

Doctor Seiferlein was a graduate of the Univer-
sity of Michigan Medical School and was affiliated
with Detroit Memorial Hospital.

Frederick B. Steiner, MD
Garden City

Frederick Brewer Steiner, MD, who practiced
medicine in Garden City, died Dec. 11 at the age
of 59.

Doctor Steiner was a graduate of Wayne State
University School of Medicine and was on the
staffs of Providence Hospital in Detroit, Oakwood
Hospital in Dearborn and Annapolis Hospital,
Wayne.

He was a member of the American Academy of
Family Physicians.

Gerber Co.
establishes
MSU fellowship

The Gerber Products Co. of Fremont has estab-
lished a “Gerber Fellowship in Human Develop-
ment” at Michigan State University’s College of
Human Medicine. Their grant of $15,000 a year will
support teaching and research activities for health
care benefiting children.

Still serving...

Miltown

(meprobamate)
400 mg tablets

WALLACE PHARMACEUTICALS kjjj
Cranbury, N.J. 08512 ^

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PSYCHIATRIC RESIDENCIES— Excellent, approved
psychiatric training; both demanding and clinically
rich with a stimulating, well-balanced program. Af-
filiated with Michigan State University’s College of
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Bay area. Three-year plan: $12,215 to $13,885; five-
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Michigan 49684. Phone: (616) 947-5550. An equal

opportunity employer.

GENERAL PRACTITIONER AND SURGEON: Com-
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An Equal Opportunity Employer.

PROFESSIONAL BUILDING— Spanish motif, presently
under construction for April 1972 completion.
Located on Schoenherr and 1 1 1/^ Mile Road, Warren,
Michigan. Suites available for lease. Excellent oppor-
tunity for physician, dental specialist, podiatrist, or
attorney, can be partitioned to suit your needs. For
information: Call (313) 755-1410.

FOR LEASE: Custom built doctor’s suite of 10 rooms
and 2 lavatories; includes reception room, 5 examina-
tion rooms, doctor’s office, nurses’ office, laboratory,
large storage or multi-purpose room. Built 1956.
Air conditioning, gas furnace, fluorescent lighting.
One block from center of Whitehall. Contact A. W.
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ANN ARBOR - YPSILANTI AREA-3 year approved,
university affiliated, psychiatric residency at mental
health center offering comprehensive services to SE
Michigan; teaching faculty and supervisors include
University of Michigan faculty, private psychiatrists
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divided approximately equally between didactic semi-
nars (including supervision) and clinical experience;
first year ADM and intensive treatment units; second
and third year assigned community psychiatry and/or
OPC and/or Children’s Unit; additional experience
in psychosomatic medicine, University Mental Hy-
giene Clinic and neurology. 3 years: $12,215 to
$13,893; 5 years: $13,927 to $18,708 (4th and 5th
year salaries negotiable) . Contact: W. Bogard, M.D.,
Ypsilanti State Hospital, Ypsilanti, Michigan 48197.
An equal opportunity employer.

WINTER SUMMER VACATIONLAND— Staff Surgeon,
Interesting and challenging assignment, small pro-
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Hospital, Saginaw, Michigan.

OFFICE SPACE: Grand Haven, Michigan, located on
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estate planning, income tax reduction, HR- 10 retire-
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ment counsel, and practice management. If you want
the best in financial and practice counseling, phone
or write Phillip Fry and Associates, 14940 Plymouth
Road, Detroit, Michigan 48227. Phone (313) 499-9044.

DOCTOR, are you tired of the urban rat race, traffic
congestion, and the grind of going to two or three
separate hospitals each day? Wouldn’t you rather
live within three minutes of your hospital and 5
minutes of your office, 4 minutes from several large
lakes, and i/2 hour from a major ski area? There is
such a place in North Central Michigan, and there
is an immediate need for a board qualified or eligible
internist, pediatrician, and anesthesiologist. Help in
starting and office space are available. If you would
like further information, please, reply to box #2,
120 West Saginaw Street, East Lansing, Michigan
48823.

178 MICHIGAN MEDICINE FEBRUARY 1972

FOR LEASE: In the Prairie Professional Building, lo-
cated in the City of Grandville, Michigan. With the
construction of phase 3 nearly complete, we have
choice suites available. Will be developed to your
exact requirements. Suitable for medical, dental or
related professions. Also, lower level suite available
at reduced rates. Lease rentals include heat, electric,
air conditioning, snow removal, paved parking, built-
in vacuum system, music, attractive landscaping. This
location is convenient and desirable. Reply to Prairie
St. Realty Corp., 2700 28th St., S.W., Grand Rapids,
Michigan or phone (616) 538-9000 days or evenings
(616) 457-9645.

MICHIGAN STATE UNIVERSITY, Department of
Human Development, East Lansing, Michigan, an-
nounces the opening of the Nephrology and Im-
munology Referral Clinic. For information contact
the Department of Human Development, Life
Sciences I Building, MSU, East Lansing, Michigan
48823, (517) 353-7806.

FOR SALE: Medical Equipment suitable for use by
internist or F.M.D.: X-Ray, Diathermy, examining
tables, treatment tables, instrument and supply cab- \

inets, surgical instruments, cautery, centrifuge, office
furniture, steel files and many other items. Will sell
at appraised value. Reply Box #10, 120 West Sag-
inaw St., East Lansing, Mi 48823.

OPPORTUNITY for Internist or Family Physician to /

take over thirty year old practice in splendid loca-
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utes drive to three local hospitals. Excellent hospital
and office facilities in city of 125,000 population.

Will introduce. Retiring. Reply Box #9, 120 W.

Saginaw St., East Lansing, Mi 48823.

Advertisers in MICHIGAN MEDICINE are
friends of the profession. By accepting their adver-
tising we show confidence in them, their services
and products. They help make the journal a qual-
ity publication. Please familiarize yourself with
their services and products and let them know
that you see their advertising in MICHIGAN
MEDICINE.

PROFESSIONAL
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preferences in confidence to Arthur A. Lepinot.

INDEX TO ADVERTISERS

Abbott

.123,

124

Bristol Laboratories

79

Brown Pharmaceuticals

163

Burroughs Wellcome Co.

Cover III,

129

Campbell Soup Co

119

Chicago Medical Society . . .

175

Classified Advertising

178,

179

Cole Pharmacol Co., Inc.

159,

160

Colgate-Palmolive Co

139,

140,

141,

142

Flint Labs

126,

127

Geigy Pharmaceuticals

83

Hospital Planning, Inc

179

Import Motors Limited, Inc. .

91

Lederle Laboratories

155,

156,

157,

158

Lilly, Eli and Co

94

Medical Protective Co

167

Mercywood Hospital

165

Merrell-National Labs ....

169,

170

Pfizer Laboratories

152,

153

Poythress, Wm. P. & Co. . . .

86

Robins, A. H . . .

143,

144,

145

Roche Laboratories

84

, 85,

Cover IV

Searle, G. D. & Co

120,

121,

122

Smith, Kline & French

171

Stratton, Ben P. Agency ....

Stuart Pharmaceuticals

130,

131,

172

Upjohn

. 88, 89,

136,

137,

138

U. S. Savings Bonds

180

U. S. V. Pharmaceutical . . .

149

Wallace

177

Warner-Chilcott

134,

135

MICHIGAN MEDICINE FEBRUARY 1972 179

U. S. Savings Bonds come in
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But unlike other gifts, you don’t
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Give U. S. Savings Bonds.

The gift idea that always fits.

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©ffi

The U. S. Government does not pay for this advertisement.
It is presented as a public service in cooperation with The
Department of the Treasury and The Advertising Council.

180 MICHIGAN MEDICINE FEBRUARY 1972

^Souqd Off

A physician's
fundamental right
in a democracy

By Sidney Adler, MD
MSMS President

I become more and more confused when I hear
my colleagues, in and out of official channels,
speak to the subject of influencing medical eco-
nomics by bargaining for physicians’ services.

Each of us, of course, influences medical eco-
nomics by bargaining for his own services. I un-
derstand that, but that is not what is being talked
about.

Groups of physicians practicing together may
bargain for the services of the group, and that, I
also understand. It is much the same thing as the
individual does, and there is little that organized
medicine or other physicians can or should do,
legally or philosophically, to limit their right to
bargain for their own services on terms and bases
which are not obviously unreasonable and which
are consistent with the law and ethical principles
which govern physicians.

So often, though, I hear my colleagues talking
about somebody else “selling his services.” He
may refer to Blue Shield, or to the Michigan De-
partment of Social Services, or to the U.S. Bureau
of Health Insurance, or to industry or to labor. He
almost surely is not talking about the hospital to
which he serves, or the P.C. of which he is a
member, or if he is salaried, the business, govern-
ment or financial corporation which pays him a
salary and which in fact does sell his services,
acting under the authority and power which he has
given to it.

We should be honest with ourselves. Until now,
nobody else has bargained for our services, if
we are self-employed and that includes labor,
industry, government, or Blue Shield. If we serve a
patient upon his terms, it has been because we
chose to do so, not because we were forced to do
so. In the case of Blue Shield, it would be because
some of us chose to participate. Others of us
chose not to. In the case of Medicare, it would
be because some of us chose to accept assign-
ments. Others of us chose not to. In the case of
Medicaid, it would be because some of us chose
to serve the State’s clients upon the State’s terms.
We were not compelled to do so.

and the way I hope to live out my span. Nobody
but me has sold or can sell my services, whether
or not he is a physician.

We can’t have it both ways. Those of us who
want to be self-employed can be self-employed.
Those of us who want to be salaried can be sal-
aried. But the self-employed shouldn’t complain
because nobody else bargains for them, and the
salaried shouldn’t complain because, while em-
ployed, they can only bargain with their employers.

Organized medicine
must listen
to individual MDs

By Herbert A. Auer, Manager
MSMS Dept, of Communications

An appeal was made recently by Homer M.
Smathers, MD, in his inaugural address as the
new Wayne County Medical Society president,
that leaders of medical societies listen to what
physicians are saying about medical organizations.

Doctor Smathers expressed the view that ques-
tions are being raised about the effectiveness of
medical organizations because “the majority of
practitioners feel they are not being heard and are,
therefore, not represented.” He continued:

“I believe the many splinter organizations re-
cently formed are not an impediment to progress,
but rather, represent a desire to be heard. In
unity there is strength, which I firmly believe is
needed in discussions with pressure groups that
would interfere with delivering quality health care.
To attain this unity the officers of the AMA, state
and county medical societies must improve com-
munication with physicians.”

That is the private system. That is the way I
have lived for more years than I like to remember,

The new WCMS president moved on, stressing
that, “I believe the leadership must do more listen-

MICHIGAN MEDICINE FEBRUARY 1972 181

Doctor

ing and to implement
following:

“1. All Wayne County Hospital staffs be re-
minded of their geographic representatives
and invite the representative to the quarterly
staff meetings.

“2. At least two hospital staffs present sum-
maries of newsworthy items for each Detroit
Medical Bulletin; the hospitals to be as-
signed dates in alphabetical order.

“3. The journal of the Michigan State Medical
Society enlarge the section on opinion, mail-
bag, etc.

“4. The state journal to print more summaries
of meetings and papers but fewer total
scientific papers.

“5. The state medical society meeting be a
one-day informational meeting at the conclu-
sion of the House of Delegates and that
reference committee chairmen be present
to explain the issues which were debated
in committee hearings.

“6. That our delegates to the AMA support
a major change in format for the annual
meeting, even to the consideration of no
scientific meeting.

“7. That the AMA journal be a source of infor-
mation regarding developing social, educa-
tional, legislative activities of importance to
the membership.”

These suggestions were presented by Doctor
Smathers, he said, “in an effort to face reality.”

Doctor Smathers presented the preceding argu-
ments to back up his several suggestions that
medical societies should decrease their efforts
in continuing medical education. He supported his
contentions by adding, “Outstanding postgraduate
courses and programs are available in every large
city in the world. Air transportation results in mini-
mum time loss. Hospitals, medical schools, and
specialty societies offer educational opportunities
by the hundreds. The time and effort formerly
expended by the county society on monthly meet-
ings, the state society at its annual meeting, and
the national society’s annual meeting can now be
more fully utilized in a concerted attempt to re-
spond to the desires of the membership.”

The inaugural address repeated the plea for
unity and new willingness to listen. Doctor Smathers
summarized by saying:

“With unity and concentrated effort once again
established, sound and constructive ideas for im-
proving the delivery of health care will come from
our members. The officers must be listening.”

Doctor Grigg
suggests changes
in Annual Session

By John W. Grigg, MD
Bay City

After the past MSMS House of Delegate's ses-
sion, I wrote, “The House fails dismally to establish
a system of priorities.”

What are the reasons for my conclusion? How
can remedies be effected for a more comprehen-
sive function by the House of Delegates without
sacrificing its deliberative role, or surpressing the
expression of grass roots sentiment?

There are submitted too many irrelevant, enig-
matic resolutions, and resolutions whose relation-
ship to medicine is obscure. Although of sincere
intent, these resolutions are as time-consuming as
those which alter basic policy and affect the
destiny of the Society for years.

Several profoundly important resolutions at the
last session were not given adequate cogitation.
A Foundation for Peer Review should receive con-
siderable contemplation both by committee and the
entire House. The magnamimous problem of mal-
practice was briefly examined and disregarded.

Other important issues were not discussed at
all. Among them were, which individuals or com-
mittee will meet with the State Social Services
Department to discuss or negotiate fees under the
new Medicaid Program. The quesion is presently
emergent since the Department of Social Services
has requested our state society to submit a fee
schedule.

The Legal Affairs Committee recommended the
new 5-digit Relative Value Scale as recently re-
vised. The Council received this recommendation
from the Legal Affairs Committee but inferred the
question to be of such importance that it should
be referred to the House of Delegates. Many indi-
viduals in the MSMS were aware of this problem.
Certainly it could have been resolved at the last
House of Delegates meeting.

Too many similar problems have the same inertia.
(The solution may simply be to give The Council

182 MICHIGAN MEDICINE FEBRUARY 1972

more latitude or authority to execute current
MSMS problems.)

At present, there is inadequate time allocated
to the House of Delegates Committees to properly
ponder the complexities of a multiplicity of reso-
lutions. The resolutions introduced from the floor
at the first evening’s session are especially per-
plexing, and it is these in particular to which I
have reference. Without the opportunity for prior
research and study, some deliberations at the com-
mittee level are superficial, rhetorical and expres-
sions of personal philosophies. Decisions to recom-
mend approval, disapproval, or substitute resolu-
tions are in some instances hastily formulated, and
not in the best interests of the Society.

A change in basic policy for the submission
of resolutions is suggested. All resolutions should
be submitted 30 days prior to the House of Dele-
gates assemblage. In addition, an accompanying
critique should be required to delineate the rea-
sons for the resolution. Further, eliminate introduc-
tion of resolutions from the floor unless declared
truly emergent by the speaker. This necessitates
no inconvenience since the House now convenes
twice a year. This will allow the MSMS staff ample
time for research and investigation of prior and
similar resolutions, and to assemble appropriate
commentary. This material can be sent to the
various committee members 10 days to two weeks
prior to convening. This will allow ample time for
study and rumination.

There has recently been formed a new com-
mittee, The Committee for Planning and Priorities.
With the inception of this committee, the problems
of establishing priorities for debate by the House
may be solved. It is suggested this committee meet
and scrutinize the resolutions before the House
assembles.

Certainly it is essential that more knowledgeable
direction be given to the House of Delegates to
insure that important topics receive the majority
of time and consideration.

The institution of these or similar recommenda-
tions will not restrict the basic function of the
House, and should create more effective operability.

Dedicated action

way to build

to good county society

By Donald G. May, MD
Kalamazoo

As the newly-elected president of a county medi-
cal society, I am aware of the challenge of the
office. There appear to be many perceptive phy-
sicians who see a crying need for an organization
which is capable of serving as a forum for our
many and diverse concerns.

Today it is difficult for individual physicians to
claim overall knowledge of the changes in medi-
cine.

It is important that we share the many sources
of first hand information that are available through
the county organization. It is only by becoming
more reliably informed that we can discuss the
current medical issues with our lay friends in a
truly representative manner.

A county president must direct his efforts to-
ward establishing a free exchange between many
diverse attitudes and disciplines represented by
(Continued on page 184)

Doctor, take time
to say "thanks"
to MM advertisers

By Robert M. Leitch, MD
Vice Chairman
MSMS Council

Michigan Medicine certainly would be a smaller
publication unable to provide good scientific ar-
ticles and timely news reports unless pharmaceuti-
cal manufacturers and other firms purchased ad-
vertising each month.

The MSMS Publication Committee sincerely urges
MSMS members during 1972 to voice appreciation
from time to time to the detail men as they call.

Yes, advertising is down slightly in the number
of pages but expenditures are up by 15 per cent
in recent years. The firms are using more color
printing which adds to costs and naturally adver-
tising rates have been increased to help meet
the rising costs of publication.

There are approximately 275 medical publica-
tions— 100 more than back in 1960 — and pharma-
ceutical firms face a real challenge in deciding
where to place their messages. Michigan Medicine
strives hard to be attractive and worth reading
in order to merit continuing support.

Please join me in thanking the next representa-
tive you see from the 35 regular advertising firms
who utilize Michigan Medicine.

MICHIGAN MEDICINE FEBRUARY 1972 183

Doctor May

the membership. To accomplish this, the selection
of reliable committee chairmen is most vital. They
should be dynamic persons who demonstrate an
interest in matters relating to their particular
committee. They should be able to utilize various
talents and interests in their committee membership
appointments. Selection of leadership primarily on
the basis of seniority can be self-defeating. The
programs of the society meetings must be related
to issues facing the medical community as a whole.
Detailed scientific, as well as the entertaining
programs, can be found elsewhere and will not
draw the majority of the membership out to a meet-
ing after a busy day.

We vary in our awareness of the rapid transi-
tions in medicine today. The new physician accepts

[I

a different style of practice than he did 25 years
ago. There has been a drastic change in the struc-
ture of medical education. Hospitals are becoming
more directly involved in the practice of medicine.
The extended concepts of peer review require our
consideration. We cannot ignore the political drum
beat for all-encompassing health programs. The
handling of the medical-social programs of alcohol,
drugs, and venereal disease deserves our combined
effort. The challenge of new concepts in the pack-
aging of health care and the complexities of es-
tablished fee schedules, add to the many timely
concerns.

A recent gathering of county presidents-elect
provided an opportunity to note the wealth of
talent in the State Society office that is available to
assist us, just for the asking. We must continue
to elect truly representative delegates to the State
Society so that our local interests will be registered
on the floor of the House of Delegates.

“Why should I belong to the county medical
society?” is a question heard all too frequently. It
cannot be answered with catchy phrases but only
by dedicated action on the part of county officers
and a real feeling of representation by the mem-
bership. Out of this should come some constructive
action that will be relevant to the changing times
in which we live.

This notice may be easily detached by
the physician to be posted in a place read-

ily accessible to all patients. It is provided
here as a service to MSMS members.

In compliance with Price Commission
Regulations, a list of professional
charges for principal services is
maintained and available for
inspection on request of patients.

184 MICHIGAN MEDICINE FEBRUARY 1972

MEDICAL CENTER LIBRARY

ME NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

February 23, 1972, Volume 71, Number 6
Michigan State Medical Society
Reading Time: 2 Mins. 40 Seconds

i

A STRONG LETTER has been sent by MSMS to Governor Milliken protesting his
recommendations to discount Medicaid reimbursements to doctors by 3% in
fiscal 1972-73 if paid within 30 days.

The MSMS Council authorized Chairman Brooker L. Masters, MD, to send such
a letter to the Governor; and the Council authorized other steps in a
militant approach to the new situation.

Governor Milliken has been told in the letter that his proposal "is un-
just, discriminatory, and detrimental to the objectives of the Medicaid
program. "

Doctor Masters brought this matter to the attention of the MSMS Council
at its last meeting, when the Council members agreed this proposal should
be vigorously opposed.

The proposal for the 3% cut was made by Governor Milliken in his Budget
Message to the State Legislature. In part, Governor Milliken said: "As
the state assumes fiscal agent responsibilities for Medicaid, it is antic-
ipated that faster claims procession will result. As this occurs, providers
of medical services will receive reimbursement for services rendered more
promptly than has been true with the contracted fiscal agent. To provide
an incentive to the department (Social Services Department) to achieve
this objective and to reduce the costs of the Medicaid program, the budget
recommends that all bills paid within 30 days of receipt be discounted by
3 %." The Governor alleges that this discounting proposal can reduce state
costs by $2 million, and federal costs by a further $2 million.

EVERY MSMS MEMBER is urged to read the following letter that was sent to
Governor Milliken:

"Dear Governor Milliken: |

"Doctors of Medicine in Michigan are shocked at your budget recommendation
to discount Medicaid bills by 3 per cent in fiscal 1972-73 if paid within
30 days .

"Once again 10,000 physicians have been isolated from Michigan's 9,000,000
people to bear the cost of a particular State financial hardship. Although
your budget message said the discount would affect hospitals and physicians,
our research causes us to believe it would be contrary to Federal law for
all but physicians. We feel this is flagrantly discriminatory.

"We further feel misled and disillusioned. Last December 29, when a dele-
gation from the Michigan State Medical Society met with you and Doctor
John Dempsey, we asked you how we could work with you toward improved state
medical care programs. We were urged to continue to communicate with you.

But we were not told that you were considering discounting Medicaid payments.

MAR 7 IS7Z

"Doctors worked for and supported the implementation of the Medicaid program
when it was enacted in 1967. Since then, however, our cooperation and good
will has been sorely strained. In December, 1968, Medicaid payment levels
were frozen. In 1971 these reduced physician payments were further cut by
10 per cent for a three month period. Still later that year, a moratorium
on all physician payments was imposed.

"Now we are faced with further erosion of our relationships with the Medicaid
program with its proposed 3 per cent discounting of 1968 physician payment
levels .

"It is unjust, discriminatory and detrimental to the objectives of the Medicaid
program to penalize physicians and patients in an attempt to resolve the State's
financial deficit.

"The greater damage will not be to physicians, however. It will be to the
recipients of Medicaid services in the inner city, where Medicaid often com-
prises more than half of a doctor's practice — and in some known cases 100
per cent. These doctors must continue to pay their nurses, medical assistants
and office personnel; they must pay rent and purchase equipment, supplies and
materials. It is difficult enough today on physicians who remain in the inner-
city, or serve older residents in rural areas. To impose upon them an arbitrary
3 per cent discount will be unconscionable.

"Your staff should recognize that such a payment reduction for inncr-city
physicians and those whose rural practice consists largely of Medicaid patients
may drive physicians from the very locations where they are most needed.

"The Michigan State Medical Society hopes that you and your staff will reeval-
uate your recommendation in light of the observations in this letter."

— Brooker L. Masters, MD, Chairman of The Council

THE MSMS COUNCIL will take additional steps to protest this proposal. Watch
for progress reports . . .

•k * *

NOTICE: A general meeting of the members of MSMS is called for Tuesday,

March 21, at the Detroit Hilton Hotel, immediately following the spring
meeting of the House of Delegates, for the purpose of voting on the ex-
tension of the corporate term of MSMS, as required by the Corporation and
Securities Division of the Michigan Department of Treasury.

Feb. 23, 1972 Vol. 71, No. 6

JMgOgd®

MICHIGAN STATE MEDICAL SOCIETY

Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

UNIVERSITY OF CAL
LIBRARY SCH OF MED
THIRD £ PARNASSUS AVE
SAN FRANCISCO CAL 94122

EDITOR: HERBERT A. AUER

IEDIGRAMS

U. C. SAN FRANCISCO
MEDICAL CENTER LIBRARY

\TE NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

MAR 1 6 1972

February 29, 1972, Volume 71, Number 7
Michigan State Medical Society
Reading Time: 2 Mins. 45 Seconds

[RST of the Spring House of Delegates meetings will be called to order
/ Speaker Vernon V. Bass, HD, at 9 a.m. Monday, March 20 at the Detroit
Llton Hotel. Several reports will be presented and some resolutions
ill be officially introduced. The House then will recess for reference
munittee meetings. The House will convene at 10 a.m. Tuesday to act on
sference committee reports.

Major item of business will be consideration of the proposed MSMS peer
iview foundation. Copies of the 7th draft of the Foundation bylaws have
jen mailed to delegates for study.

GENERAL MEETING CALLED: The Michigan State Medical Society, in order to

extend its term as a Michigan corporation, must have a formal vote thereon
by its membership.

Of course a meeting of 8,000 members is difficult, if not impossible,
but there is a meeting of the House of Delegates on March 20-21, 1972, in
Detroit. Notice is hereby given of a meeting of the general membership
of MSMS at the Detroit Hilton Hotel to which all members are invited. The
membership meeting will be at the conclusion of the House of Delegates
meeting. The only item of business will be the question of extending the
term of the corporation. It will take 3 minutes of your time. This is
official notice to all members of the meeting.

HE STATE AFFAIRS Committee of the Michigan House reported favorably on
SMS-sponsored revised Michigan Medical Practice Act, but the bill was re-
ef erred to the Appropriations Committee Friday. Substitute reported to
ouse floor eliminated the physician assistant sections, but left the rest
f the bill generally intact. Votes for certification of physician's
ssistants were lacking. As Substitute HB 5767 was reported, it contains
rovisions for a 10-member Board of Registration all of whom are MDs; an
dvisory Committee to the Board of Registration in Medicine, with three
aymen and two members of the board, who are doctors; provisions for
lternatives for the board to act on medical discipline, including limited
icenses, suspensions and letters of reprimand; adjustments in educational
equirements to coordinate with modern medical education curricula; re-
uirement that all internships be posted with the board; the "Sick Doctor
ct" whereby physicians may be removed temporarily for physical or mental
isability. A legislative study committee to take a long look at physi-
ian's assistant concept is a likely outcome of hearings on HB 5767.

THREE MICHIGAN DOCTORS spent dinner and participated in a working session
March 25 with the Subcommittee on Social Services, Michigan House Appropri-
ations Committee. Rep. Raymond Kehres , subcommittee chairman, invited MSMS
to present views on Medicaid and the Governor's recommended 3% discount to
the three-member subcommittee, including Kehres, Rep. Earl Nelson and Rep.
James Farnsworth. Participating for MSMS were Robert E. Rice, MD,
chairman. Committee on Government Medical Care Programs; Charles
Vincent, MD, president, Detroit Medical Society; and Thomas Berglund,

MD, member of both Government Medical Care Programs and Legal Affairs
Committees. Dr. Rice is from Greenville, Dr. Vincent from Detroit,
and Dr. Berglund from Kalamazoo.

MICHIGAN PHYSICIANS are praised "for their excellent cooperation" in the
MMS news release issued Friday which announced that Michigan Blue Shield
on July 1 would cut the average base rates by 3.1% for prepaid medical

care .

John C. McCabe, MMS president, in the release stated, "Our analysis
of payments to physicians indicates that they are seeking lower dollar
increases than those to which they are entitled under our own and federal
wage and price limitations — and they are seeking them less frequently."

He explained that the rate of physicians’ fee increases have tended to
stabilize at a rate nearly half that of a year ago in many areas. Mr.

McCabe also thanked Shield members for their cooperation "to combat
unnecessary utilization of medical services." Blue Cross announced that
its rates would be increased 7.6% "because of continuing cost increases
in hospitals." The combined result will be an increase in MMS-MHS premiums
at an average of about 3^%.

The requests to change base rates have been filed with the Michigan
Insurance Bureau.

1C

lei

■•re

!SD

THE NEW ADVISORY COMMISSION on Drug Abuse and Alcoholism has been appointc
by the Governor and includes Richard Bates, MD, Lansing, chairman of the
MSMS Committee on Alcoholism and Drug Dependency.

IE

THE LARGEST DELEGATION ever from Michigan — 56 physicians, wives and 5S(

children — will participate in the annual AMA-AMPAC Workshop in Washington,

March 9-10-11. MSMS staff has arranged for a special, extra event with
members of the Michigan congressional group. Louis Zako, MD, Allen Park,

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chairman of MDPAC, worked with staffers Sherry Hall and Bruce Ambrose on
the details.

MSMS REPRESENTATIVES, osteopathic physicians, insurance carriers, hospital
and plaintiff lawyers exposed many of the problems in medical malpractice
a forum Monday, Feb. 28, called by the Michigan Commissioner of Insurance
the urging of MSMS. The inability of young doctors to obtain insurance
coverage for malpractice, the threat of medical college graduates leaving
Michigan for a more favorable insurance atmosphere and the rapid increase
premiums were cited by Frank Bicknell, MD, MSMS Councilor, Detroit, and
Fredrick Weissman, MD, Detroit, speaking for MSMS. The forum was informal
in nature and arrived at no particular conclusion other than establishing
communications among the interested parties. Members of the Legislative
Study Committee on Malpractice and its Advisory Committee sat in.

E

THE ANNUAL BEAUMONT LECTURE will be presented by E.S. Gurdjian, MD , Detroit,
at the Wayne County Medical Society headquarters, Monday evening, April 10.
He will discuss "Head Injuries from Antiquity to the Present."

Feb. 29, 1972 Vol. 71, No. 7

n

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

1©(Mib©

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MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

UNIVERSITY OF CAL
LIBRARY SCH OF MED
THIRD E PARNASSUS AVE
SAN FRANCISCO CAL 94122

EDITOR: HERBERT A. AUER

[DIGRAMS

TE NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

U. C. SAN FRANCISCO
MEDICAL CENTER LIBRARY

MAR 2 8 1972

March 16, 1972, Volume 71, Number 8
Michigan State Medical Society

te: This issue of Medigram is devoted to legislative issues of 1972 before the
ngress and the Michigan Legislature. It was written by Bruce Ambrose, Manager,
MS Department of Government Relations.)

MSMS ACTIONS TO OPPOSE PROPOSED 3% CUT

VERNOR MILLIKEN in his state budget message Jan. 20, as you know, made a proposal
discount payments to providers of medical services by 3% if Medicaid payments are
de within 30 days of receipt of billing.

E MSMS COUNCIL on January 26 voted to oppose such a proposal and a strong letter
s sent to Governor Milliken by MSMS Council Chairman Brooker L. Masters, MD, The
b. 23 issue of this newsletter carried the full letter.

nee then, MSMS has informed Legislators and the Department of Social Services
its strong objection to the proposal.

REE REPRESENTATIVES of MSMS met with the Subcommittee on Social Services of the
use Appropriations Committee to explain the MSMS objections. Speaking for MSMS
re Robert Rice, MD, Greenville, chairman, MSMS Committee on Governmental Medical
re Programs; Thomas Berglund, MD, member of the MSMS Legal Affairs Committee and
airman of the MSMS Committee on Public Relations, and Charles Vincent, MD , past
esident of the Detroit Medical Society and a member of the Wayne County Medical
ciety Council. Officials of the Medicaid project participated in the discussions.

Tuesday, March 14 the House Appropriations Committee reported the Social Services
dget Bill, containing Medicaid allocations with additional funds for all providers,
e bill does not implement the 3% discount advocated by the Governor. The bill
ces a floor fight in the House and then will go to the Senate.

LLOWING is the letter sent March 7 by Governor Milliken to Michigan Medicine about
s proposal:

he February 23 issue of Michigan Medicine contained a reprint of a letter which
received from Dr. Brooker L. Masters regarding my proposal to discount payments
providers of medical services by 3 percent if Medicaid payments are made within
days of receipt of billing.

n response I am requesting this letter be printed in the next issue of Michigan
dicine , the official journal of the Michigan State Medical Society.

he budget recommendation to discount Medicaid payments to providers of medical
rvices by 3 percent if payment is made within 30 days of receipt of billing was
veloped with consideration given to the implications upon costs to the Medicaid
ogram, costs to providers, and cost to the public at large.

roviders of medical services have long been critical of the Medicaid system
cause of delays in reimbursement for services rendered. Such delays, it has been

argued, have forced providers to borrow money in order to meet operating costs.
Interest paid by the provider on the borrowed funds increases operating costs, thereb;
increasing the costs to the consumer of medical services.

"As the state assumes fiscal agent responsibilities, it is anticipated the payments
to providers will occur more promptly than has been true with the contractual agents.
The anticipated result is an increase in the cash flow of providers, thereby decreasii
the necessity to borrow funds, thereby decreasing operating costs. Increasing the
cash flow of the provider through faster payment also increases the earning potential
on cash reserves. Therefore, it is assumed that the 3 percent reduction in payments
to providers will have marginal impact upon health costs to the consumer or earnings
of the provider.

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"The implications to the state and the taxpayer are also marginal. As a result of
faster processing of Medicaid bills, the state’s earning potential on cash reserves
is reduced. The 3 percent reduction will serve to offset the loss of interest which
could be earned by delaying payment.

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"Therefore, the 3 percent reduction in payment should be considered as an efficiency
measure to control Medicaid costs and not an arbitrary reduction. We assume payments
will be made within 30 days. When payment is not made within that time period,
however, it should be recognized that the 3 percent discount does not apply. Hence,
if the state operations are as inefficient as is often charged, payments will not
be reduced and status quo will be maintained.

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"In summation, it is recognized that 1) this probably is not the perfect solution
to control health care costs and meet the needs of Michigan’s population, and 2)
there is an urgent necessity to continue evaluation of alternatives."

— William G. Milliken, Governor

MDPAC DELEGATION VISITS WASHINGTON

FIFTY-NINE MDPAC MEMBERS and families met with 12 Michigan congressmen and one
senator in a four-day Washington, D.C., visitation March 9-12. Doctors met their
congressman at a reception, and then entertained him privately at dinner. Those
who attended included Senator Philip Hart and Congressmen Marvin Esch, Garry Brown,
Edward Hutchinson, Gerald R. Ford, Charles E. Chamberlain, James Harvey, Guy VanderJag
Elford A. Cederberg, Lucien N. Nedzi, William D. Ford, William S. Broomfield and Phili
Ruppe. The Michigan doctors and wives participated in the AMP AC workshop. MDPAC
hosted the reception the evening of March 9 for the Michigan congressional delegation.

a v

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NATIONAL LEGISLATION

.1, the omnibus Welfare and Social Security measure, has passed the House and is now
l the Senate Finance Committee. Many amendments have been introduced already in-
uding the Bennett PSRO Amendment. That amendment was approved by the Senate Finance
immittee 8 to 1. The Bennett Amendment would: (1) Permit organizations composed of

acticing physicians (MD and DO) in an area to have priority for designation as a
ofessional Standards Review Organization; (2) If such an organization is not per-
irming, HEW Secretary may appoint another organization to conduct reviews; (3) Mem-
:rship in PSRO must be open and voluntary for all doctors of medicine and osteopathy
t the PSRO region; (4) Requirement of dues payment to organized medicine or organized
teopathy is waived; (5) Qualifying organizations may not restrict eligibility of
iy member for service as an officer of PSRO or assignment to review duties; and
) Review activity would encompass the use of provider, patient and practitioner
■ofiles and regional norms as review checkpoints . . . PSRO would determine three
ings: (1) Whether health care services in any given case were medically necessary;

) Whether quality of services meets professionally recognized standards; and
i) Whether the proposed hospital or health facility could be provided by more eco-
mical alternative method.

Reported favorably by the Senate Finance Committee, 8 to 1, Bennett Amendment now
part of HR 1, which is expected to receive Senate action in mid-April.

NATOR RUSSELL LONG will offer another amendment to HR 1 embodying his catastrophic
Iness insurance proposal. Basic idea is that persons under age 65 could receive
dicare benefits after first $2,000 of costs, and depending somewhat on assets of
tient. Senator Long is expected to push hard for enactment in 1972.

HER MAJOR HR 1 provisions in the health area include: (1) Providing Medicare bene-

ts to an additional 1.5 million disabled persons under age 65; (2) Establishment of
e Office of Inspector General within HEW to oversee Medicare and Medicaid programs;

Q Provision for a single Medicare payment to HMOs so that beneficiaries are entitled
i both Parts A and B on prepaid contract service; (4) Provisions for incentive to
ates to emphasize comprehensive health care under Medicaid; (5) Establishment of
idelines for strict limitations on charges by physicians; and (6) Provision for
;udy of chiropractic services under Medicare and Medicaid.

HR 1 is passed by the Senate with amendments not in the House-passed version, the
ro would be sent to a conference committee.

NNEDY-JAVITS HMO BILL was introduced in Senate March 13. It has same far-reaching
itent in contract medical practice as does Kennedy-Grif f iths National Health Insurance
11. Cost is estimated at 25 billions for the first year. Nixon HMO bill was st;resse
t President's Health Message March 2.

i HMO LEGISLATION has been enacted, although HEW has authority to make grants for
:perimental contract service. 52 such grants were made in 1971, and goal of
[ministration is 450 by July 1, 1973. AMA has testified that voluntary prepaid
•oup practice is appropriate element of pluralistic delivery system, but not as a
.ngle mode of delivery. AMA urges HMO development on demonstration basis.

)USE WAYS AND MEANS Committee will begin executive sessions on national health in-
lrance bills in April. Kennedy-Grif f iths bill lacks support; Administration Health
irtnership Act is stronger; Medicredit is getting more attention than expected.

;st information, however, is that no insurance program will be passed in 1972.

MICHIGAN LEGISLATION

Following are brief descriptions of some of the bills pending in the Michigan
legislature of interest to physicians and MSMS:

HB 5767 would rewrite the 1899 Medical Practice Act for medical doctors only,
provides alternatives to Board of Registration in Medicine for action on complaints,
including limited license, suspensions, letter of reprimand; also "sick doctor act";
Advisory Committee to the Board including laymen and physicians; changes in educa-
tional requirements to correlate with modern medical education. Originally bill
contained Physician’s Assistant certification section, but votes were lacking for
passage. HB 5767, reported favorably by House Committee on State Affairs, now lies
before House Committee on Appropriations.

HB 4949 AND HB 5574, the first would require "certificate of need" for hospital or
health facility construction, and the second would require non-profit health benefits
corporations (Blue Cross) to contract with all licensed Michigan hospitals. These
bills are connected by language so one cannot be effective unless other is. This
may be eliminated by amendment. Both bills have passed House and now are before
Senate Committee on Commerce.

SB 1136, introduced by Sen. Pittenger, and HB 5883, introduced by Reps. Snyder and
Jowett, are one-sentence bills to repeal Basic Science Act. The Senate bill is
before Committee on State Affairs; House bill is before Committee on Public Health.

SB 1133, introduced by Sen. Cooper, would require certification that turtles sold as
pets must be certified free of salmonella bacteria contamination. Bill was referred

I

to Senate Committee on Health, Social Services and Retirement.

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Bill

SB 1212, introduced by Sen. DeGrow, would exempt Canadian medical school graduates
from Basic Science Examination. Bill is before the Senate Committee on Health, Social
Services & Retirement.

HB 5920, introduced by Rep. Snyder, would give Director, Department of Public Health,
determining authority for immunizations required to enter school. HB 5921, introduced
by Rep. Snyder as an option to 5920 would eliminate requirement for smallpox vacci-
nation. Both bills lie before House Public Health Committee.

March 16, 1972 Vol. 71, No. 8

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MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

UNIVERSITY GF CAL

library SCH OF mec

THIRD 8 PARNASSUS AVE

SAN FRANCISCO CAL 94122

'

EDITOR: HERBERT A. AUER

1972 MSMb

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OFFICIAL JOURNAL OF THE MICHIGAN

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The negative power of undue anxie
in congestive heart failure...

This man th^jsteGan no longer
take breathing for granted.

Typical of many patients with congestive
heart failure, he also suffers from severe
anxiety a psychic factor that may influence the character
and degree of his symptoms, such as dyspnea.

His apprehension may also deprive him of the
emotional calm so important in maintenance therapy

Aid in rehabilitation

Specific medical and environmental meas-
ures are often enhanced by the antianxiety
action of adjunctive Libritabs (chlordiaz-
epoxide) . Libritabs can also facilitate treat-
ment of the tense convalescent patient until
antianxiety therapy is no longer required.
Whereas in geriatrics the usual daily dosage
is 5 mg two to four times daily, the initial
dosage in elderly and debilitated patients
should be limited to 10 mg or less per day,
adjusting as needed and tolerated.

Concomitant use with primary agents
Libritabs is used concomitantly with certain
specific medications of other classes of
drugs, such as cardiac glycosides, diuretics,
antihypertensives, vasodilators and oral
anticoagulants, whenever excessive anxiety
or emotional tension adversely affects the
clinical condition or response to therapy.
Although clinical studies have not estab-
lished a cause and effect relationship, phy-
sicians should be aware that variable effects
on blood coagulation have been reported
very rarely in patients receiving oral anti-
coagulants and chlordiazepoxide HC1.

The positive power of

Libritabs-

(chlordiazepoxide)

5 -mg, 10-mg, 25-mg tablets

t.i.d/q.i.d.

up to 100 mg daily

for severe anxiety
accompanying
congestive neart failure

Before prescribing, please consult complete product
information, a summary of which follows:

Indications: Indicated when anxiety, tension and apprehension
are significant components of the clinical profile.

Contraindications : Patients with known hypersensitivity to the
drug.

Warnings : Caution patients about possible combined effects
with alcohol and other CNS depressants. As with all CNS-acting
drugs, caution patients against hazardous occupations requiring
complete mental alertness ( e.g ., operating machinery, driving).
Though physical and psychological dependence have rarely been
reported on recommended doses, use caution in administering to
addiction-prone individuals or those who might increase dosage;
withdrawal symptoms (including convulsions), following discon-
tinuation of the drug and similar to those seen with barbiturates,
have been reported. Use of any drug in pregnancy, lactation, or in
women of childbearing age requires that its potential benefits be
weighed against its possible hazards.

Precautions: In the elderly and debilitated, and in children over
six, limit to smallest effective dosage (initially 10 mg or less per
day) to preclude ataxia or oversedation, increasing gradually as
needed and tolerated. Not recommended in children under six.
Though generally not recommended, if combination therapy with
other psychotropics seems indicated, carefully consider individual
pharmacologic effects, particularly in use of potentiating drugs
such as MAO inhibitors and phenothiazines. Observe usual pre-
cautions in presence of impaired renal or hepatic function. Para-
doxical reactions (e.g., excitement, stimulation and acute rage)
have been reported in psychiatric patients and hyperactive
aggressive children. Employ usual precautions in treatment of
anxiety states with evidence of impending depression; suicidal
tendencies may be present and protective measures necessary.
Variable effects on blood coagulation have been reported very
rarely in patients receiving the drug and oral anticoagulants;
causal relationship has not been established clinically.

Adverse Reactions: Drowsiness, ataxia and confusion may occur,
especially in the elderly and debilitated. These are reversible in
most instances by proper dosage adjustment, but are also occa-
sionally observed at the lower dosage ranges. In a few instances
syncope has been reported. Also encountered are isolated instances
of skin eruptions, edema, minor menstrual irregularities, nausea
and constipation, extrapyramidal symptoms, increased and de-
creased libido— all infrequent and generally controlled with dosage
reduction; changes in EEG patterns (low-voltage fast activity)
may appear during and after treatment; blood dyscrasias (includ-
ing agranulocytosis), jaundice and hepatic dysfunction have been
reported occasionally, making periodic blood counts and liver
function tests advisable during protracted therapy.

Supplied : Tablets containing 5 mg, 10 mg or 25 mg chlordiazepoxide.

.Roche Laboratories
ROCHE ^Division of Hoffmann-La Roche Inc.
Nutley, N.J. 07110

Our* leaders

MSMS Officers and Councilors

PRESIDENT

PRESIDENT-ELECT

SECRETARY

TREASURER

ASS T SECRETARY

ASS T TREASURER

SPEAKER

VICE SPEAKER

PAST PRESIDENT

AMA DELEGATION CHAIRMAN

COUNCIL CHAIRMAN

COUNCIL VICE CHAIRMAN . . .

Sidney Adler, MD Detroit

John J. Corny, MD Port Huron

Kenneth H. Johnson, MD Lansing

John R. Ylvisaker, MD Pontiac

Ross V. Taylor, MD Jackson

Ernest P. Griffin, MD Flint

Vernon V. Rass, MD Saginaw

James D. Fryfogle, MD Detroit

Harold H. Hiscoek, MD Flint

Donald N. Sweeny, Jr., MD Detroit

Brooker L. Masters, MD Fremont

Robert M. Leiteh, MD Battle Creek

COUNCILOR
DISTRICT MAP

Second District Councilor: Ross V. Taylor, MD, Jackson
Counties: Clinton, Eaton, Hillsdale, Ingham, Jackson
Third District Councilor: Robert M. Leiteh, MD, Battle Creek
Counties: Branch, Calhoun, St. Joseph
Fourth District Councilor: W. Kaye Locklin, MD, Kalamazoo
Counties: Allegan, Berrien, Cass, Kalamazoo, Van Buren
Fifth District Councilor: Noyes L. Avery, MD, Grand Rapids
Counties: Barry, Ionia-Montcalm, Kent, Ottawa
Sixth District Councilor: Ernest P. Griffin, Jr., MD, Flint
Counties: Genesee, Shiawassee

Seventh District Councilor: James H. Tisdel, MD, Port Huron
Counties: Huron, Sanilac, Lapeer, St. Clair
Eighth District Councilor: William A. DeYoung, MD, Saginaw
Counties: Gratiot-Isabella-Clare, Midland, Saginaw, Tuscola
Ninth District Councilor: Adam C. McClay, MD, Traverse City

Counties: Grand Traverse-Leelanau-Benzie, Manistee, Northern Michigan (Antrim, Charlevoix,
Cheboygan and Emmet combined), Wexford-Missaukee
Tenth District Councilor: Robert C. Prophater, MD, Bay City

Counties: Alpena- Alcona- Presque Isle, Bay-Arenac-Iosco, North Central Counties, (Otsego, Mont-
morency, Crawford, Oscoda, Roscommon, Ogemaw, Gladwin and Kalkaska, combined)

Eleventh District Councilor: Brooker L. Masters, MD, Fremont

Counties: Mason, Mecosta-Osceola-Lake, Muskegon, Newaygo, Oceana
Twelfth District Councilor: Raymond Hockstad, MD, Escanaba

Counties: Chippewa-Mackinac, Delta-Schoolcraft, Luce, Marquette-Alger
Thirteenth District Councilor: Donald T. Anderson, MD, Wakefield

Comities: Dickinson-Iron, Gogebic, Houghton-Baraga-Keweenaw, Menominee, Ontonagon
Fourteenth District Councilor: Donato F. Sarapo, MD, Adrian
Comities: Lenawee, Livingston, Monroe, Washtenaw
Fifteenth District Councilor: Sydney Scher, MD, Mount Clemens
Counties: Macomb, Oakland

First District Councilors: (Wayne County)
Edward J. Tallant, MD, Detroit
Ralph R. Cooper, MD, Detroit
Frank G. Bicknell, MD, Detroit
Brock E. Brush, MD, Detroit
Louis R. Zako, MD, Allen Park

DIRECTOR

GENERAL COUNSEL

LEGAL COUNSEL

ECONOMIC CONSULTANT
SCIENTIFIC EDITOR

Warren F. Tryloff East Lansing

Lester P. Dodd Detroit

A. Stewart Kerr Detroit

Clyde T. Hardwick, PhD Houghton

John W. Moses, MD Detroit

186 MICHIGAN MEDICINE MARCH 1972

cptesideiit’s page

At the meeting of the House of Delegates on
March 20-21, 1972, there will be three important
issues to be considered:

I. The question of a foundation for peer re-
view as a non-profit corporation separate from the
Michigan State Medical Society.

II. The update of the Michigan Relative Value
Schedule.

III. A report of the Alexander Grant study,
Phase II, of the Michigan State Medical Society.

These vital issues should be carefully studied
by all members of the House of Delegates and
their component county societies.

I. The question is: Can peer rieview best be
done at the local county level or by state-wide
foundation composed of representatives of Michi-
gan State Medical Society and Michigan Associa-
tion of Osteopathic Physicians and Surgeons? Peer
review is an important activity. It can be defined as
a review of a physician’s services by his medical
colleagues. It should include the standard of care.
Physicians should monitor and review themselves.

I have said it before and repeat it again.

I believe Medicare and Medicaid were poorly
planned and poorly administered, spawning huge
bureaucracies and extravagant costs and inviting
widespread abuses.

I believe that Blue Cross and Blue Shield pro-
grams have been in need of review and reform in
order to control and limit escalating costs.

I do not believe that a state society-sponsored
“foundation” will do any more to eliminate those
abuses and control those costs than the state
society, Blue Cross, Blue Shield or the federal
and state governments have done in the past.

Our profession has suffered from much criticism,
some well-founded, most unfounded, from various
sectors of the community. If we follow the founda-
tion-peer review path, we will be blamed for every
shortcoming of government, Blue Cross, Blue
Shield, and to some degree, the insurance industry.
Costs which we cannot control will continue to
escalate and we will have to bear the blame and
onus.

I believe, therefore, that if our society puts itself
in that position, it is either stupid or greedy or
both. I don’t think we are being greedy, but we
will be charged with it. I do think we are being
stupid.

Perhaps a better mode of accomplishing the
analysis of peer review, would be by a federation
of the various types of medical practice (solo,
group, HMOs, medical university groups, hospitals,
clinics, etc.). By pooling the experience and ex-
perimentation of its members, such a federation

Sidney Adler, MD
MSMS president

possibly could do a better job. A better delivery
system should evolve and hopefully curtail un-
necessary costs. Axiomatically, high standards of
medical care are costly, but poor medical care is
even more costly. The various methods of delivery
of health care have approximately the same cost
when carefully analyzed. The standards and ap-
propriateness of the medical care must be in the
control of physicians. Underutilization is worse than
overutilization for our patients.

Such a system will be capable of constant im-
provement and can be altered to meet changing
needs of the public.

II. The update of the revised Michigan Relative
Value system must be analyzed as to its fiscal
impact in comparison tcf the previous Michigan
Relative Value Scale. Do we really want a fee
schedule or the usual, customary and reasonable
charge? Can we have one schedule for one group
or patients and another schedule for other pa-
tients? Current procedural terminology in a five-
digit computer is not the entire answer; It is merely
a tool.

III. Phase II of the Alexander Grant Study has
not been analyzed. And the House of Delegates
should not make any final judgments in haste. The
House of Delegates authorized the study. Judge-
ment, reason and careful deliberation are essen-
tial. Neither the wisdom of a Solomon nor the
leadership of a Moses can lead us out of the
wilderness or part the waters for us.

Political expediency may be a factor but our
patients’ needs should be paramount in our minds
and deliberations.

MICHIGAN MEDICINE MARCH 1972 187

Coqtei\ts

SCIENTIFIC ARTICLES

193 A case report: Idiopathic pulmonary hemosiderosis;

Julio Badin, MD, Willys F. Mueller, Jr., MD
201 Expanding the role of the office obstetric nurse; F. W.

Jeffries, MD, Meredith Lentz, RN
205 The Stokes*Adams Syndrome: definition and etiology;

Robert A. O’Rourke, MD

207 Bacteriuria screening of youngsters; Mary L.
Cretens, MD

SPECIAL ARTICLES

204 Suggested minimum schedule for immunization of
children

211 New day for the mentally retarded

213 The community physician and the mentally retarded;
Homer F. Weir, MD

219 An HMO in your future? Herbert Mehler
222 Medicredit’s advantage; Donald N. Sweeny, Jr., MD
235 Answers to your questions about proposed MSMS
foundation

251 Physician’s personal account of Port Huron tunnel
disaster; E. D. Shoudy, MD

272 Genesee county society changes directions; Jeanne
Smith

OTHER FEATURES

186

Leadership

232

MSMS in action

187

President's page

238

Michigan mediscene

191

Medico-legal

241

Welcome

199

Monthly surveillance report

254

In small doses

200

Drug therapy problems

258

County scenes

Michigan authors

274

Zip code 48823

210

Perinatal tips

287

In memoriam

215

Your opinion please

290

Socio-economic

219

Medical care programs

295

Sound off

Publication of Michigan Medicine is under the direction
of the Publication Committee, Michigan State Medical So-
ciety. The scientific editor is responsible for the scientific
content. The managing editor is responsible for the pro-
duction, correspondence and contents of the journal. He
and the executive editor share final responsibility of the
entire publication.

Neither the editors nor the state medical society will
accept responsibility for statements made or opinions ex-
pressed by any contributor in any article or feature pub-
lished in the pages of the journal. In editorials, the views
expressed are those of the writer and not necessarily offi-
cial positions of the society.

SCIENTIFIC EDITOR

John W. Moses, MD

EXECUTIVE EDITOR

Herbert A. Auer

MANAGING EDITOR

Judith Marr

PUBLICATION COMMITTEE

Edward J. Tallant, MD
Detroit
Chairman

Robert M. Leitch, MD
Battle Creek
Donato F. Sarapo, MD
Adrian

(fMichigati (fMediciqe

Devoted to the interests of the medical profession and
public health in Michigan.

INFORMATION FOR CONTRIBUTORS

1. Address scientific manuscripts to the Publication Com-
mittee, Michigan State Medical Society, 120 West Saginaw
Street, East Lansing, Michigan 48823. Submit original, double-
spaced typewritten copy and two carbon copies or photo copies
on letter size (8V2 x 11 inch) paper. On page one, include
title, authors, degrees, academic titles, and any institutional or
other credits.

2. Authors are responsible for all statements, methods, and
conclusions. These may or may not be in harmony with the
views of the Editorial Staff. It is hoped that authors may have
as wide a latitude as space available and general policy will
permit. The Publication Committee expressly reserves the right
to alter or reject any manuscript, or any contribution, whether
solicited or not.

3. Illustrations should be submitted in the form of glossy
prints or original sketches from which reproductions will be
made by Michigan Medicine.

4. Articles should ordinarily be less than four printed pages
in length (3000 words).

5. References should conform to Cumulative Index Medicus,
including, in order: Author, title, journal, volume number,
page, and year. Book references should include editors, edition,
publisher, and place of publication, as well.

6. The editors welcome, and will consider for publication,
letters containing information of interest to Michigan physi-
cians, or presenting constructive comment on current contro-
versial issues. News items and notes are welcome.

7. It is understood that material is submitted for exclusive
publication in Michigan Medicine.

MICHIGAN MEDICINE is the official organ of the Michigan
State Medical Society, published under the direction of the
Publication Committee. Published Semi-Monthly, Trimonthly
in January and December; 26 issues, by the Michigan State
Medical Society as its official journal. Second class postage
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Lansing, Michigan 48823. Phone Area Code 517, 337-1351.
© 1972 Michigan State Medical Society.

188 MICHIGAN MEDICINE MARCH 1972

Old winner,
new bottle.

capsules of SO and 100 mg.

Indications: Stable adult diabetes mellitus;
sulfonylurea failures, primary and second-
ary; adjunct to insulin therapy of unstable
diabetes mellitus.

Contraindications: Diabetes mellitus that
can be regulated by diet alone; juvenile
diabetes mellitus that is uncomplicated and
well regulated on insulin; acute complica-
tions of diabetes mellitus (metabolic acido-
sis, coma, infection, gangrene); during or
immediately after surgery where insulin is
indispensable; severe hepatic disease; renal
disease with uremia; cardiovascular collapse
(shock); after disease states associated with
hypoglycemia.

which, in spite of relatively normal blood
and urine sugar, may result from excessive
phenformin therapy, excessive insulin reduc-
tion, or insufficient carbohydrate intake.
Adjust insulin dosage, lower phenformin
dosage, or supply carbohydrates to alleviate
this state. Do not give insulin without first
checking blood and urine sugar.

2. Lactic Acidosis: This drug is not recom-
mended in the presence of azotemia or in
any clinical situation that predisposes to
sustained hypotension that could lead to
lactic acidosis. To differentiate lactic acido-
sis from ketoacidosis, periodic determina-
tions of ketones in the blood and urine
should be made in diabetics previously sta-
bilized on phenformin, or phenformin and
insulin, who have become unstable. If elec-
trolyte imbalance is suspected, periodic
determinations should also be made of elec-
trolytes, pH, and the lactate-pyruvate ratio.
The drug should be withdrawn and insu-
lin, when required, and other corrective
measures instituted immediately upon the
appearance of any metabolic acidosis.

3. Hypoglycemia: Although hypoglycemic
reactions are rare when phenformin is used
alone, every precaution should be observed
during the dosage adjustment period particu-
larly when insulin or a sulfonylurea has
been given in combination with phenformin.
Adverse Reactions: Principally gastrointes-
tinal; unpleasant metallic taste, continuing
to anorexia, nausea and, less frequently,
vomiting and diarrhea. Reduce dosage at
first sign of these symptoms. In case of vom-
iting, the drug should be immediately
withdrawn. Although rare, urticaria has been
reported, as have gastrointestinal symptoms
such as anorexia, nausea and vomiting fol-
lowing excessive alcohol intake.

(B) 98-146-103-C

For complete details, including dosage,
please see full prescribing information.

GEIGY Pharmaceuticals
Division of CIBA-GEIGY Corporation
Ardsley, New York 10502
Distributors

DBI- 0345-9

ALL IN HIS HEAD: ALL IN ‘ORNADE1.

Watery Eyes

Nasal

Congestion

Drying Agents
(isopropamide,
as the iodide—
2.5 mg.)

Decongestant

(phenylpropanol-
amine HC1 — 50 mg.)

Sneezing

Runny Nose

Antihistamine

(chlorpheniramine
maleate— 8 mg.)

THE COLD THE
SYMPTOMS INGREDIENTS
THAT HENEEDS
MAKE HIM FOR PROLONGED
MISERABLE RELIEF

Before prescribing, see complete prescribing information in
SK&F literature or PDR

Indications: Upper respiratory congestion and hypersecretion
associated with the common cold; acute and chronic sinusitis;
vasomotor rhinitis; allergic rhinitis (hay fever, "rose fever,” etc.)
Contraindications: Hypersensitivity to any component;
concurrent MAO inhibitor therapy; severe hypertension;
bronchial asthma; coronary artery disease; stenosing peptic
ulcer; pyloroduodenal or bladder neck obstruction. Children
under 6

Warnings: Advise vehicle or machine operators of possible
drowsiness Warn patients of possible additive effects with
alcohol and other CNS depressants.

Usage in Pregnancy In pregnancy, nursing mothers and
women who might bear children, weigh potential benefits
against hazards. Inhibition of lactation may occur.

Effect on PBI Determination and 7131 Uptake: Isopropamide
iodide may alter PBI test results and will suppress I131 uptake.
Substitute thyroid tests unaffected by exogenous iodides.
Precautions: Use cautiously in persons with cardiovascular
disease, glaucoma, prostatic hypertrophy, hyperthyroidism.
Adverse Reactions: Drowsiness, excessive dryness of nose,
throat or mouth, nervousness; or insomnia. Also, nausea,
vomiting, epigastric distress, diarrhea, rash, dizziness,
weakness, chest tightness, angina pain, abdominal pain,
irritability, palpitation, headache, incoordination, tremor,
dysuria, difficulty in urination, thrombocytopenia, leukopenia,
convulsions, hypertension, hypotension, anorexia, constipation,
visual disturbances, iodine toxicity (acne, parotitis).

Supplied: Bottles of 50 capsules.

SK&F Smith Kline & French Laboratories

Trademark

ORNADE SPANSULE

®

Each capsule contains 8 mg of Teldrin®(brand of
chlorpheniramine maleate); 50 mg of phenylpropanolamine
hydrochloride; 2.5 mg of isopropamide, as the iodide

brand of sustained release capsules

UNCOMMON RELIEF FORCOLD SYMPTOMS

OR 203

'Specter of liability
one of the causes
in malpractice claims'

“Availability of legal services for a contingency
fee undoubtedly has had major impact on the inci-
dence of malpractice claims.”

That statement was made by Arthur J. Mannix,
MD, AMA spokesman, at one of the recent hearings
held by the new HEW Commission on Medical
Malpractice. Doctor Mannix is the former chairman
of the Malpractice and Defense Board of the Med-
ical Society of the State of New York. The Com-
mission is holding five hearings to explore the
national aspects of professional liability problems.

Despite continuous improvement in the quality of
medical care, physicians have been subjected to
constantly rising premium costs for liability insur-
ance, Doctor Mannix stressed. He reported that
only a small part of the sum spent for liability
coverage goes to claimants as compensation.

Doctor Mannix said AMA statistics show that
physicians in 1968 paid a total of $75 million in
professional liability premiums but only $20 mil-
lion went to claimants. The bulk of the liability
dollar, he said, went for legal and investigation
expenses ($18 million) and for contingency fees
and expenses of claimant’s attorneys ($15 million).

The specter of liability is one of the causes of
claims, Doctor Mannix said. “Perfect — or near per-

MSMS will cooperate
in gathering
of health statistics

MSMS was represented at a meeting late in Jan-
uary in Detroit to explore ways that Michigan can
collaborate in a gathering of federal, state and
local statistics to support the country’s health pro-
grams.

John Anthony, chief, MSMS Bureau of Economic
Information, offered MSMS cooperation at the joint
meeting of the Committee to Evaluate the National
Center for Health Statistics and related operations,
and Michigan’s Ad Hoc Committee on Health Sta-
tistics and Computer Systems.

Michigan Department of Public Health has drawn
up a grant proposal for more than $2 million under
the research and development phase of the new
Cooperative Federal-State-Local Health Statistics
system.

feet — solutions to medical problems are more and
more expected by the general public and there is
also an increasing public tendency to sue doctors.”

Ways must be found to provide equitable pro-
tection to patients and physicians without causing
any unreasonable increase in medical care costs,
the AMA spokesman declared at the HEW hearing.

<£Medico legal

The AMA's CITATION newsletter, prepared by the
AMA Law Department, lists the following cases in-
volving health personnel in Michigan. Persons in-
terested in obtaining more information on individual
cases may write MSMS headquarters.

“Damages may be recovered for death of fetus”
Michigan Supreme Court, July 7, 1971
from Citation, Vol. 24, No. 6

“Failure to hospitalize infant is basis for suit”
Michigan Court of Appeals, April 27, 1971
from Citation, Vol. 24, No. 6

“Malpractice Statute of Limitations protects nurse”
Michigan Court of Appeals, April 26, 1971
from Citation, Vol. 24, No. 6

“Child Can Recover
For Prenatal Injuries”

MICHIGAN SUPREME COURT, JUNE 1, 1971
from The Citation, Oct. 15, 1971

“Reassurance or contract to cure?

Jury must decide”

MICHIGAN SUPREME COURT, JULY 7, 1971
from The Citation, Vol. 23, No. 12

U-M interns, residents
not a bargaining unit,

Appeals Court says

The interns and residents at the University of
Michigan are not public employes and therefore
the University need not bargain with them, the
State Appeals Court has held.

The interns, residents and post-doctoral fellows
associated with the University Medical Center
formed an association for collective bargaining pur-
poses but the University has refused to bargain
with them.

The appeals court ruling in January reversed a
ruling by the Michigan Employment Relations Com-
mission favorable to the association.

MICHIGAN MEDICINE MARCH 1972 191

Two dosage
strengths-
125 mg./5ml.
and

250 mg. /5 ml.

V-Cillin K.Pediatric

potassium
phenoxymethyl

, available to the

Ani^lllin profession on request.

UUlllUIIIII Eli Lilly and Company

Indianapolis, Indiana 46206

'Based on Lilly selling price to wholesalers.

192 MICHIGAN MEDICINE MARCH 1972

Scieqtjfic papers

A case report:

Idiopathic pulmonary hemosiderosis:

Use of gastric washings
in diagnosis

By Julio Badin, MD
Willys F. Mueller, Jr., MD
Flint

Idiopathic Pulmonary Hemosiderosis (IPH) is
a relatively rare disease of childhood and young
adults with a well-defined clinical course of repeti-
tive episodes of respiratory distress, hemoptysis,
pulmonary infiltration, iron deficiency anemia,
pulmonary fibrosis and eventual terminal cardio-
respiratory failure.

Although originally described by Virchow1 in
1851 the first clinical report by Ceelen2 did not
appear until 80 years later. Borsos-Nachtnebel3
reported the first adult case, a 38-year-old man,
supporting his clinical impression with roentgeno-
logic, clinical and pathologic findings. Walden-
strom4 in 1944 published his findings in a 16-year-
old girl. Wyllie, et al.5 presented a comprehensive
description of the disease in 1948, collecting 17
cases from the literature and adding seven cases
of their own. Ognibene6 in 1963 collected 52 cases
of IPH in adults, added one of his own and
published an excellent- review of the symptomatol-
ogy of the disease in adults.

The following report documents the occurrence
of IPH in a two-year-old child who presented with
intermittent recurrent episodes of respiratory dis-
tress, fever and iron deficiency anemia. The in-
teresting feature in this case is that the diagnosis
of IPH was made clinically on the finding of
hemosiderin-laden macrophages in gastric washings.

Doctor Badin is a resident in pathology and
Doctor Mueller is associate pathologist at Hurley
Hospital, Flint.

I

Fig. 1. X-ray taken on first admission showing
extensive infiltration of both lung fields.

Case Report

On April 5, 1969 a two-year-old Negro boy was
hospitalized because of a slight cough, fever of
three days duration, and anorexia. The only physi-
cal findings were marked pallor, lethargy, and
acute respiratory distress with bronchial breathing
bilaterally.

Temperature was 99.8°F; pulse 170/min.; res-
pirations 50/min.; and blood pressure 120/60.
X-rays of the chest (Fig. 1) demonstrated an exten-
sive infiltration of both lung fields without pleural
effusion. The cardiac silhouette was within normal
limits. Significant laboratory findings included a
hemoglobin of 2.9 grams per cent with hematocrit
of 12%, reticulocytes 9.4%, MCV 67 u3; MCHC

MICHIGAN MEDICINE MARCH 1972 193

HEMOSIDEROSIS/Continued

■

Fig. 2. X-ray taken five days later. Note the
marked clearing of the infiltrative process of
both lungs.

Fig. 3. Note obliteration of cellular morphology
of macrophages by iron pigment stained with
Prussian Blue stain (900x).

Fig. 4. X-rays taken 3 days before death. Note
diffuse and extensive pulmonary infiltrate.

24%; MCH 16 uug. Red cells displayed marked
anisocytosis, poikilocytosis and polychromasia with
moderate hypochromasia. Urine urobilinogen was
positive 1:40 dilution. Direct and indirect Coombs
tests were negative. Sickle cell preparations, serum
electrophoresis and coagulation studies failed to
demonstrate any abnormalities. Total bilirubin
was 2.6 mg. per cent with 0.8 mg. per cent direct.
Therapy consisted of blood transfusions, ampi-
cillin, aminophylline and oral iron.

The patient’s temperature fell to normal ap-
proximately seven days after admission and there
was almost complete clearing of the infiltration
on chest x-ray (Fig. 2) when he was discharged
asymptomatic eleven days after admission.

On April 28, 1969 he was re-admitted because
of fever, cough and respiratory distress. Chest
x-rays revealed a similar infiltrative process. Micro-
cytic hypochromic anemia was again noted. Bone
marrow examination revealed nonnoblastic ery-
throid hyperplasia with decreased iron stores. Two
weeks later there was marked improvement and
the patient was discharged asymptomatic 17 days
after admission.

On May 16, 1969 hospitalization was again re-
quired because of cough, fever, and similar x-ray
and laboratory findings. Immunoglobulin studies
were normal. Osmotic fragility was diminished.
Sputum specimens were negative for hemosiderin-

194 MICHIGAN MEDICINE MARCH 1972

laden macrophages and Pneumocystis carinii.
Treatment consisted of antibiotics, antitussive
agents and antipyretics. On June 5, 1969 he went
home asympomatic.

On re-admission, 20 days later, he presented
with similar clinical, x-ray and laboratory findings.
Cell blocks and pap smears prepared from gastric
washings and stained with Prussian Blue contained
many hemosiderin-laden macrophages (Fig. 3). The
diagnosis of idiopathic pulmonary hemosiderosis
was made based on clinical picture and gastric
washings. Prednisone (12 mg. every other day)
was added to the therapy and the patient was
sent home on July 9, 1969. On July 16, 1969 the
patient was re-admitted for the fifth time because
of anemia and similar lung changes. Clinical im-
provement was obtained with larger doses of
prednisone (5 mg. every six hours) , ampicillin,
oral iron therapy and cough syrup. However, on
July 27, 1969, a week after discharge, similar
physical complaints and findings made hospitaliza-
tion necessary. Treatment was similar and clinical
response was apparent.

On August 16, 1969, the patient was re-admitted
for the last time because of cough, shortness of
breath and fever. This admission, one day after
discharge, was necessitated because of recurrent
pulmonary hemorrhage. His hemoglobin progres-
sively fell to 4.8 grams per cent. Six days after
admission the serum bilirubin was 10.5 mg.%.
Chest x-rays again revealed a similar parenchy-
matous infiltrate of a severe degree (Fig. 4).
Treatment included ampicillin, antitussives, pred-
nisone, and starting August 18th, deferoxamine
(0.5 gm. intramuscularly every six hours) . He had
multiple episodes of hematemesis and his condi-
tion progressively deteriorated and he died August
24, 1969.

Autopsy Findings

The body weighed 25 lbs., measured 72 cm. in
length and exhibited marked pallor of the skin
and mucous membranes and scleral jaundice.

The right and left lungs, weighing 150 and
145 grams respectively, were consolidated but with-
out discrete nodulation. The external surfaces
were smooth and red-brown, with focal yellow-
brown discolored areas. On sectioning, the lungs
revealed yellow-brown discoloration with consoli-
dation and evidence of hemorrhage. A consider-
able amount of blood and edema fluid could be
expressed from the surface. Recent pulmonary
emboli were identified in the larger branches of
the pulmonary artery.

The heart weighed 65 grams and there was
dilatation of the right atrium as well as the pul-
monary conus. The right ventricle measured 3
mm. in thickness. Small mural thrombi were seen

Fig. 5. The alveolar spaces are filled with red
cells and pigment-laden macrophages (450x).

Fig. 6. There is early organization with ingrowth
of fibroblasts into the alveolar spaces. Numerous
pigment-laden macrophages are again noted
(450x).

in the right ventricle attached to the septum.
Microscopic examination of the lungs revealed
that the alveoli were filled with red blood cells
and hemosiderin-laclen macrophages. In some areas
they also contained fibrin. The alveolar septa
were thickened. In focal areas there was "fibro-
blastic proliferation and organization of hemor-
rhage (Fig. 5 and 6). Prussian Blue stains revealed
abundant iron in the macrophages and also in
the alveolar septa and vessel walls (Fig. 7). A

MICHIGAN MEDICINE MARCH 1972 195

HEMOSIDEROSI S/Continued

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recent embolus occluded the lumen of a large
pulmonary artery (Fig. 8).

Sections of the other organs revealed no evi-
dence of hemosiderosis. The bone marrow was
hypercellular with erythroid hyperplasia. The
iron content of ashed lung tissue was 10 times
greater than a normal control. Five grams of
lung tissue were ashed and the resulting ash was
reconstituted with 30% Nitric Acid. The resulting
mixture was then centrifuged and the iron con-
tent of the supernatant solution was determined.
The procedure used for iron determination was
the American Monitor System (method of Good-
win-modified) .7

Fig. 7. In Prussian Blue stain the pigment-laden
macrophages are quite prominent and there is
deposition of iron pigment in the alveolar duct
and septa (lOOx).

eosinophilia noted, lymphoid hyperplasia and
lymphocytic and plasmocytic infiltration of bron-
chioles reported in some cases. The apparent re-
sponse to corticosteroids and the alleged beneficial
effects of splenectomy lend credence to this po-
sition. Soergel and Sommers10 searched for anti-
bodies to human lung and kidney tissues in the
serum of six patients with IPH. Various methods
were used and no antibodies to this human tissue
antigen could be demonstrated.

Discussion

Although many theories have been postulated,
the exact etiology of IPH is unknown. Some
authors2'4'5 suggest a primary developmental ab-
normality of the elastic fibers in the lungs with
subsequent fragmentation. This leads to marked
stasis in the capillary vessels with intra-alveolar
hemorrhage. Schidegger and Dreyfus8 reported
a case in which the first symptoms had occurred
at the age of 3 months and death in one year.
They could not detect defective development nor
fragmentation of the elastic fibers in the lungs.
Steiner9 also stressed the failure to show deficiency
or destruction of elastic tissue in his three cases
of fulminating IPH. The case reported herein
had a short and fatal course of six months and
no anomaly of the elastic fibers could be demon-
strated. Areas of thickening and fibrosis of the
alveolar wall were seen only in the organizing
lesions; fragmentation of elastic fibers was not
striking.

These findings seem to suggest that fragmen-
tation of elastic fibers and the fibrotic thickening
of the alveolar wall are the results rather than
the cause of the disease.

Another theory is that antibodies are formed in
IPH, the pulmonary alveoli acting as the shock
organ. Support for this theory is based on the
repetitive nature of the disease, the occasional

Others111213'14 have postidated that a disturb-
ance of the vasomotor control in the pulmonary
artery was responsible for the pulmonary hemor-
rhages by increasing the intrapulmonary vascular
pressure. But, pulmonary hypertension, cor pul-
monale, and right sided heart failure are uncom-
mon in IPH, and right heart catheterization
shows normal pressure values in most of the cases.
The exceptions are seen in only protracted ill-
nesses. Viral infection has also been incriminated
as well as inhalation of directly irritating or aller-
genic substances. Soergel and Sommers10 feel that
IPH is a primary disease of the pulmonary alveo-
lar epithelial cells which affect the mechanical
stability of the alveolar capillaries and leads to
widespread alveolar capillary hemorrhages of vari-
able intensity.

Clinical Features

IPH usually commences in early childhood, but
may be delayed until adulthood. Most children
are in the middle of their first decade and most
adults are under 30. There is no difference in the
sex distribution in children; however in adidts,
the male sex predominates 2:1°. No hereditary nor
familial predisposition is present in this condition.
The condition has no typical pattern but usually
is characterized by recurrent acute or subacute
episodes of dyspnea, cyanosis, cough with hemop-
tysis, fever, tachycardia and anemia. These symp-

196 MICHIGAN MEDICINE MARCH 1972

Fig. 8. A recent embolus completely occluded
the lumen of a pulmonary artery (50x).

toms are precipated by continuous mild or severe
sudden intra-alveolar hemorrhage. During remis-
sion, there may be apparent complete recovery
but frequently some dyspnea and anemia remain.
Jaundice can be present. Weakness and weight
loss are frequent. Occasionally there is generalized
lymphadenopathy. The severity of attacks depends
on the degree of pulmonary hemorrhage. Fever
may be present in acute or subacute episodes.
These attacks can be confused or misdiagnosed as
pneumonia.

The mean duration of the fatal cases reviewed
by Soergel15 was 2.9 years, the shortest being 5
weeks and the longest 10 years. Fine rales and
dullness to percussion over the bases is a common
finding on physical examination. In patients who
survive for several years, clubbing of the fingers
may develop and pulmonary hypertension with
cor pulmonale and right sided heart failure may
occur. Hepatosplenomegaly can be present in
about 20% of the cases.10

Chest x-rays usually vary with the stage of the
disease. Initially, diffuse homogeneous opacities
may be seen, although at times the denser areas
are localized to the mid or central lung fields. The
apices are usually clear but when involved may
have a coarse, mottled appearance. With the pas-
sage of time, a flecked reticular pattern becomes
apparent and complete clearing may result. With
recurrence, x-rays will show a similar type of in-
filtrate. With progression of the disease the roent-
genologic appearance characteristic of pulmonary
fibrosis may occur and persist. Moderate heart en-
largement may be present mainly in the long
standing cases.

"ip?

wBm.

Laboratory studies reveal a hypochromic, micro-
cytic anemia in the vast majority of the cases.
Serum iron levels are low with a normal or a
moderately elevated iron binding capacity. Re-
ticulocytosis is common. Serum bilirubin and
urinary urobilinogen are slightly elevated during
crisis, presumably due to hemoglobin destruction
in the intra-alveolar blood. The serum total pro-
tein concentration is slightly decreased. Measure-
ments of the clotting mechanism, iron metabolism
and capillary fragility are within nonnal limits.
Eosinophilia up to 20% has been reported in
about one out of eight cases.10 Coombs tests are
generally negative, however positive direct
Coombs tests during episodes of bleeding have
been reported.16 Fifty percent of Soergel and
Sommers10 tested cases and five of six cases re-
ported by Wyllie, et al.,5 had a cold agglutinin.
The anemia is due to hemorrhage into the lungs
with excessive deposition of iron which is not
available for hemoglobin synthesis. This has been
confirmed by several authors6-1017 using radioiron
and radiochromate. Injected red cells from a
normal donor have been found to have a normal
life span in patients in remission with normal
serum iron level, and the patient’s red cells have
normal survival in a normal recipient. Right heart
catheterization performed during remissions are
usually normal and in only occasional long stand-
ing cases is there demonstrated an elevated pul-
monary pressure.

The case reported herein revealed no clinical
evidence of right sided heart failure; however at
autopsy, thickening of right ventricle, right atrium
and a prominent pulmonary conus, probably due
to cor pulmonale and mural thrombus formation
in the right ventricle with large pulmonary em-
boli were found. There was also congestion of
lungs, liver and spleen, presumably due to ter-

MICHIGAN MEDICINE MARCH 1972 197

HEMOSIDEROSIS/Continued

minal heart failure. Few cases reported in the
literature have been complicated by cardiac mural
thrombosis and embolization.18’19 The literature
is scant regarding pulmonary function studies.
In a few cases, normal values of vital capacity
were reported while in others the values were
slightly altered. Examination of sputum, gastric
washing, lung aspiration or lung biopsy are strik-
ing in showing numerous hemosiderin-laden mac-
rophages. Since sputum is difficult to obtain from
small children, several gastric washings should
be done before lung aspiration or biopsy are
attempted. In this case two initial sputums were
negative but later the diagnosis was verified by
the demonstration of many hemosiderin-laden
macrophages in the gastric washings.

Pathological findings

Repeated intra-alveolar hemorrhages are re-
sponsible for the pulmonary changes, and the
appearance and color of the lungs will vary as to
the age of the hemorrhage. The lungs appear
heavy and retain their shape and there is very
little aerated tissue. Typically, they have a mottled
brown and red-purple discoloration but the
pleural surface is fairly smooth and homogeneous.
The more recent hemorrhages will be bright red
or dark purple and the older hemorrhages will
be represented by brown discolored areas irregu-
larly distributed. Microscopic findings will also
vary as to the stage of the disease. In the areas
of recent hemorrhage there will be intact red
cells filling alveolar spaces with occasional pig-
ment-laden macrophages. In other areas there will
be proliferation of fibroblasts with organization
and numerous hemosiderin-laden macrophages will
be within the areas of organization and fill nu-
merous alveoli. Macrophages will also be present
in the alveolar septa and in the walls of small
blood vessels. Elastic fibers of the alveolar septa
and small medium-sized blood vessels may exhibit
some degree of fragmentation and degeneration.
In long standing cases, marked thickening of the
alveolar wall and fibroblastic proliferation will
be noted. Abnormal deposition of hemosiderin in
organs other than the lungs and mediastinal
lymph nodes is generally absent. In IPH the iron
content of washed and dried lung tissue is mark-
edly increased, the degree proportional to the
duration of the disease. In some cases minimal
hemosiderosis of the liver and spleen may be
present secondary to repeated blood transfusions
and prolonged iron therapy. Prussian Blue stains
are very striking in that these pigment-laden mac-
rophages stain very strongly for iron.

Therapy

The chronic iron-deficiency anemia due to
continuous and slow pulmonary bleeding requires
almost constant iron medication, and in many

198 MICHIGAN MEDICINE MARCH 1972

cases, blood transfusions. A few cases of slight
accumulation of iron in liver and/or spleen have
been reported and were attributed to iron therapy
and transfusions. Blood transfusions and iron
therapy were used in our case and no hemosidero-
sis was seen in other organs. Some authors postu-
late that IPH is an immunologic problem and
have used corticosteroids or ACTH as a primary'
form of treatment. Other clinicians, however,
have utilized these drugs only as a last resort to
prevent pulmonary fibrosis.20 Soergel and Som-
mers10 reviewed 28 cases in which the patients
were treated with corticosteroids and have ob-
tained the following impressions:

1) Corticosteroid therapy, in short term use

during bleeding episodes, speeds recovery and
perhaps improves the patient’s immediate prog-
nosis. |d

2) Prolonged steroid therapy does not alter
the course or prognosis of the basic disease.

Other case studies using the same form of therapy
and our similarly treated case support the above im-
pressions. Splenectomy was advocated as the treat-
ment of choice by Steiner9 who considered IPH
to be an immunologic problem also. But, review
of the literature yields contradictoiy results re-
garding the beneficial effect of splenectomy as a
treatment of choice.19 21 Because of this conflicting
evidence splenectomy cannot be recommended as
primary therapy in IPH. Deferoxamine and ethyl-
enediaminetetra-acetic acid (EDTA)22 have been
tried in an attempt to increase iron excretion.

The former was administered in the case reported
herein but for only a few days before death. No
beneficial results were noted.

Summary and Conclusions

A fatal case of IPH is presented in which the
diagnosis was based on findings in gastric wash-
ings. A 2-year-old Negro boy had intermittent
episodes of pulmonary hemorrhage terminating
in death after a six month course. The literature
was reviewed stressing the clinical and pathologic-
al features. The pathogenesis and treatment was
discussed. The importance of this case is the use
of gastric washings to make the diagnosis of IPH
and the recommendation that they should be
performed before a more traumatic procedure,
such as, lung puncture or biopsy is considered.

References

1. Virchow, R.: Die krankhaften Geschulste, Mono-
graph, Berlin, August Hirshwald, 1864, Part 2.

2. Ceelen, W.: Die Kresilaufstorijngen der Lungen,
in Henke, F., and Lubarsch, O., Editors: Hand-
buch der speziellen pathologischen Anatomie and
Histolgie, Berlin, Springer-Verlag, Bd. 3, t 3, p 1,

1931.

3. Borsos-Nachtnebel, O.: Zur Pathologic der Lungen-
Hemosiderose. Zbl. Allg. Path. 70:174, 1942.

4. Waldenstrom, J: Relapsing, Diffuse Pulmonary

Bleedings or Hemosiderosis Pulmonum: A New
Clinical Diagnosis. Acta Radiol. 25:149, 1944.

5. Wyllie, W. G., Sheldon, W., Bodian, M„ and Bar-
low, A.: Idiopathic Pulmonary Haemosiderosis (es-
sential brown induration of the lungs) . Quart. J.
Med. 17:25, 1948.

6. Ognibene, A. J., and Johnson, D. F.: Idiopathic
Pulmonary Hemosiderosis in Adults (Report of
Case and Review of Literature) . Archives of Int.
Med. 111:503, 1963.

7. Goodwin, J. F., Murphy, B., and Guilemette, M.:
Direct Measurement of Serum Iron and Binding
Capacity. Clin. Chem. 12:47, 1966.

8. Scheidegger, S. and Dreyfus, A.: Braune Lungenin-
duration des Kindes mit Sekundaerer Anaemiae.
Ann. paediat., 165:2, 1945.

9. Steiner, B.: Essential Pulmonary Haemosiderosis as
an Immunohaematologic Problem. Arch. Dis.
Childhood, 29:391, 1954.

10. Soergel, K. H., and Sommers, S. C.: Idiopathic
Pulmonary Hemosiderosis and Related Syndromes.
Amer. J. Med. 32:499, 1962.

11. Nancekievill, L.: Acute Idiopathic Pulmonary Hem-
osiderosis. Brit. M. J., 1:431, 1949.

12. McLetchie, N. G. B., and Colpitts, G.: Essential
Brown Induration of the Lungs (Idiopathic Pul-
monary Haemosiderosis). Canad. M. A. ]., 61:129,
1949.

13. Blachpood, R. D., Idiopathic Pulmonary Haemo-
siderosis: Report of Case. Guy’s Hosp. Rep., 103:
26, 1954.

14. Manderson, W. C.: Idiopathic Pulmonary Haemo-
siderosis with Report of Case in Adult. Glasgow
M. J., 35:19, 1954.

15. Soergel, K. H.: Idiopathic Pulmonary Hemosider-
osis: Review and Report of 2 cases. Pediatrics
19:1101, 1957.

16. Wiesmann, W., Wolvius, D. and Verloop, M. C.:
Idiopathic Pulmonary Hemosiderosis. Acta Med.
Scandinav., 146:341, 1953.

17. Apt, L., Pollycove, M. and Ross, J. F.: Idiopathic
Pulmonary Hemosiderosis. A Study of the Anemia
and Iron Distribution Using Radioiron and Radio-
chromium. /. Clin. Invest. 36:1150, 1957.

18. Skogrand, A. and Myhre, E.: Idiopathic Pulmonary
Hemosiderosis. Postmortem Examination of 2
cases. Acta Path. Microbiol. Scandinav., 40:96,
1957.

19. Campbell, S. and Macafee, C. A. J.: A Case of
Idiopathic Pulmonary Hemosiderosis with Myo-
carditis. Arch. Dis. Childhood, 34:218, 1959.

20. Halvorsen, S.: Cortisone Treatment of Idiopathic
Pulmonary Hemosiderosis. Acta Pediatrica 45:139,
1956.

21. Steiner, B.: The Value of Splenectomy in the
Treatment of Essential Pulmonary Hemosiderosis.
Acta Med. Acad. SC. Hung, 14:211, 1959.

22. Steiner, B.: Ethylenediaminetetra-acetic acid

(EDTA) in Treatment of Essential Pulmonary
Haemosiderosis. Helvetic Paediatric Acta, 1:97,
1961.

MICHIGAN
DEPARTMENT
OF PUBLIC
HEALTH

Monthly Surveillance Report

Cases of Certain Diseases Reported
To the Michigan Department of Public Health
For the Four-Week Period Ending January 28, 1972

1972

1971

1972

1971

Total

This

Same

Iota!

Total

Cases

4-Week

4-Week

To Above

Same

for

Period

Period

Date

Date

1971

Rubella

104

156

104

156

2,955

Congenital Rubella Syndrome

0

0

0

0

1

Measles

164

53

164

53

2,659

Whooping Cough

13

4

13

4

139

Diphtheria

0

0

0

0

1

Mumps

Scarlet Fever &

344

1,090

344

1,090

10,748

Strep Sore Throat

1,092

1,249

1,092

1,249

11,244

Tetanus

0

0

0

0

7

Poliomyelitis (paralytic)

0

0

0

0

0

Hepatitis

Salmonellosis

422

392

422

392

4,828

(other than S. typhi)

64

55

64

55

691

Typhoid Fever (S. typhi)

0

0

0

0

10

Shigellosis

48

28

48

28

295

Aseptic Meningitis

6

10

6

10

239

Encephalitis

8

10

8

10

108

Meningococcic Meningitis

5

4

5

4

64

H. Influenza Meningitis

5

9

5

9

82

Tuberculosis

112

103

112

103

1,824

Syphilis

365

348

365

348

4,689

Gonorrhea

1,514

1,634

1,514

1,634

22,115

Information can be supplied by the local health department on the local incidence of disease.

Maurice Reizen, M.D., Director
Michigan Department of Public Health

MICHIGAN MEDICINE MARCH 1972 199

Drug tfierapy' problems

By Louis Depping, RPh
Ann Arbor

Q. Why is Tigan® injection contraindicated in
children? (B.G., Detroit) .

A. When Tigan® was originally approved only
several hundred cases regarding parenteral
use in children were included in the data.
Therefore, the recommendation that Tigan®
injectable not be used in children was not
predicated on toxicity reports, but on the lack
of statistical validity represented in the num-
ber of cases included in the original data.

Q. What are the effects of injecting propoxy-
phrene I.V. on the vein? (M.W., Ann Arbor) .

A. I.V. administration of propoxyphene causes
sclerosis of the vein within the first few in-
jections. Therefore, abuse of the drug by this
route would, of necessity, be limited.

Q. Why can’t Valium® be mixed with other
drugs or I.V. fluids? (M.S., Ann Arbor) .

A. Valium ® is insoluble in water. It has a spe-
cial diluent composed of propylene glycol and
absolute alcohol. If mixed with other dilu-

ents it will crystallize. In an I.V. fluid these
crystals may not be visible to the naked eye.
hi addition to the obvious possible danger of
injecting a crystal into the bloodstream, the
crystals may settle to the bottom of the I.V.
bottle. This would provide a bolus dose when
the I.V. is first started. Cardiac arrest has been
reported when Valium® has been injected
intravenously too quickly.

Q. Can LSD be detected in the blood? (D.H.,
Ann Arbor) .

A. A procedure has been developed but it is not
suitable for routine application.

Q. Will tetracycline appear in a nursing moth-
er’s milk? (C.M., Ann Arbor) .

A. Yes. 500 mg. given four times a day for three
days produced levels in the milk of 1 mg. per
liter of milk.

Q. What is the % of hexachlorophene in Dial
soap? (M.C., Ann Arbor) .

A. 0.75%.

Q. How many calories per milliliter of absolute
alcohol? (P.F., Detroit) .

A. 6 calories /ml.

Q. Can Sub Q Regitine® counteract Levophed®
which has infiltrated? (F.A., Ann Arbor) .

A. No. Regitine® pharmacologically counteracts
Levophed® by alpha receptor blockade and
not by physical or chemical antagonism.

£Mictiigaii authors

H. J. Magnuson, MD, Ann Arbor, “Symptom
Gallimaufry on Exposure to Chemicals," page 228,
Journal of the American Medical Association, Jan.
10, 1972.

Regine Aronow, MD; S. D. Paul, MD, and P. V.
Woolley, MD, Detroit, “Childhood Poisoning with
Methadone,” page 321, Journal of the American
Medical Association, Jan. 17, 1972.

Donald N. Sweeny, Jr., MD, Detroit, “Are Your
Ethics Showing Any Tattletale Gray?” page 102,
Medical Economics, Oct. 25, 1971.

H. H. Itabashi, MD, Torrance, Calif., and L. O.
Granada, MD, Ann Arbor, “Cerebral Food Embolism
Secondary to Esophageal-Cardiac Perforation,”
Page 373, Journal of the American Medical Asso-
ciation, Jan. 17, 1972.

200 MICHIGAN MEDICINE MARCH 1972

Expanding the role of the office
obstetric nurse

By F. W. Jeffries, MD, FACOG
Meredith Lentz, RN
Ann Arbor

For many years prenatal care has been ce-
mented into a rigid schedule of doctor-patient
appointments that are carefully followed by most
practitioners. In many instances, both physicians
and patients have believed that merely following
this program insured good care.

However, it is now evident that the discrimin-
ating physician can identify the high-risk patient
and tailor her care individually.12 Likewise, it is
time that we besfin to modernize the established
routine of our prenatal programs.

As recently reported in the A.C.O.G. News-
letter,3 the College surveyed a nationwide sample
of ob/gyn fellows on the use of allied health
workers in maternity care. The report indicated
that over half of the respondents clearly endorsed
greater utilization of maternity nursing services.
“Physicians’ assistants were endorsed by the Na-
tional Academy of Sciences’ Board on Medicine
as the quickest way to relieve the physician short-
age. Calling for a ‘major change in the organiza-
tion of health care delivery,’ the report says
physicians’ assistants can ‘extend the arms, legs,
and brains of the physician’ by performing tasks
that do not require the unique talents of the
medical doctor.”4

With these goals as our objective, we have
taken a step towards this end by expanding the
role of an obstetric nurse in a private practice
setting.

Program

The program has been carried out in a two-
man obstetric office in a city with a University
Medical Center. The position has been filled by
registered nurses with a special interest in ob-
stetrics and several years’ experience in this area.
In preparation for this, the nurse was carefully
oriented in our policies, and guidelines were de-
veloped for her to follow.

When a new patient calls, she is given an ap-
pointment with our obstetric nurse within the
next seven days. She is told that a doctor’s ap-
pointment will be scheduled by the nurse de-
pending on the duration of her pregnancy and
her individual needs. She is also instructed to
bring a first-voided morning urine for a pregnancy
test should it seem indicated. The following list
summarizes the nurse’s responsibilities at the time
of the first office visit:

1. Obtaining a complete obstetric and medical
history.

2. Obtaining blood for type, Rh, Hb, VDRL,
antibody screen, and Rubella titer.

3. Checking weight, blood pressure, and urine.

4. Determination of pregnancy test on first-
voided urine if indicated.

5. Providing a prescription for prenatal vita-
mins and iron.

6. Dispensing a prenatal instruction sheet and
booklet.

7. Discussion of financial responsibility and
insurance coverage.

8. Discussion of diet and exercise.

9. Discussion of available prenatal classes.

10. Scheduling of the first physician appoint-
ment.

The nurse averages thirty to forty-five minutes to
complete these tasks. If, in her judgment, a
problem may exist, an appointment is worked in-
to the doctor’s schedule that same day.

The second nursing visit is made at the begin-
ning of the third trimester after she has seen the
physician at monthly intervals through mid-preg-
nancy. This point in the pregnancy was chosen
as the patient begins more frequent office visits
at that time. Patients are informed that this visit
will be used to present information relating to
labor, delivery, and postpartum care. The nurse’s
responsibilities for this second visit include the
following:

1. Discussion of hospital policies and hospital
pre-registration procedures.

MICHIGAN MEDICINE MARCH 1972 201

OFFICE OB NURSE/Continued

2. Routine rechecking of weight, blood pres-
sure, and urine.

3. Rh titer is ordered when indicated.

4. Hemoglobin is rechecked and a prescrip-
tion for additional iron is given if indi-
cated.

5. Chest X-ray is ordered or tine skin test is
done.

6. Plans for pediatric care are discussed.

7. Discussion of symptoms of early labor and
when to call the doctor and when to go to
the hospital.

8. Discussion of anesthesia for normal labor
and delivery.

The time needed for this appointment varies
greatly, depending on the number of the pa-
tient’s questions, parity, and previous obstetric ex-
periences.

Results

After the first two years of this program, we
decided to evaluate its effectiveness in serving the
patient. Over 500 obstetric patients began in the
program during this period. Due to changes of
address, abortions, and incomplete prenatal care,
we were able to include only 400. From these we
chose the first 200 survey sheets returned and
completed for analysis. All subjects included in
the study registered for all care in their first tri-
mester and carried pregnancies to term, deliver-
ing live infants. Of these, 99 were primigravidas,
59 had one previous child, and 42 had delivered
two or more. As the practice draws largely from
a university community, 116 of the patients had
completed two or more years of college and 73
had college degrees.

The 200 completed, returned, and evaluated
survey forms gave the following answers to four
questions asked:

1. Approval of initial nursing visit 170/200

2. Approval of second nursing visit 139/200

3. Approval of both visits as con-
tributing to better understanding

of her pregnancy 113/200

4. Number of patients who stated they

were able to communicate some
problems and questions with the
nurse mose easily than with the doc-
tor 68/200

The results were analyzed with regard to age,
parity, and educational achievement. Neither in-
creasing age nor education caused greater ap-
proval or disapproval of the program. However,
as can be seen from the following table, parity
was a factor. The woman having her first pre-
natal experience was more receptive.

Question

Primips Approval

Multips Approval

l

92%

76%

2

79%

55%

3

66%

46%

4

38%

26%

Discussion

The two

basic aims of this

program were to

provide better obstetric care and to do so in a
more effecient manner by increased utilization of
the office nurse. We feel better care was provided
by the program in the following ways:

1. The patient was seen sooner. By making an
appointment with the obstetric nurse with-
in one week of their call, patients were not
forced to wait for an opening in the ob-
stetrician’s schedule. This avoids the need
for patients to convince a busy secretary
of their individual problems in an effort to
get an early appointment with the doctor.
Then, each woman is evaluated through a
direct interview and the appointment with
the doctor is made at the most reasonable
time considering her needs and the sched-
ule of the doctor.

2. The patient was given more time. Prenatal
care can become terribly routine and re-
petitive to many obstetric practitioners. Be-
cause of th is, preparations and explanations
are often brushed over or even omitted. In
order to give more time to the urgent or
interesting problems, the prenatal visit is
frequently rushed through. The obstetric
nurse does not have these other pressures
on her schedule and can plan adequate time
for each visit with the patients.

3. The patients’ prenatal instruction and advice
was improved. With an enthusiastic nurse
covering a specific checklist, errors and omis-
sions were unquestionably reduced. Avail-
able prenatal classes in the community were
recommended, tailoring the choice of the
class to each individual’s wants and previous
experiences. Patients with unusual social or
financial problems were informed of com-
munity resources. The patient desiring an
abortion was given immediate attention to
facilitate the earliest possible termination.
Accomplishing these ends was obviously aid-
ed by the earlier availability of a nursing
appointment plus the greater amount of
time she had to spend with each patient.

4. Some patients could communicate with the
obstetric nurse more easily than with the
doctor. As can be seen from the survey, over
1/3 of the patients did feel this to be true.
Frequently patients hesitate to ask the doc-
tor questions they do not consider essential

202 MICHIGAN MEDICINE MARCH 1972

because of his busy schedule and full wait-
ing room. Often, this feeling does not in-
hibit them when talking with the nurse.

Efficiency in the delivery of prenatal care was
improved in the following ways:

1. Physician time was saved. In a normal and
uneventful pregnancy the second nursing
visit completely replaced an appointment
that had formerly been with the physician.
Following the initial visit the physician need
only review the history that has already been
taken and organized. Also, throughout the
pregnancy, patients’ questions are more spe-
cific and meaningful after the nurse’s pres-
entation of information regarding hospital
procedures, labor, anesthesia, delivery, and
available pediatric care.

2. Having a single person responsible for these
areas has reduced duplications and incon-
sistencies that occasionally occur when more
than one doctor is involved in the prenatal
care. A standard base of information is pro-
vided consistently to all patients, neutraliz-
ing some of the differences that invariably
exist between obstetricians working to-
gether.

S. The two visits with the nurse not only les-
sen the questions on other prenatal visits,
but reduce the phone calls to the office. And,
with the obvious confidence placed in the
nurse by the doctors, she is now able to
answer a major percentage of these phone
questions herself. This provides the patient
with an immediate answer and again saves
the doctor time previously spent returning
a call.

4. Improved legibility of antepartum records
has resulted. Although a minor point, the

careful script of a nurse has certainly been
an improvement in our records.

Since the completion of our survey, we have
hired a nurse who not only sees the patients for
the two nursing visits, but also assists the doctor
at the time of the routine appointments. Initially,
two separate nurses were used. With the increased
contact between the nurse and the patients a
much more trusting and friendly relationship
seems to have been established. We feel this has
further improved patient acceptance of the pro-
gram. We are now finding that many patients
call with questions and specifically ask for the
obstetric nurse. Also, with increased patient ac-
ceptance of the program we now have the nurse
see routine returning patients at any time the
doctor is absent for emergencies or deliveries. At
this time she measures the fundus and listens to
the fetal heart tones, in addition to checking the
weight, blood pressure, and urine. If all findings
are normal, and the patient has no significant
problems, an appointment is made at the time the
next regular visit would have occurred if she had
seen the doctor.

Finally, we have not noted any deterioration in
the patient-physician relationship that is so im-
portant in a private obstetric practice. The physi-
cian sees our normal obstetric patients seven or
eight times during her pregnancy, and it is
thought this could be further reduced by one or
two visits, as has been done in the Virginia Mason
Clinic,5 without undermining patient confidence
and quality of care. As a program of this type
becomes understood and widely used, it could
easily be enlarged to the point that alternate visits
could be with an obstetric nurse. The major
challenge is to convince the possessive obstetrician
to hire and train qualified personnel to perform
more of his routine jobs, thus freeing him for
more challenging and demanding tasks.

MICHIGAN MEDICINE MARCH 1972 203

The following suggested immunization schedule is prepared for MICHIGAN
MEDICINE by the Communicable Disease Control Division of the Michigan De-
partment of Public Health.

Suggested Minimum Schedule
For The Active Immunization
Of Infants and Children1

2-3 months 1st dose DTP . . . OPV (T ri va lent)2

4-6 weeks later 2nd dose DTP . . .

4-6 weeks later 3rd dose DTP . . . OPV (Trivalent)

12-24 months DTP 4th dose (supporting OPV) (Trivalent)3

Tuberculin test4

Measles, Rubella and Mumps Vaccines (or com-
bined MR or MMR)

5 years DTP (Booster) OPV (Trivalent)

Measles, Mumps or Rubella Vaccines (as indicated)

15 years Td (adult booster) (every 10 years thereafter)

Over 6 Years of Age (No Previous Inoculations)

Td (adult) 2 doses not less than one month apart.

Third dose (supporting) six months to
one year later.

OPV (Trivalent) two doses given at least eight
weeks apart followed in one year
with a third dose.

Measles, Mumps or Rubella Vaccines as indicated

DTP — Diphtheria, tetanus, pertussis.

OPV — Oral polio vaccine (Trivalent).

MR = Measles, rubella (live, attenuated virus vaccine).

MMR — Measles, mumps, rubella (live attenuated virus vac-
cine).

Td = Tetanus, diphtheria (adult).

NOTE: 1. This schedule is meant to be a guide only and should be used, at the physician’s
discretion, after considering the individual needs of the patient.

2. Inactivated polio vaccine (Salk) either singly or in combinations with diphtheria,
tetanus, and pertussis antigens are available from MDPH and may be substituted
for attenuated live polio vaccine (Sabin). Consult package insert for recommended
schedules.

3. Routine smallpox vaccination is not felt to be necessary at present to protect the
public health. If primary vaccination is indicated, in the judgment of the physician,
the second year of life is the optimum period for this procedure. Consult package
insert for contraindications.

4. Depends on risk of exposure and prevalence of diseases in population groups.
Future testing at physician's discretion.

204 MICHIGAN MEDICINE MARCH 1972

The Stokes - Adams Syndrome :

Definition and Etiology

By Robert A. O'Rourke, MD
San Diego

The Stokes-Adams syndrome is defined as an
abrupt, transient loss of consciousness due to a
sudden but pronounced decrease in the cardiac out-
put, which is caused by a sudden change in the
heart rate or rhythm. This definition does not
include vasovagal syncope or epilepsy although
patients with Stokes-Adams syncope may have
seizures during periods of cerebral ischemia. Al-

(First of a two-part series)

though partial or complete heart block is usually
present during asymptomatic periods, many ar-
rhythmias may produce syncopal episodes with
or without the presence of previously established
complete heart block. “Arrhythmia-induced Syn-
cope” is a more specific term and includes the
primary cause of the decreased cerebral blood
flow.

Clinical Features

The clinical manifestations of arrhythmia-in-
duced syncope depend upon the duration and
type of underlying arrhythmia as well as the status
of the cerebral circulation. Symptoms of arrhy-
thmia-induced syncope vary from slight faintness
to loss of consciousness, with or without convul-
sions.

Characteristically, during the attack there is an
initial pallor. Following resumption of the normal
circulation there is usually a facial flush due to
reactive hyperemia. The absence of an aura tends
to separate seizures occurring during Stokes-Adams
syncope from seizures of primary cerebral origin.
Stokes-Adams seizures usually commence and
terminate abruptly. The patient may resume a
previous conversation or activity without being
aware of the pause produced by the period of
arrhythmia-induced cerebral ischemia. A slow or
very rapid pulse during the period of uncon-

Doctor O’Rourke is with the Department of
Medicine of the University of California at San
Diego. His manuscript was prepared by the
American Heart Association and made available
to Michigan Medicine by the Michigan Heart
Association.

sciousness points toward the correct diagnosis.
Electrocardiographic monitoring during a syncopal
episode demonstrates the responsible rhythm and
makes appropriate therapy possible.

Etiology

Since most patients with arrhythmia-induced
syncope have some impairment of atrioventricular
(A-V) conduction either during or between at-
tacks, the etiologies of Stokes-Adams syncope are
often the causes of complete heart block.

Structural Lesions of the Heart. Approximately
7 percent of the cases of complete heart block
in adults are congenital in etiology, with or with-
out associated cardiac defects. Syncopal episodes
complicating congenital heart block are uncom-
mon but do occur and may necessitate pacemaker
insertion.

Myocarditis of various etiologies may involve the
conduction system, resulting in complete heart
block and syncopal episodes. Diphtheria has long
been known to be associated with conduction de-
fects particularly complete heart block.

Heart block, occasionally writh Stokes-Adams
Syncope, has been reported during the course of
connective tissue disease and in association with
degenerative skeletal muscle and nervous system
disorders. In valvular heart disease valve calcifica-
tion or endocarditis may involve the conduction
system and produce incomplete or complete heart
block.

Acute myocardial infarction is complicated by
complete heart block in approximately two to
seven percent of cases. Complete heart block com-
plicating inferior wall myocardial infarction usual-
ly proves to be transient and restoration of normal
conduction occurs within two or three weeks. The
conduction defect involves the A-V junctional tis-
sue. When an anterior wall infarction is the
cause of complete heart block the mortality rate
is extremely high even with pacemaker insertion.
In this situation the complete heart block is fre-
quently due to extensive myocardial necrosis in-
volving the right bundle and the two divisions
of the left bundle (trifasicular block) rather than
to a conduction defect in the A-V junction.

In a considerable number of patients no etiology
can be established for complete heart block. Care-

MICHIGAN MEDICINE MARCH 1972 205

STOKES-ADAMS SYNDROME/Continued

ful pathological examination has shown that many
such patients with heart block do not have ex-
tensive coronary artery disease but have areas of
fibrosis involving the conduction system distal to
the common bundle (trifasicular block) , either
alone or in association with scattered areas of
fibrosis throughout the myocardium. In elderly
people this has been attributed to “sclerosis of the
left side of the cardiac skeleton” which presum-
ably results from wear and tear due to the re-
peated pull of the contracting left ventricular
musculature.

Primary and metastatic neoplastic disease, meta-
bolic disease and infiltrative disorders of the myo-
cardium may produce heart block. Complete
heart block is a potential risk during corrective
heart surgery, particularly during repair of ven-
tricular septal defects. Surgical heart block fre-
quently reverts to sinus rhythm within three to
four weeks following operation. If it continues
beyond this period a permanent pacemaker is
usually inserted. Non-penetrating chest injury is
an occasional cause of complete heart block.

Heart block has been reported in association
with Reiter’s Syndrome, amyloidosis, Pagets di-
sease and sarcoidosis. The myocardium is involved
in approximately 20 percent of autopsy proven
cases of sarcoidosis. Conduction disturbances,
Stokes-Adams syncope and sudden death are
known to occur in sarcoidosis and this entity is
an important consideration in the differential
diagnosis of acquired complete heart block in the
young adult.

Electrolyte Disorders. Potassium is the most

important electrolyte in relation to A-V conduc-
tion. Isolated instances of advanced A-V block
have occurred in patients during or following the
administration of large doses of potassium salts.
Hyperkalemia markedly decreases the ventricular
rate in pre-existing heart block.

Acidosis depresses the ventricular pacemaker
in complete heart block and may precipitate
Stokes-Adams syncope. Alkalosis, hypokalemia and
hypernatremia increase A-V conduction and may
reverse heart block. However, alkalosis and hy-
pokalemia may increase ventricular ectopic ac-
tivity, leading to ventricular tachycardia or fibril-
lation.

Toxic Effect of Drugs. Digitalis is the drug
most frequently responsible for producing com-
plete heart block. Syncopal episodes are uncom-
mon during heart block due to digitalis toxicity
because the ectopic pacemaker frequently orig-
inates in A-V junctional tissue and the ventricular
rate is faster than in complete heart block of other
etiology. The supraventricular rhythm in these
patients is often atrial fibrillation.

The antiarrhythmic agents, quinidine and pro-
caineamide, depress the conduction system as well
as pacemaker rhythmicity and are contraindicated
in complete heart block. Diphenylhydantoin and
Lidocaine may also depress the ectopic pacemaker
and are therefore contraindicated in the presence
of high degree A-V block. However, any of these
antiarrhythmic drugs may be safely employed to
suppress premature contractions in the presence
of heart block if an adequately functioning elec-
trical pacemaker has been inserted.

206 MICHIGAN MEDICINE MARCH 1972

Bacteriuria screening of youngsters

By Mary L. Cretens, MD, MPH
Menominee

Urine screening of various population groups
has gained enthusiastic response from some work-
ers, while others feel that it is not worthwhile.
However, there are several areas that have not
been assessed ftdly. For the past two years our
health department has been running extremely
inexpensive projects on the age group that seldom
have medical examinations— or at least, seldom
have urine checks. The results of these findings
are presented in this paper.

Over 25,000 deaths occur in the United States
each year from urinary tract disease. Not counted
in this number are deaths due to hypertensive
renal disease. This number would bring the total
annual death count to near 100, 000. 1 The Nation-
al Kidney Foundation estimated in 1966 that 3,-
300,000 Americans have unrecognized, undiagnosed
disease of the urinary system.1

In young adults kidney problems are the com-
monest cause of loss of work time.1 Bacteriuria
acquired in childhood may be the reservoir of in-
fection becoming evident in adult life. Chronic
pyelonephritis has poor results even with good
medical management.2 Early detection, treatment,
monitoring, and patient education may well have
significant effects on a number of persons who
otherwise might develop severe renal damage later
in life.3

Girls are more prone to have urinary infections.
Some estimates run approximately 30 girls to one
boy.2 Because of the higher incidence of urinary
infections in girls, and clue to economies involved,
urine bacteria studies were not done on boys in
either year of screening. The current year’s screen-
ing program (1971) is described.

Materials and Methods

The study was conducted in two rural counties
of Michigan (Delta and Menominee) . Grades 3,
4, 5, and 8 were screened. The program was con-

Doctor Cretens is director of the Delta-Menom-
inee District Health Department. This screening
program was sponsored by the district depart-
ment and the Michigan Department of Public
Health. Christine Gail Smith, RN, Escanaba, was
project nurse.

ducted by a registered nurse, assisted by a clerk
technician, and volunteers made up of mothers,
a few area nurses, and students. A permission-
history type form was obtained from each parent
whose child participated in the program. The
form explained that oftentimes early urinary di-
sease gave no symptoms. Answers filled in by
parents included:

1. Physician to receive the report.

2. History of past urinary trouble.

3. Diabetes or kidney disease in close blood
relatives.

4. Symptoms that may indicate urinary disease
— (blood in urine, bedwetting, difficulty in
holding urine, pain or burning on urina-
tion) .

5. Use of bubble bath or detergent in child’s
bath water.

Each school in the two counties was visited and
a mobile laboratory set up in a convenient place.
All participating children were checked for al-
bumen and glucose and most girls were checked
for bacteria. (Late in the series, eighth grade girls
were eliminated for bacteria screening because of
problems connected with menstruation.)

Exton’s reagent was used to check albumen and
Test-Tape was used for screening glucose. Test-
uria kits were used for bacteria. The urine was
incubated shortly after plating it. These results
were read in 18 to 24 hours. 26 or more colonies
were considered positive. Volunteer mothers were
instructed in the procedure of catching a clean
mid-stream specimen, and they, in turn, explained
this to each youngster. Clean sterile test tubes
(previously used in a blood drawing program)
were used as urine containers. The girls were in-
structed to sit on the toilet backwards (facing
the wall) to facilitate catching the specimen.
Sputum cups (government surplus) were used as
containers for the boys.

Those students whose studies were positive for
albumen, glucose, or bacteria were referred back
to the Health Department for a second' screening.
These second specimens were obtained under
close supervision of the program nurse. If this
second test was positive, the child was referred
to the family physician for additional follow-up
tests. The physician was requested to submit re-

MICHIGAN MEDICINE MARCH 1972 207

BACTERIURIA SCREENING/Continued

suits of his follow-up examination to the Health
Department.

Results

Combining the results of the two counties, 76%
of the children enrolled in grades 3, 4, 5, and 8
participated. There were 1,989 boys and 1,820
girls screened for a total of 3,809. From these,
there were 135 referred to the Health Depart-
ment for rescreening and 118 returned to re-
screening. Of these, 22 were referred to their
physicians. Thirteen were reported as having di-
sease by their physicians. A breakdown of the
diagnoses included five infections, five albumin-
uria, one renal glycouria, one chronic renal di-
sease.

Statistics on Urine Screening Program

% of Unit

Boys

Girls

Total

Above

Participants

Referrals to

. .1,989

1,820

3,809

76% *

Health Dept. . . .
Returned to

10

125

135

3.5%

Rescreening

10

108

118

88%

Referred to MD ..

3

19

22

18.6%

New Cases Found

2(0.15%) 10(0.55%) 12

54.1%

Old Cases

0

1

1

8.3%

* Of enrolled students

Discussion and Conclusions

The actual statistical yield was quite low. In
studies done elsewhere approximately 1% of girls
and 0.03% of boys were found positive for urinary
tract disease. If these studies are continued all
through school there would be a five-fold increase
in these statistics.2 Our results were higher in
boys (0.15%) and lower in girls (0.55%). How-
ever, the boys and some of the girls were not
screened for bacteria, so the results were not com-
parable.

In absolute numbers, however, there were 12
children found with previously unknown abnor-
malities on one or two rescreenings, plus the phy-
sician’s examination. Some of the physicians did
not repeat bacteria tests and very few did micro-
scopic examinations of the urine on follow-up.
This may have been the cause of missing a few ac-
tual cases of disease.

It was observed that cold weather and recent
exercise increased positives for albumen. The
girls did quite well in collecting clean specimens
although no “prep” was used. Occasionally, a
volunteer group would not be careful in giving the
girls instructions and on those days the number
of positive cultures would increase above the

average number of positives. Repeat cultures
eliminated unnecessary referrals.

The cost of the bacteriuria screening media
was the biggest item of expense, especially when
repeat tests were done. If the test for bacteria
had not been carried out, 58% of the number re-
ferred in the program would have been referred
on the basis of glucose and albumen. With the
simple albumen-glucose urine screening, using
volunteers, the cost for materials would amount
to about two cents per child.

Many parents commented favorably on the pro-
gram. Generally they expressed the fact that they
did not realize urinary disease could be present
without symptoms.

Summary

A urinary screening program was conducted by
Delta-Menominee District Health Department on
3,809 school children in grades 3, 4, 5, and 8.
118 were rescreened and 22 referred to the family
physician. At least 12 of these children were
found to have persisting urinary disease from time
of screening to diagnosis (one week to one
month) . Urine screening in the school is simple,
low in cost, and has some educational merit.
Over-referral is a problem unless rescreening is
done.

Bibliography

1. U. S. Department of Health, Education and Wel-
fare. Kidney Disease.

2. Kunin, Calvin, et al. Urinary Tract Injections in
School Children, New England Journal of Medi-
cine—266:25, June 21, 1962, pp. 1288-1316.

3. Werner, D. Urine Screening Report Delta and
Menominee Counties 1970.

References

1. Aubry, R. H. & Nesbitt, R. E.; "High Risk Ob-
stetrics I,” American Journal Obstetrics-Gynecology,
Vol. 103: p. 972-985, 1969.

2. Aubrey, R. H. & Nesbitt, R. E.; “High Risk Ob-
stetrics II,” American Journal Obstetrics-Gynecol-
ogy, Vol. 105: p. 241, 1969.

3. Yankauer, Alfred et al, “Use of Allied Health
Workers in Maternity Care,” American College of
Obstetrics & Gynecology Newsletter, Vol. 15; p.
6-7, 1971.

4. “Assistants Endorsed to Speed Care,” American
Medical News, Vol. 13, p. 1, 1970.

5. Smith, Michael et al., “The R. N. Obstetric As-
sistant,” American Journal Obstetrics-Gynecology,
Vol. 38, p. 308-312, 1971.

208 MICHIGAN MEDICINE MARCH 1972

New registry
of placental tissue
handles 109 specimens

By Joseph R. Cipparone, MD, Chairman
Subcommittee on Placenta! Tissue Registry
MSMS Committee on Maternal and Perinatal
Health

(Note: The MSMS Placental Tissue Registry was
started in 1970 as another effort to further improve
maternal and perinatal health. Here is a report of
the Registry for 1971 from the chairman, a Lansing
pathologist.)

From January 1, 1971 through December 31,
1971 a total of 109 placentas had been submitted
to the registry from a variety of physicians in a
number of different hospitals throughout the state
(see below).

Only eight placentas were received in 1970 as
submission of specimens did not begin until late
November, 1970. The number of specimens is in-
creasing as more physicians become aware of the
merits of the registry. A gross and microscopic
examination of each placenta was made and a
report submitted to the attending physician. Some
reports included recommendations to be made rela-
tive to the care of that patient or her infant. The
registry is therefore both service- and research-

oriented as statistical data is being kept on all
gross and microscopic observations made.

The following hospitals have submitted spec-
imens to the registry:

HOSPITAL

LOCATION

1.

Emma L. Bixby

Adrian

2,

McPherson Community

Howell

3.

St. Mary’s

Saginaw

4.

Mercy Hospital

Cadillac

5.

War Memorial

Sault Ste. Marie

6.

Kelsey Memorial

Lakeview

7.

Sparrow

Lansing

8.

Blodgett

Grand Rapids

9.

St. Francis

Escanaba

10.

Pennock

Hastings

11.

Ingham Medical

Lansing

12.

Burns Clinic

Petoskey

13.

Albion Community

Albion

14.

Bronson Methodist

Kalamazoo

15.

St. Lawrence

Lansing

16.

Mount Carmel Mercy

Detroit

General categories relative to the placentas in-
clude specimens from multiple births, configura-
tion abnormalities (such as duplex, circumvalla-
tion), multiple congenital anomalies in the infant,
toxemias of pregnancy, maternal conditions affect-
ing pregnancy (such as severe heart disease), IUD
devices with surrounding placental growth, drug
ingestion in mothers (such as LSD), and a number
of other miscellaneous conditions. In approximate-
ly one-half of the cases of specimens submitted to
the registry, the placenta was associated with an
infant death — hence the reason for submitting the
specimen as to probable cause of death via pla-
cental abnormality, etc.

Cancer experts
receive 55 requests
to speak around state

“Hodgkin’s Disease, Leukemia and Lymphoma,”
“Cancer Chemotherapy,” “Introduction to Oncol-
ogy,” “Recent Uses of Chemotherapy,” “Intra-
adbominal Cancer,” and “Care and Treatment of
the Cancer Patient” are just a few of the titles
of speeches presented to medical groups by doc-
tors knowledgeable in the field of cancer. The
lectures are part of the 1971-72 Professional Edu-
cation Program of the Michigan Cancer Coordin-
ating Committee.

Based on its success of the previous two years,
the Professional Education Program, chaired by
William Bromme, MD, of Grosse Pointe, was au-
thorized by the Michigan Cancer Coordinating
Committee to continue for 1971-72.

Invitations were sent in the spring of 1971 to
administrators of MD and DO hospitals, as well as
to secretaries of Michigan’s component medical
societies, component districts of the Michigan

Dental Association and component societies of the
Michigan Association of Osteopathic Physicians
and Surgeons. Fifty-two replies were received in-
dicating interest in arranging a meeting on a can-
cer subject.

Speakers participating in the program are: Wil-
liam Arnold, PhD, Detroit; Robert Kastenbaum,
PhD, Detroit; R. Roderick Abbott, MD, Flint; M.
R. Abell, MD, Ann Arbor; David G. Anderson, MD,
Ann Arbor; James R. Borst, MD, Grand Rapids;
Robert W. Brownlee, MD, Detroit; Frances E. Bull,
MD, Ann Arbor; Max E. Dodds, MD, Flint; James
A. Ferguson, MD, Grand Rapids; George S. Fisher,
MD, Detroit; Charles Frey, MD, Ann Arbor; Wil-
lian J. Fuller, MD, Grand Rapids; Edward L. Moor-
head II, MD, Grand Rapids; Robert M. O’Brien, MD,
Detroit; Melvin L. Reed, MD, Detroit; Phillip B.
Stott, MD, Kalamazoo; Lee B. Stevenson, MD, De-
troit; Robert W. Talley, MD, Detroit; W. G. Tucker,
MD, Kalamazoo; V. K. Vaitkevicius, MD, Detroit;
Leo Zelkowitz, MD, Kalamazoo; James R. Hay-
ward, DDS, MS, Ann Arbor; Robert B. Hoek, DDS,
Grand Rapids; Nathaniel H. Rowe, DDS, MSD, Ann
Arbor; Philip Adler, DO, Farmington; Norman W.
Arends, DO, Flint; Michael DiMattie, DO, Bloom-
field Hills; George E. Himes, DO, Flint; Michael L.
Opipari, DO, Highland Park; and the Midwest On-
cology Center at Borgess Hospital, Kalamazoo.

MICHIGAN MEDICINE MARCH 1972 209

cPeriqatal <T ips

By Paul M. Zavell, MD
Detroit

The following case from the files of the Wayne
County Medical Society Perinatal Mortality Com-
mittee is presented as an aid in continuing educa-
tion.

This was the sixth pregnancy of a 30 year-old
gravida VI, Para IV white mother. In 1959, at
age 19, with her first pregnancy, her blood type
was reported as AB + . This was not rechecked
as far as we can ascertain at any other time.

Her first three infants each had an uncompli-
cated pregnancy, delivery and perinatal course.
However, her fourth infant after an uneventful
pregnancy and delivery, was quite jaundiced in
the first five days with indirect bilirubin reaching
a total of 18mgm% and hemoglobin dropping
to 15.0 gms. This was dismissed as “physiologic
jaundice.”

Two years ago the fifth pregnancy ended in a
stillbirth at 35-36 weeks. No autopsy was done
here.

Doctor Zavell is chairman, Neo-Natal and Hos-
pital Care Committee, Michigan Chapter, A.A.P.,
and chairman, Perinatal Mortality Study Commit-
tee, Wayne County Medical Society.

This sixth pregnancy was uneventful until the
25th or 26th week when the mother noted ces-
sation of movement. She consulted her doctor
who confirmed that the infant was probably dead
as no heart tones could be heard. Nothing further
was done until three weeks later, when the mother
went into labor and after 10 hours delivered a
macerated stillborn. Because she had lost two in-
fants in a row, the mother desired an autopsy.

The post mortem study of the infant and the
placenta revealed definite evidence of hemolytic
disease of the newborn. Following this the
mother’s serum was retested with a panel of
known antigens and carried beyond the usual
ABO to Rh typing. She was found to be AB
Negative with Anti-D easily identified in her
serum. Studies also showed the Indirect Coombs
to be 1:16384!!

Perinatal Committee Comments

1. The Committee felt that the earlier infant
findings of 18 mgm% bilirubin with a hemo-
globin of 13.0 gm were not really compatible
with “physiologic jaundice.” They felt the
pediatrician should have been clued that an
unusual situation existed here and he should
have suggested retesting of the mother’s blood
type.

2. Ideally, ABO Rh and Coombs tesing should be
done with each pregnancy. But where necessary,
at least Coombs test should be done.

3. Where an ABO setup is present it can be very
helpful to get both an Indirect as well as a
direct Coombs test.

4. Where there has been an unusual infant loss in
a prior pregnancy, the obstetrician should
order retesting of the mother’s blood using a
panel of known (common and rare) antigens.

210 MICHIGAN MEDICINE MARCH 1972

These mentally retarded children practicing motor coordination skills are
students at Lansing’s Beekman Center. Operated by the Lansing School
District, Beekman is one of an ever-increasing number of facilities operated
by local school districts for the mentally retarded.

A new day dawns. . .

for Michigan’s mentally retarded

Action at state and community levels indicates
a new day is approaching for the mentally retarded
residents of Michigan.

More of the mentally retarded are staying at
home longer; more of them are leaving state insti-
tutions to return to community life; more of them
are receiving training, finding jobs and are either
partially or completely self-supporting.

Cold statistics illustrate the trend. For more
than 70 years after the opening of Lapeer State
Home in 1895 the number of mentally retarded
in Michigan institutions increased every year. But
during the last three years the number has de-
creased each year — today there are 2,000 fewer
mentally retarded in state institutions than there
were in January 1969.

New Department of Mental Health policies re-
cently announced by E. Gordon Yudashkin, MD,
director, are accelerating the downward trend in
institution residents, the upward trend in com-
munity placements. To illustrate: institution census
dropped nearly 10% (more than 1,000 patients)
during 1971; community placements jumped more
than 20%.

The “mandatory education” act passed by the
Legislature in December (1971) will give impetus

"To take the state out of the business of
fostering a hopeless, unrewarding existence
for those who are handicapped by mental re-
tardation; to help them overcome their handi-
caps to whatever degree possible; and to
return them to their communities, to familiar
surroundings, to families, to friends where
they can benefit from associations which will
enhance their further development;

"To have educators provide training and
education in the community where it should
be, where it is provided for more fortunate
children; to help parents and the community
understand and accept the retarded; to avoid
the deteriorating effects of neglect, imper-
sonalization, and the feeling of rejection
which is bound to be more prevalent in a
large institution than in a home-like resi-
dence."

These are the aims of new policies adopted
by the Michigan Department of Mental Health
to help the mentally retarded, as explained
by E. Gordon Yudashkin, MD, director. Those
policies and the community medical practi-
tioner’s role in treating the retarded are de-
scribed in the two articles on these pages,
prepared by the MDMH.

MICHIGAN MEDICINE MARCH 1972 211

MENTALLY RETARDED/Continued

At the Community Workshop in Flint,
mentally retarded clients learn, among
other things, the art of assembling
fish nets. The workshop is operated
by Genesee County Community Mental
Health Services.

to this movement when school programs are fund-
ed to serve the mentally handicapped.

The Department policy is described by Dr. Yu-
dashkin as follows:

“No admission will be accepted on the premise
that it's for a lifetime.

“The idea now is to stop taking in new admis-
sions who really don’t need institutional care, re-
habilitate and place in communities as many
people as we possible can, retain all of the exist-
ing staff that we can, and close inadequate build-
ings. If we do this, we’ll have enough staff in our
institutions to treat retarded persons adequately.

Criteria for State Service Revised

“Except in emergency situations, state institu-
tions for the retarded will not accept persons who
are diagnosed as trainable or educable — they will
be the primary responsibility of the community
and public school districts.

“The waiting list is no longer meaningful as an
indicator of actual need for facilities for the
mentally retarded.

“Seniority on the list will no longer be the
criteria for admission. We will take those in most
critical need first, regardless of position on the list.
Priority will be established by the emergency nature
of each case.

“Immediate admission will be granted in cases
where there is evidence a mentally retarded person
is dangerous to himself or others.

“The philosophy, the policy and the program-
ming for retarded persons will be geared to a con-
centrated effort to develop their functioning ca-
pabilities to whatever level possible. At that point,
the person will be placed in the appropriate com-
munity setting.

“Residents in state institutions who require only

nursing care will be placed, whenever possible,
in nursing homes in their communities.

Community Responsibility Emphasized

“Communities will be expected to provide resi-
dential facilities and activity programs. State funds
up to $15 per day per person are now available
to match local funds on a 75% -25% basis, for
programs under Act 54 which meet acceptable resi-
dential standards and provide activities such as
recreation, sheltered workshops and traininq pro-
grams.

“Community residential facilities will be in-
spected frequently to ensure that safety, sanitation
and physical comfort standards are being met and
that operators are conducting designated daily
activity programs.

“Preventative measures aimed at reduction of
the incidence of mental retardation will receive
high priority in the funding of community services.

“Day training programs for the severely retarded
which were initiated by the Department of Mental
Health and funded by the state will be continued
under the Department of Education. The Depart-
ment of Mental Health will give full support to
Department of Education requests for funds to
expand these programs.

School Programs Essential

“Community schools should develop programs
for all levels of mental capabilities, not just for
those who fit into the tight limitations of the norm.
There is no reason to the concept that all those
with an IQ under a certain level should be ex-
cluded from our schools and shipped off to a state
institution.

“The community school should adapt to the
child’s need, not the child to some standard es-
tablished for other children who are blessed with

212 MICHIGAN MEDICINE MARCH 1972

normal intelligence and are further advantaged
by a system which excludes all others.

“Of course a mentally retarded child cannot
compete on the same level as a normal child —
to force him to do so is destructive. He needs to
be educated in special ways. What we need to
develop is a person who can cope with society,
not necessarily a person who excells in reading,
writing and arithmetic.

New Centers in Urban Areas

“The Department of Mental Health will continue
its emphasis upon construction of mental retarda-
tion centers in major metropolican areas. These
centers will be designed primarily to accommodate
persons with under 30 intelligence quotient and the
multiply handicapped. They will be programmed to
provide outpatient, emergency and consultation
services to schools and community agencies.

“As these centers are developed, old, uninhabit-
able buildings will be vacated, and the number of
residents in larger state institutions will be re-
duced.”

The community physician
and the mentally retarded

By Homer F. Weir, MD

Plymouth

Mental retardation is essentially a learning de-
ficiency which originates during the development
period and results from a variety of causes. It is
not a single disease state.

Mental retardation exists in various degrees
ranging from almost complete inadequacy to close
to normal functioning. There is little or no rela-
tionship between diagnostic entities and prognosis
for future achievement. For example, people with
Down’s syndrome usually are moderately retarded
but may be severely retarded.

Early diagnosis of the mentally retarded, par-
ticularly those with multiple handicaps is essential
to appropriate developmental planning. Research
has demonstrated that the early years (0-5) are

The role of the community physician, especially
the family doctor, is of major significance in main-
taining mentally retarded residents in the com-
munity. Homer F. Weir, MD, a pediatrician with
many years of experience as a private practitioner
and institution director presents in the following
article information and suggestions which may be
helpful to community physicians in dealing with
the specific problems related to mental retardation.
Dr. Weir is superintendent of Plymouth State Home
and Training School.

crucial to the development of the individual, so-
cially, intellectually, emotionally and physically.
Adequate assessment requires medical examina-
tion, psychological services, audiological examina-
tion, EEG, etc.

When acting upon the results of an early diag-
nosis, it is important to remember:

a. Tests available to determine mental capa-
bilities in the very young are heavily affected
by neuromotor or maturational factors and can-
not be used to accurately predict the degree
of eventual retardation. They only serve to sug-
gest that program intervention is indicated.

b. Many studies have stressed the positive
and negative effects of the physician’s manner
of approach to the retarded and his parents.
(Deisher 1957; Olshansky 1963; Bryant and
Heischer 1962; R. Koch 1959; and Weir and
Kelley 1963.) Premature and inappropriate prog-
nosis and rejection of the retarded by the psy-
sician can be disastrous to the child, the parent
and the doctor.

c. Program activity must follow diagnosis of
retardation. If the family’s community does not
have appropriate programs, Regional Interagency
Committees on Mental Retardation, local or state
mental health agencies should be contacted by
and be aided by the doctor in establishing pro-
grams readily accessible to the family.

Frequently valuable time is lost in providing
appropriate medical treatment because the retarded
child is unnecessarily sent to an institution. De-
cisions to place a retarded child out of his home
are frequently complex, always require inputs
other than medical information, and most impor-
tantly, must be made by the parent, not the doctor.

It is important not to base expectations of ac-
complishment of the mentally retarded solely on
the results of psychological testing. While testing
may set certain outside limits in achievement, there
is substantial variation in what can be expected
of people with similar I.Q.’s depending on training,
instruction, supportive services, and attitudes of
those in closest contact with the retarded person.
This is true in the “normal” population and it is
true with the retarded.

It is well to consider that such tests may include
a variety of factors (age, anxiety, cultural back-
ground) and may not adequately measure indi-
vidual capacity even in areas in which such tests
are supposed to be the most accurate.

Mental retardation is not a problem which the
physician can approach solely from a medical
point of view. The role of the physician in ap-
proiate medical management of the mentally re-
tarded must be supplemented by the services and
advice of educators, social workers, and psycholo-
gists. While medical intervention designed to
eliminate or minimize basic handicaps is essential,
particularly with multiply handicapped children,
successful overall treatment of the retarded neces-
sarily involves other professional skills.

MICHIGAN MEDICINE MARCH 1972 213

MENTALLY RETARDED/Continued

Sheltered workshops, like this one at Beekman Center, provide an oppor-
tunity for mentally retarded persons to learn job skills and get paid for their
work, while they remain in the community. The adults above are sorting
small auto parts.

Treatment of mental retardation cannot be
limited to the afflicted person alone. The effects of
a diagnosis of mental retardation on the child's
family can often be devastating, and frequently,
considerable supportive help must be provided. In
some cases, psychiatric treatment is required to
assist families in accepting the situation.

Most cases of mental retardation require no
special medical services. Approximately 85%
of the mentally retarded are only mildly retarded
and require no more medical services than the
normal person.

None of the mentally retarded present medical
problems which cannot be managed, as are other
health problems, within the health service delivery
system. The important difference lies in profes-
sional, public and family attitudes toward the
mentally retarded.

Physicians through their counseling, recommen-
dations and treatment programs can exert a major
influence in changing outmoded negative attitudes
and in establishing necessary community programs
for the retarded.

More attention should be devoted to mental
retardation preventive programs. Programs de-
signed to provide better pre-natal care and more
adequate instruction can have a profound effect on
the incidence of mental retardation.

Two specific conditions are not generally ap-
proached appropriately by many physicians pri-
marily because of lack of current knowledge or
because of cultural rejection of the retarded by
the physician.

a. Mongolism — These babies should go home

with parents. They should not be told that their
“child will never walk, will never talk, will not
live long, and will be severely retarded.” None
of these statements are true (Centerwall’s Study).
In contradistinction most mongols can become
productive members of society.

b. Infants with meningomyelocele should be
shunted. About 66% of such children pro-
vided with shunts will have normal intelligence.
They are paralyzed, but lower extremity paraly-
sis and other complications can be greatly allevi-
ated by modern surgical and habitation tech-
niques allowing the meningomyelocele patient
to become a highly contributory member of
society.

References

1. Deisher, R. W., Role of the Physician in Main-
taining Continuity of Care and Guidance, J.
Pediatrics, 50:231, 1957.

2. Simon Olshansky, Gertrude C. Johnson, Leon
Sternfield: Attitudes of Some GP’s Toward
Institutionalizing Mentally Retarded Children.
Mental Retardation, Vol. 1, No. 1, pp. 18-20:
57-59, February 1963.

3. Bryant and Heischer: Helping Parents of the
Retarded Child. AM A J. Dis. Child., 102:52,
1961.

4. Koch, R., et al: Attitude Study of Parents with
Mentally Retarded Children, Pediatrics, Vol.
23, pp. 582-584, March, 1959.

5. H. F. Weir and Frances Kelley, Management
of the Retarded Child Under Three Years of
Age, Pediatric Clinics of North America, Vol.
10, No. 1, pp. 53-66, February, 1963.

214 MICHIGAN MEDICINE MARCH 1972

‘Your opiqioti please

MSMS asked the question:

In Governor William Milliken’s 1972
budget message he recommended that
the state deduct 3% from its payments
to doctors for Medicaid services if the
payments are made in 30 days. Would
you accept this discount to be paid in
30 days? What is your reaction to this
proposal ?

These doctors replied :

By Brooker L. Masters, MD
MSMS Council Chairman

We are getting battered from the left and from
the right.

It is not a new experience for physicians and
organized medicine but it does seem to be coming
at more frequent intervals.

The latest, as you have been informed via Medi-
gram, is the Governor’s health message recom-
mendation that the state “save two million” by dis-
counting Medicaid provider payments 3% if paid
within 30 days.

The Council has adopted a four-step response
to this proposal. My purpose here is not to discuss
the four steps — I am sure you have read about
them elsewhere — but to tell you my personal phi-
losophy as Chairman that MSMS must continue to
respond to such challenges in the strongest pos-
sible way. I believe that the MSMS members expect
their state organization to speak for them in the
most forceful possible manner. I can remember
years ago when this was not MSMS policy — when
we were afraid of hurting feelings or getting a
poor public image.

It is also my personal conviction thdt MSMS has
to continue its dialogue with people who don’t
necessarily agree with us, just as we did last
month in presenting our views to the Democratic
National Policy Council’s Subcommittee on Health.
I think we must make an opportunity to talk with
the Republican Policy Council. I am not personally
convinced that they fully understand the position
of organized medicine or the practicing physician.

The many letters that I have received in the past
few weeks convince me that the course that we are
now taking, outlined above, is the one that the
greatest number of members of MSMS believe in,

Doctor Masters Doctor Barton

too. I think I would only like to make it clear that
I realize that whatever action MSMS takes must be
responsible and not simply negative and reaction-
ary.

Thomas A. Barton, MD
Howell

I have tried to think of a reason why I would
be agreeable to accepting the above proposal
and can only conclude that if everyone else who
is being paid for rendering services or supplies
were placed in the same situation, I would be
agreeable. Secondly, I would feel much differently
about this if the government were in a financial
bind and had requested the medical profession’s
help on a temporary basis. Since neither of the
above situations exist, the answer is an emphatic
“no” with further amplification as follows:

The state government has clearly shown the
medical profession what it thinks of us. For ex-
ample, in the 1970 Medicaid budget for the three
divisions involved, only the medical profession
did not use up all of the allocated funds. The
administrative division and the hospital division
exceeded their budgetary allotments by many
millions of dollars. It was, therefore, proposed in
the 1971 budget that the hospital and administra-
tive divisions be increased well over their 1970
allotments but that the medical profession be cut
substantially below their 1970 allotment. Thus fru-
gality, efficiency and honesty were penalized. This,
I might add, was done with little fanfare or little
criticism on the part of the government relative
to the hospital and administrative divisions of the
Medicaid program. Since the physicians continue
to be efficient and economical in their operation,
one may also infer that the medical profession
has very little clout when it comes to budget prep-
aration regarding payments to physicians as com-
pared to hospitals and administrators of the medi-
cal programs. It is the present law of the land
that the medical profession may grant 5.5% in-
crease in salaries but is held to a 2.5% increase
in fees. How this is to be done and the medical
profession remain solvent, defies prudent financial
operation of any office.

MICHIGAN MEDICINE MARCH 1972 215

YOUR OPINION /Continued

As a result of the above feelings, several ideas
become quite clear in my mind:

(A) Neither the federal, state, nor local gov-
ernments respect the medical profession as a
whole. In the state, the doctors number approxi-
mately 7,800 people and this number of votes does
not constitute a real liability inasmuch as they are
not organized to bargain with any of the three
units of government.

(B) The patient blames the medical profession,
not the government, for the high cost of the hos-
pital and doctor bills. The patient does not under-
stand that it was the government that had formu-
lated both the Medicare and Medicaid programs
regardless of whether the medical profession was
able to fulfill these programs or the government
finance them. As a result of experience, it is ap-
parent that the government cannot afford either
program and that the doctors are now called upon
to subsidize both programs.

(C) Since there is no one to bargain collec-
tively for the doctors the government can cut the
payments to the 75th percentile point as it has
done in the Medicare program. There is no reason
to expect that the state government, being further
pinched financially, will not cut the Medicaid pro-
gram payments to the 75th percentile point. Then
to add insult to injury, they will discount the pay-
ments 3% because they are being paid by the
government within 30 days.

(D) It might at first glance appear that the
physicians might be able to counter the above
measures by being non-participating (i.e., refus-
ing care to Medicaid cases). However, as far as
the Medicaid program is concerned, that action
will continue to merely force the Medicaid bene-
ficiary into the emergency room for treatment. The
treatment there has been rendered by the doctor
on call, who in order to maintain his staff mem-
bership has to take his call in rotation.

I realize there are other ways of covering the
emergency rooms. However, the costs here have
skyrocketed and will continue, not only because
of non-participation but because of the increase
in the number of people who are unable to pay
their bills. The example that comes to mind here
is the case of an acute otitis media who can be
seen in my office and appropriate medication dis-
pensed for $10.00 or'less. In the hospital, the same
patient will be charged $9.00 by the hospital for
the use of the emergency room; the doctor on call

Doctor Berglund

will charge $10.00, and the druggist $5.00, for a
total of $24.00. These payments will be made by
the government with little or no quibbling; how-
ever, payment for the same treatment in the doc-
tor’s office often will be contested.

(E) My final conclusion is that the medical
profession had best organize itself as rapidly as
possible into a bargaining unit in an effort to
negotiate with any third party who wishes to pur-
chase medical services from the medical profes-
sion. This can be done on a state or area basis.
It may well be that the government is right and
that the medical profession is too fat financially
to recognize its peril until it is too late. It would
appear that when the profession has its back up
against the wall is the only time that it has tried
to organize itself in order to negotiate with any
unit of government.

In conclusion then, my course of action will be
to try to have the medical profession organize
either on an area or state basis, and to reject
the government’s payment with a 3% discount.
As far as the federal program is concerned, I am
non-participating and have chosen to let the pa-
tient argue with the government for the differential
in payments.

Thomas R. Berglund, MD
Kalamazoo

Governor Milliken’s proposal to deduct 3% from
payments to doctors, for Medicaid services, if
made within 30 days makes me mad!! It assumes
that either we have so much money we won’t miss
a little or that we are already overcharging. It
treats our work as goods rather than services. It
once again singles out doctors “alone” and sug-
gests by implication, that we are the source of the
state’s financial ills.

Medicaid is in trouble not because doctors
have failed to make it work, but rather because
the “government” has failed to budget enough
money to pay for the medical care that is the
RIGHT of our Medicaid recipients. Doctors are
already bitter from last year’s arbitrary reduction
of payments by 10%. To further incense them by
deducting 3% from already inadequate fees is re-
volting.

The government, both state and federal, has for
years picked on doctors’ fees. Every day we are
beseiged to fill out Social Security forms for free,
to examine people for vocational rehabilitation at
rates far less than our regular patients pay, and
we are “allowed” to care for a child under MCCC
at degrading rates. This same “double standard”
rate structure does not exist for everyone, how-
ever, as construction companies make huge profits
on improperly built roads (and no 3% is deducted),
plumbers, carpenters, bricklayers, etc., get union
scale working for the state, and doctors alone
are asked to accept a 3% discount.

Governor Milliken has failed to realize that
there exists a crisis in regards to Medicaid in this

216 MICHIGAN MEDICINE MARCH 1972

state. Many doctors will not accept Medicaid pa-
tients. Those who do have some, will accept no
new Medicaid patients. The reasons are obvious,
inadequate rates are cut arbitrarily and now it is
suggested that we accept a 3% discount just for
being paid. The crisis may worsen — a few ghetto
doctors care for only Medicaid patients. If their
cost ratio is 50%, a 3% deduction in payment
would be a drop in income of 6%. I would stop
seeing Medicaid patients.

Governor Milliken AND the legislature have got
to come to grips with the realization that people
deserve good medical care and good medical
care is not cheap.

I do not expect nor will I accept a 3% discount
for cash by my patients any more than I will accept
the same from the State of Michigan.

Robert M. Jesson, MD
Muskegon

My reaction to Governor Milliken’s proposal to
give a further discount to the State of Michigan
on cash payments for Medicaid patients is one of
disgust. It is a purely political gimmick designed to
demonstrate that the governor is saving money,
but at whose expense?

The State of Michigan already gives itself a
large discount from usual, customary and reason-
able fees (If I may use the jargon of Blue Shield)
in payments for patients under Medicaid. While
it is taking this discount at the expense of the
medical profession and the patient, the state ad-
ministration and legislature have given themselves
raises far in excess of 3 percent, are pursuing
plans for a billion dollar monstrosity of a capitol
building, plus having spent hundreds of thousands
in remodeling the present capitol building, and in
general have demonstrated little sense of fiscal
responsibility by making an effort to cut spending.

The Robin Hood concept of fees went out of
date in the medical profession quite some time
ago. State medicine wants to revive it. I can see
no solution for this policy but to refrain from
treating clients of state medicine.

Emergency cases should be accepted, of course,
but the great majority of Medicaid people require
care in other than emergency situations.

As politicians well know, such a policy would
immediately create a conflict in the conscience of
doctors who are for the most part motivated by
the desire to help others. They have relied too
long, however, on this psychological make-up,
and we should refuse to continue under their
terms because of a sense of duty. Why should our
employed patient pay his fee from his own pocket
while the wealthy state receives a substantial dis-
count?

A drastic step must be taken to emphasize to
the administrators of the Medicaid plan that any
delivery of medical care will require the coopera-
tion of the providers.

(The Grand Rapids Press, in a recent edition,
carried this editorial on the governor’s proposed
3% discount on Medicaid payments to physicians.)

Gov. Milliken’s budget message to the Legisla-
ture included a peculiar provision. In the message
the governor proposed that “as the state assumes
responsibilities (from Blue Cross and Blue Shield)
for invoice processing for Medicaid ... all pay-
ments to providers (health care facilities) that
are made within 30 days of receipt of billing be
discounted by 3 percent.” This, Milliken remarked,
“Can reduce state costs by $2 million and provide
an incentive to the department (of Social Services)
to process claims in a timely manner.”

Disregarding the incentive angle, which seems to
suggest that state employes need some sort of
bonus plan to assure their efficiency and devotion,
we think that the governor’s proposal poses an
important question. It is simply this: What will the
hospitals and nursing homes in Michigan do to
make up that $2 million they will be owed for
services already rendered Medicaid patients?

Does Gov. Milliken really believe that these in-
stitutions can absorb this “discount” to permit
the state to realize a “savings?” This, it seems
to us, is most unrealistic — for hospitals, too, must
pay their bills.

Ultimately this 3 percent discount, or $2-million
windfall, with which the state intends to reward
itself for performing its job properly, will be borne
by all patients using health care facilities in Michi-
gan. This follows because what is actually a 3 per-
cent cost to health care facilities doubtless will
be reflected in higher room rates and service
charges.

Furthermore, had Blue Cross and Blue Shield —
the former carrier for the state’s Medicaid pro-
gram— been permitted to operate on Gov. Milliken’s
discount plan, it might have been able to show a
$2-million “savings.” For better or ill, however,
Blue Cross and Blue Shield as a member of the
private sector was expected to “pay its bills in
full.”

If adopted, the governor’s plan could introduce
an entirely new principle into the state’s financial
operations. Applying that principle in reverse, we
are tempted to ask: Why shouldn’t Michigan resi-
dents be permitted a similar 3 percent discount
on state income taxes if they file returns within
30 days of receiving their W-2 forms?

MICHIGAN MEDICINE MARCH 1972 217

YOUR OPINION/Continued

Doctor Jesson Doctor Moore

In 1971 the governor arbitrarily omitted payments
to doctors because the legislature was unable or
unwilling to agree upon a budget. One of the
first groups to be hit by this malfeasance of the
legislature was the welfare recipient, of which
Medicaid is a small part. You will recall, however,
that only 11 to 12 percent of the total in payments
to doctors was omitted, and the remaining dis-
bursement to other providers continued, as did
the full salaries of the legislature and state em-
ployees.

The actions of the Governor are simply indicative
of the trend of thinking towards regulation of phy-
sicians and show us the iron hand beneath the
velvet glove. This issue should be fought out now
while there is still some room for maneuver be-
cause of the fact that doctors do have private
patients. I do not feel that the private patient
should bear the brunt of decreased fees set by
the state, and this is exactly what the Governor
proposes.

Until the administration and legislature of the
State of Michigan demonstrate a sense of fiscal re-
sponsibility in all their expenditures, I will per-
sonally object strongly to even a 3% discount
as proposed. When sincere efforts are made by
the state governing bodies to decrease expendi-
tures of the state, then I believe he has the right
to ask for a discount. Until that time, why should
we be singled out?

The entire subject may be academic, however, as
the state will have to process claims in 30 days
to qualify if I understand it, and they don’t even
have the MMS computer to expedite matters.

Glenn E. Moore, MD
Flint

This proposal is another straw added to the
camel’s load. Last year, because of a state budge-

tary crisis, physicians were subjected to a 10%
cut in medicaid fees, and though we protested
loudly among ourselves, no concerted action was
taken. And now a proposed 3% discount for
prompt payment. One need not be clairvoyant to
see where the first cuts will always be made as
medicine comes into competition with police and
fire departments, schools, and street sweepers
for a place in the state budget.

Several provocative questions are raised by this
recommendation. If a 3% discount is imposed for
prompt payment, does it not logically follow that
interest should be paid for delayed payments?
What doctor accepting medicaid patients has not
waited months for payment while red tape is un-
ravelled? Is this maneuver legal? In both California
and Kansas legal action was instituted when the
state altered handling of federal funds, and it is
reported that there were federal restrictions against
such changes. What will happen to depressed area
medicine? Is it not likely that the already inadequate
supply of physicians in these areas will be ad-
versely affected by such a ruling? Will the phy-
sicians with a small percentage of medicaid patients
in their practice continue to care for them — or
will they be gradually “weeded out” in favor of
people who may be less difficult to care for and
who have methods of payment which are less cum-
bersome and are not subject to the vicissitudes
of state regulation and red tape? If the average
doctor refuses to continue to care for these pa-
tients, in whatever number they occur in his prac-
tice, who will care for them?

Few among us would deny that we are rapidly
approaching the time when most of our patients
will expect third parties of one sort or another
to handle all medical expenses. If it has been es-
tablished that medicine will docilely accept a uni-
lateral discounting of 3% on an already inadequate
fee schedule, then I am sure we shall be con-
sidered easy prey by all third parties. Though
many physicians may not be financially involved
in medicaid, the time has come when we must all
defend each segment of our profession as if we
were being personally attacked. Unless we follow
such a course, we shall soon all be the victims.

Another straw? Yes — one which should be vig-
orously refused. The precedent it would set is
totally unacceptable. And yet, perhaps I am too
dogmatic. Will I ever accept a 3% discount? Of
course — on the same day the governor, the state
legislators, the teachers, etc. accept a decreased
paycheck for services honestly rendered — because
the check arrives on payday.

218 MICHIGAN MEDICINE MARCH 1972

(f 'Medical cart programs

Second in a series:

HMO in your future ?

Here are terms of first state contract
to provide medical services

By Herbert Mehler

Chief, Research and Analysis

Government Medical Programs

On Dec. 23 the Michigan Department of Social
Services signed the first state contract to deliver
medical services to a defined population. The con-
tract provides services to Group I Medicaid eligi-
bles, through the Model Neighborhood Compre-
hensive Health Program, Inc., of Detroit, and
comes close to the HMO concept.

This article is the second in a series about
HMOs or prepaid group practice plans. It will
provide the MSMS membership with detailed
information of various methods evolving to de-
liver medical sendees in Michigan.

Such information is important in order that the
physician can determine the type of practice best
suited to him and his patients.

The MSMS staff for research and analysis will
make an on-site visit to the Center to seek addi-
tional information not available in the contract.

Following are the essentials in the demonstra-
tion contract:

Effective date: March 1, 1972 to February 28,
1973 unless terminated sooner.

Enrollees: Any person certified as eligible for
Group I Medicaid services as authorized by law
and amendments thereto. The total number of
persons enrolled shall not exceed 10,000 during
the contract and without regard to physical or
mental condition, age, sex, national origin or
race.

Service Area: Jefferson to Mt. Elliott — tip of
Hamtramck to NYC RR to 16th & Grand River to

Bagley (not business district) to Chrysler Free-
way to Jefferson.

Hospitals: Harper, Grace (Central), Hutzel,
Childrens’ and Rehabilitation Institute.

Hospital Services: Room and board, general
nursing services, operating room, anesthesia,
drugs and medication, laboratory, X-ray, and
casts. All medical, surgical, obstetrical, and re-
lated services, including outpatient services, are
provided.

Authorized Subcontracts: Hospitals, profes-
sional medical physician corporation, marketing
and enrollment, laboratory services, X-ray serv-
ices, extended care facility and nursing homes,
pharmacies, medical consultants, physician con-
sultants, visiting nursing association, emergency
ambulance services, social work agencies, med-
ical laboratories, and marketing and enrollment
— same to be accomplished through a subcon-
tract with the Health Council of the Detroit
Model Neighborhood, Inc., with said entity to
have complete responsibility for this function.

Scope of Services

A. General and Specialty Medical and Related
Health Services

1. General

(a) General and specialty medical-surgical-
health services will be provided at the
Model Neighborhood Comprehensive
Health Center; hospitals; other facili-
ties; or the patient's home as arranged
by the MNCHP.

(b) When required and where health serv-
ices are not directly available by the

MICHIGAN MEDICINE MARCH 1972 219

MEDICAL CARE PROGRAMS/Continued

professional staff of the Center, such
services are considered benefits and
will be made available, by referral to
qualified specialists outside the Cen-
ter.

(c) A twenty-four hour emergency service
is available through the Center at affil-
iated institutions when ordered by a
MNCHP staff member.

2. In the Model Neighborhood Comprehensive
Health Center

All preventive, diagnostic and treatment
services provided by physicians and other
professional staff members of the MNCHP
without charge to the members.

Benefits include:

(a) Comprehensive health examinations
and other screening tests.

(b) Immunizations as required by the
needs of the enrollee.

(c) Laboratory and X-ray services including
diagnostic and therapeutic radiological
procedures such as radioisotopes,
radiation treatment, electrocardiog-
raphy and all other diagnostic services
as required.

(d) Pre- and post-natal care.

(e) Eye examinations, refractions for
glasses and eye glasses. (Maximum of
one pair per year)

(f) Prescription drugs prescribed by
MNCHP physicians provided in the
Center and/or pharmacies located in
Detroit Model Neighborhood.

(g) Emergency ambulance service to the
MNCHP and other affiliated facilities
when ordered by a MNCHP staff mem-
ber.

(h) Pharmaceutical services including co-
ordination of an individualized coun-
seling service to members for drug
related problems.

(i) Health education.

(j) Social work services.

(k) Rehabilitation services including physi-
cal, occupational and speech therapy.

(l) Nutritionist, dietetic and home econ-
omist services.

(m) Outpatient visits to psychiatrists upon
referral.

(n) Prosthetic appliances when prescribed
by a MNCHP physician.

3. In Hospital

All medical, surgical, obstetrical, and re-
lated health services, as indicated, in an

affiliated hospital or other general hospital
when ordered by a MNCHP physician.

4. At Home

Home care services by the Visiting Nurse
Association and the Homemakers Service p
of Metropolitan Detroit when ordered by a c
physician or other professional employee
of the MNCHP and including nutritionist
service, home health aids, oxygen and the
administration of oxygen.

5. In Extended Care Facilities

Up to 730 days of convalescent care when
ordered by a MNCHP physician in an ex-
tended care facility or in a nursing home
for each continuous period of confinement
or for successive periods of confinement
separated by less than 60 days. Where
these periods are separated by more than
60 days, the 730 day period will be renewed.

The 730 day period will be reduced by 2
days for every day of general hospitaliza-
tion provided to the same patient.

B. Hospital Care

1. General

(a) Up to 365 days of care in a short-term
general hospital with which the
MNCHP is affiliated. Such care must
be ordered by a MNCHP physician.

(b) Inpatient hospital services including
semi-private room service; meals; gen-
eral nursing services; operating room
facilities, equipment and materials; de-
livery room facilities, equipment and
materials; surgical dressings and casts;
any equipment required while in hos-
pital; X-ray, radium and radioisotopes
for diagnosis and therapy; admission
screening procedures; laboratory and
other diagnostic services; anesthesia
services; drugs, biologicals and related
preparations; blood; and all other
medically indicated hospital services
rendered by hospital personnel.

2. Mental Illness and TB

Up to 90 days of care for mental illness
or TB when such care is ordered by a
MNCHP physician and when he deems it to
be short term care. The benefit period is
available for each continuous period of
confinement or for successive periods of
confinement separated by less than 60
days. Where these periods are separated
by more than 60 days, the 90 day period
will be renewed except that coverage will
cease upon discharge and admittance to
a hospital or institution specializing in the
care of mental illness or TB.

do

y

! Me
I cif

ere

l

ore

c

220 MICHIGAN MEDICINE MARCH 1972

3. Rehabilitation

Up to 30 days of care in a rehabilitative
institution.

Benefits provided by institutions and other
providers not affiliated with the health program
of the Detroit Model Neighborhood, Inc.

4. Emergency Care

(a) When emergency care is urgently re-
quired; and when it is not practicable
to use the Plan’s emergency telephone
service or to reach an affiliated facility;
and when it is deemed to be a true
emergency, the Health Plan will pay
for such care in a non-affiliated facility
or for care obtained by non-affiliated
physicians, providing that the Health
Plan is notified within 48 hours of the
emergency.

(b) Payment for emergency outpatient and
inpatient hospital care; medical; and
surgical care will be made by the
Health Plan on the basis of reasonable
costs and charges.

(c) When a MNCHP physician deems it to
be medically safe, a patient may be
transferred to an affiliated institution.
Cost of appropriate transportation in an
authorized transfer of a patient to an
affiliated facility will be made payable
by the Health Plan. When a patient
cannot be safely transferred to an af-
filiated facility the benefit will be ex-
tended until such transfer is practi-
cable or until discharge.

5. Referral Care

When a professional staff member of the
MNCHP refers a patient for special treat-
ment or diagnosis to qualified specialists
and institutions not affiliated with the
MNCHP, these services are considered
benefits as though they were provided at
the MNCHP or affiliated institutions.

Exclusions

1. Non-emergency services obtained through
doctors and/or institutions which are not formal-
ly affiliated with the Health Plan of the Detroit
Model Neighborhood.

2. Long-term hospitalization beyond that spe-
cifically provided for in the Agreement.

3. Medical and/or surgical services consid-
ered to be experimental in nature.

4. Dental care, except for oral surgery when
ordered by a MNCHP physician.

5. Cosmetic surgery.

6. Private duty nursing, except when ordered
by a MNCHP physician.

Compensation Proposed

Monthly per person payments by category

Old Age Assistance

(OAA)

$ 67.20

Aid to the Disabled

(AD)

104.58

Aid to the Blind

(AB)

47.25

Aid to Families Dependent Children

(AFDC)

17.46

For the Health Care Benefit package as de-
tailed, not including the additional benefit cate-
gories of Rehabilitative services for drug addic-
tion; Rehabilitative services for alcoholism not
Dental care.

State’s takeover
of Medicaid
soon underway

On April 1 the Michigan Department of Social
Services plans to begin taking over fiscal inter-
mediary functions for the state’s Medicaid program,
according to its own time table.

The Social Services Department will first begin
administering ambulance services payments, with
pharmaceutical payments to follow. Physicians are
scheduled for state-handled reimbursement about
Aug. 1. Hospitals and nursing homes will be last.

A pilot program is planned in a portion of the
state to determine the difficulties that may be en-
countered when the state takes over physician
services.

Certain key members to staff the Social Services
Department’s new operations now are on the
scene, most particularly Paul Allen, director of the
Bureau of Management and Information Systems.
Mr. Allen is a retired naval officer with extensive
experience in computers and information systems.

Other high-level personnel have been hired in
bill review and client information systems projects.
Implementation of the computerized program in the
Department of Social Services will require more
than 300 more people, although all this will not be
directly attributable to the Medicaid program.

In the meantime, the Social Services Department
is establishing liaison with MSMS and the Michigan
Association of Osteopathic Physicians and Sur-
geons to discuss a fee schedule. J. K. Altland, MD,
medical director of the department, is in charge of
this phase of the program.

Details of the administrative change-over, first
announced Oct. 13 by Bernard Houston, director,
Social Services Department, have been explained
to all members of The MSMS Council in a letter
written by Chairman Brooker L. Masters, MD, Fre-
mont.

MICHIGAN MEDICINE MARCH 1972 221

Medicredit's advantage:
it's ready to go,

AMA testifies

By Donald N. Sweeny, Jr., MD
Chairman, Michigan Delegation to AMA

“Build on the very real strength that now exists.”

That advice was given recently by the AMA in
testimony before the House Ways and Means Com-
mittee in Washington on the national health insur-
ance proposals.

Few MSMS members realize how often the AMA
appears before Congressional Study Committees to
represent physicians of our nation.

The AMA in these appearances on the national
insurance issue urges adoption of Medicredit as a
national health insurance proposal that “can be put
into operation now.”

AMA officials oppose the various programs that
would not build upon present strengths.

Recently Max H. Parrott, MD, chairman, AMA
Board of Trustees, explained to the congressional
committee:

“We have a medical system with impressive ac-
complishments, a system that is flexible and inno-
vative, a system responsive to the need for change
and improvement. In whatever action this commit-
tee chooses to take the AMA strongly urges that
you build on the very real strength that now
exists.”

Doctor Parrott drew the attention of the commit-
tee to many achievements in American medicine,
saying, “Those who criticize our system of med-
icine imply that it is static and must be replaced.
Let me call your attention to some of the salient
accomplishments of our pluralistic medical system.
Accomplishments that are obscured in the radical

chic, by a disaster lobby which stridently proclaims
a need for revolutionary change.”

Doctor Parrott continued:

“Probably our highest achievement is in the
quality of medical care in this country. The world
standard of medicine is here in this country. Amer-
ican medical schools produce men and women
with the best medical education there is. Our tech-
nology is unsurpassed.”

Doctor Parrott cited the 25 per cent drop in the
nation’s infant mortality rate in the last decade and
the steady growth of life expectancy in the U.S. as
evidence “that American medicine — our pluralistic,
evolving, pragmatic system — is changing things for
the better, that we are making progress.”

American medical schools, Doctor Parrott noted,
have increased from 89 in 1967 to 108 this year
and first-year enrollment has grown from 9,000 to
12,000 students.

Organized medicine has also undertaken initia-
tives to bring medical costs under control, the
AMA officer told the committee. This is being ac-
complished mainly through medical society founda-
tions, based on the concept of peer review, which
screen hospital admissions and review procedures.

The AMA has been underlining in its work on
Capitol Hill that, “Medicredit avoids the mistake in-
herent in proposals such as H.R. 22 (the Kennedy-
Labor bill), which would lock medicine into a rigid,
monolithic, no choice, bureaucratic system before
there is any real evidence that it would make
things better,” he said.

In contrast to H.R. 22, Medicredit would build
upon outstanding accomplishments of American
medicine “which has shown a capability of being
the best in the world.”

“And it can be put into operation now. It has no
dependence on untried theory or dubious econ-
omies. It does not require an unreasonable ex-
penditure of federal dollars and it does not jeop-
ardize the funding of other vitally necessary pro-
grams to improve the nation’s health. It places em-
phasis on greater financial support for persons
needing this assistance. It does not create an un-
reasonable, unrealistic and burdensome adminis-
trative bureaucracy.”

The AMA Medicredit proposal has 160 sponsors
in Congress.

222 MICHIGAN MEDICINE MARCH 1972

Campbell’s Soups . . .

wide variety ... for limited appetites

Many people lose interest in food as they grow
older. Some of them are fussy eaters — with only
a few favorite foods. Others become indifferent
to foods — because planning and preparing meals
becomes a chore. Here Campbell’s Soups can help
— for these four very good reasons:

Appeal With a variety of tastes, textures,
aromas, and colors, Campbell’s Soups can
add interest and appetite appeal. And they’re
easy to eat — ingredients are tender, bite-size.

Many patients on special diets will find soups
they can enjoy among the more than 50 dif-
ferent varieties available.

Nourishment Campbell’s Soups contain selected
meats and sea foods, best garden vegetables —
carefully processed to help retain their natural
flavors and nutritive values.

Convenience Within 4 minutes a bowl of deli-
cious soup is heated and ready to eat.

Economy Campbell’s Soups are inexpen-
sive— an important consideration to those
whose budgets are limited.

Recommend Campbell’s Soups . . . and,
of course, enjoy them yourself. Remember,
there’s a soup for almost every patient and
diet . . . and for every meal.

Break the
ulcer circuit
to hyperacidity,

hypermotiOty and
ulcer pain.

Pro-Banthliie

propantheline bromide

R Relief Factor in Peptic Ulcer

Worry, frustration, job pressure — all
set up excessive vagal currents in
patients with peptic ulcer.

Pro-Banthine"insulates" the stom-
ach, the duodenum and the lower
intestinal tract — the sites where
these destructive currents take their
toll.

This "insulation" helps block ex-
cessive enteric activity and acidity,
thus helping to provide the proper
environment for the healing of pep-
tic ulcers.

It's nice to know that Pro-Banthine

provides this protection at a dosage
that causes little or no discomfort
and that, unlike ataractic agents, Pro-
Banthine does not cloud the patient's
awareness or thought processes.

By moderating excessive vagal
currents Pro-Banthine relieves
spasm, acid burn and pain. By re-
ducing gastric motility Pro-Banthine
also prolongs the activity of antacids .

Indications: Peptic ulcer, gastroenteritis,
pylorospasm, biliary dyskinesia, functional
hypermotility and irritable colon.
Contraindications: Glaucoma, severe cardiac
disease.

Precautions: Since varying degrees of urinary

hesitancy may occur in elderly men with pros-
tatic hypertrophy, this should be watched for
in such patients until they have gained some
experience with the drug. Although never re-
ported, theoretically a curare-like action may
occur with possible loss of voluntary muscle
control. Such patients should receive prompt
and continuing artificial respiration until the
drug effect has been exhausted.

Side Effects: The more common side effects, in
order of incidence, are xerostomia, mydriasis,
hesitancy of urination and gastric fullness.
Dosaqe: The maximal tolerated dosage is usu-
ally the most effective. For most adult patients
this will be four to six 15-mg. tablets daily in
divided doses. In severe conditions as many as
two tablets four to six times daily may be re-
quired. Pro-Banthine is supplied as tablets of 15
mg., as prolonged-acting tablets of 30 mg. and,
for parenteral use, as serum:type vials of 30 mg.
The parenteral dose should be adjusted to the
patient's requirement and may be up to 30 mg.
or more every six hours, intramuscularly or in-
travenously.

Research in the Service of Medicine

Distributed by G. D. Searle & Co., P. 0. Box 5110, Chicago, Illinois 60680

Helps control
the underlying problem
anxiety

Miltown

(meprobamate)

when reassurance is not enough

Indications: Relief of anxiety and ten-
sion; adjunctively in various disease
states in which anxiety and tension are
manifested; and to promote sleep in
anxious, tense patients.
Contraindications: Acute intermittent
porphyria and allergic or idiosyncratic
reactions to meprobamate or related
compounds such as carisoprodol, meb-
utamate, tybamate, carbromal.
Warnings: Drug Dependence: Physical
and psychological dependence and
abuse have occurred. Chronic intoxica-
tion, from prolonged use and usually
greater than recommended doses, leads
to ataxia, slurred speech, vertigo. Care-
fully supervise dose and amounts pre-
scribed, and avoid prolonged use,
especially in alcoholics and addiction-
prone persons. Sudden withdrawal after
prolonged and excessive use may pre-
cipitate recurrence of pre-existing
symptoms (e.g., anxiety, anorexia, in-
somnia) or withdrawal reactions (e.g.,
vomiting, ataxia, tremors, muscle twitch-
ing, confusional states, hallucinosis;
rarely convulsive seizures, more likely
in persons with CNS damage. or pre-
existent or latent convulsive disorders).
Therefore, reduce dosage gradually (1-
2 weeks) or substitute a short-acting
barbiturate, than gradually withdraw.
Potentially Hazardous Tasks: Driving a
motor vehicle or operating machinery.
Additive Effects: Possible additive
effects between meprobamate, alcohol,
and other CNS depressants or psycho-
tropic drugs. Pregnancy and Lactation:
Safe use not established; weigh poten-
tial benefits against potential hazards
in pregnancy, nursing mothers, or
women of childbearing potential. Ani-

mal data at five times the maximum
recommended human dose show reduc-
tion in litter size due to resorption. Mep-
robamate appears in umbilical cord
blood at or near maternal plasma levels,
and in breast milk at levels 2-4 times
that of maternal plasma. Children Un-
der Six: Drug not recommended.
Precautions: To avoid oversedation, use
lowest effective dose, particularly in
elderly and/or debilitated patients. Con-
sider possibility of suicide attempts; dis-
pense least amount of drug feasible at
any one time. To avoid excess accu-
mulation, use caution in patients with
compromised liver or kidney function.
Meprobamate may precipitate seizures
in epileptics.

Adverse Reactions: Central Nervous Sys-
tem: Drowsiness, ataxia, dizziness,
slurred speech, headache, vertigo,
weakness, paresthesias, impairment of
visual accommodation, euphoria, over-
stimulation, paradoxical excitement,
fast EEC activity. Gastrointestinal: Nau-
sea, vomiting, diarrhea. Cardiovascu-
lar: Palpitations, tachycardia, various
forms of arrhythmia, transient ECG
changes, syncope; also, hypotensive
crises (including one fatal case). Aller-
gic or Idiosyncratic: Usually after 1-4
doses. Milder reactions: itchy, urticarial,
or erythematous maculopapular rash
(generalized or confined to groin).
Others; leukopenia, acute nonthrombo-
cytopenic purpura, petechiae, ecchy-
moses, eosinophilia, peripheral edema,
adenopathy, fever, fixed drug eruption
with cross reaction to carisoprodol, and
cross sensitivity between meproba-
mate/mebutamate and meprobamate/
carbromal. More severe, rare hypersen-

sitivity: hyperpyrexia, chills, angioneu-
rotic edema, bronchospasm, oliguria,
anuria, anaphylaxis, erythema multi-
forme, exfoliative dermatitis, stomatitis,
proctitis, Stevens-Johnson syndrome;
bullous dermatitis (one fatal case after
meprobamate plus prednisolone). Stop
drug, treat symptomatically (e.g., possi-
ble use of epinephrine, antihistamines,
and in severe cases corticosteroids).
Hematologic: Agranulocytosis and
aplastic anemia (rarely fatal), but no
causal relationship established. Rarely,
thrombocytopenic purpura. Other: Ex-
acerbation of porphyric symptoms.
Usual Adult Dosage: 1200 to 1600 mg
daily, in three or four divided doses;
doses above 2400 mg daily not recom-
mended.

Overdosage: Suicidal attempts with me-
probamate, alone or with alcohol or
other CNS depressants or psychotropic
drugs, have produced drowsiness, leth-
argy, stupor, ataxia, coma, shock, vas-
omotor and respiratory collapse, and
death. Empty stomach, treat symptomati-
cally; cautiously give respiratory assist-
ance, CNS stimulants, pressor agents
as needed. Meprobamate is metabo-
lized in the liver and excreted by the
kidney. Diuresis and dialysis have been
used successfully. Carefully monitor
urinary output; avoid overhydration; ob-
serve for possible relapse due to incom-
plete gastric emptying and delayed

absorption. REV. 10/71

Before prescribing, consult package cir-
cular or latest PDR information.

TTi WALLACE PHARMACEUTICALS
kA/Cranbury, N.J. 08512

t4 is the

PREDICTABLE
HORMONE BECAUSE
IT LOVES PROTEIN.

SYNTHROID® (sodium
levothyroxine) is pure synthetic T4,
the major circulating thyroid
hormone. It is reliable to use
because of its affinity for protein-
binding sites in the blood. T3 is
more fickle. Sometimes it binds.
Sometimes it doesn’t. T4 more
predictably binds to protein.

Synthroid

(sodium levothyroxine)

ALL THYROID-
FUNCTION TESTS ARE
USEFUL IN
MONITORING
SYNTHROID THERAPY.

No calculations are needed, test
interpretation is simple.

Any of the commonly used T4
thyroid function tests (P.B.I., T4 By
Column, Murphy-Pattee, Free
Thyroxine) are useful in monitoring
patients on T4 because they all
measure T4. Patients on
SYNTHROID are thereby easy to
monitor because their results will
fall within predictable, elevated
test ranges. Of course, clinical
assessment is the best criterion of
the thyroid status of the drug-
treated patient.

THYROID STATUS IS
SO SMOOTH FOR THE
SYNTHROID PATIENT.

(1) The onset of action of T4 is
gradual. It has a long in vivo
“half-life” of over six days.
(Occasional missed doses or
accidental double-doses are of less
concern because of this factor)1;

(2) since SYNTHROID contains only
T4, the potential for metabolic
surges traceable to more potent
iodides (T3) is eliminated.

1. Latiolais, C. J., and Berry, C. C.: Misuse of
Prescription Medications by Outpatients,

Drug Intelligence & Clin. Pharm. 3:270-7, 1969.

tv;

TEST

HYPOTHYROID

SYNTHROID

THERAPEUTIC

NORMAL

P.B.I.

Less than 4 meg %

6-10 meg %

T« By Column

Less than 3 meg %

7-9 meg %

Ta (Resin)

Less than 25%

27-35%

Ta (Red Cell)

Less than 11%

11.5-18%

Free Thyroxine

Less than 0.7
nanograms %

0. 7-2.5

nanograms %

Murphy-Pattee

Less than 2.9
meg %

4-1 1 meg %

(otipose

the Smooth

tfiyroid replacement therapy

y y f —

TOLL

AHEAD

DOES SYNTHROID
►ST LESS THAN
NTHETIC DRUGS
►NTAINING T3?

KNOWLEDGE OF THE
’70’s CHALLENGES
CUSTOMS CONCERN-
ING DESICCATED
THYROID DRUGS.

SWITCHING PATIENTS
TO SYNTHROID
IS EASY.

y simple. T3 costs more to make
thetically than does T4. So it is
nomically necessary for a
thetic thyroid medication
taining T3 to cost more than
containing T4 alone. Synthetic
ibinations cost patients nearly
> more than SYNTHROID3
ause the T3 costs more to start
i; also there is the additional
ense of formulating a tablet
taining two active ingredients.

lerican Druggist BLUEBOOK, March, 1971.

In the past, desiccated thyroid
produced from animal glands was
considered “good, and cheap.” We
now know that improved products
are available and the price
difference has narrowed to the
point of being inconsequential.
(SYNTHROID, for instance, costs
patients about a penny a day more
than brands of desiccated thyroid.)

What does this additional $3.65
a year buy the patient? Quite a bit in
terms of quality, reliability and service.

Switching present patients to
SYNTHROID (or starting new ones)
is a simple matter. SYNTHROID
is available in the widest range
of dosage strengths of any thyroid
drug. Seven scored, color-coded
tablet strengths are available plus a
lyophilized injectable form for
emergency or postoperative uses.

RESPONSE, RELIABILITY, SERVICE -COMPARISON OF FIVE PARAMETERS

'ARAMETERS DESICCATED THYROID U.S.P. SYNTHROID® (sodium levothyroxine)

IOURCE OF HORMONE

Animal glands (swine, sheep, cows). Hormone
content of glands and ratio of T3-T4 varies by type of
animal, season in which gland is harvested, and diet
of animal. 1.13.4.5

Synthetically derived pure crystalline hormone.
Because no animal protein is present, no objection-
able odor occurs upon aging.

5ENERAL ASSAY TECHNIQUE

"Its major disadvantage is inadequate
standardization of hormonal content.”8

Unlike desiccated thyroid U.S.P., thyroxine does not
require biologic standardization to establish its
potency. 2 6 Crystalline T4 is used. Purity is verified
by paper chromatography. Content of tablets is
standardized by weight.

FINICAL RESPONSE

"T3 and T4 ratio varies according to gland source.
Fluctuations in response can occur.

Potency can vary.”8

“Sodium levothyroxine has been extensively used
with satisfaction and is widely held to be superior
to (desiccated) thyroid.”7

"There are well documented examples of patients
who failed to respond satisfactorily to desiccated
thyroid but subsequently responded to (sodium-1)

thyroxine.”4

’REDICTABILITY

Failure of thyroid U.S.P. treated patients to show
clinical improvement and/or lack of correlation in
clinical findings to thyroid function test results has
been frequently discussed in the literature.8- 9 n-

12, 13. 14. 15, 16 Regardless of which factor or factors
accounts for this phenomenon the fact remains that
discrepancies do occur.

Test results predictably elevated. “. . . oral potency
of this material is attested to by a uniformly good
clinical response corroborated by a prompt and
sustained increase in the serum PBI levels.”!6

. Mangieri, C. N. and Lund, M. H.: Potency of United States Pharmacopeia
desiccated thyroid tablets as determined by the antigoitrogenic assay in
rats, J. Clin. Endocrinol. Metab., 30: 102-4, 1970.

. Lavietes, P. H. and Epstein, F. H.: Thyroid therapy of myxedema: a
comparison of various agents with a note on the composition of thyroid
secretion in man, Ann. Intern. Med., 60:79-87, 1964.

. Armour Pharmaceutical Company— discussing Armour Thyroid, PROLOID,
other generics. Literature No. 21329 — 274— YZ— 1— IM 2/71.

Abelson, D. M.: Hypothyroidism, Med. Sci., 70:442-8, 1961.

McGregor, A. G.: Why does anybody use thyroid B. P.?. Lancet, 1:

329-32, 1961.

. Hart, F. D. and Maclagen, N, F.: Oral thyroxine in treatment of
myxedema, Brit. Med. J., 7: 512-8, 1950.

. Goodman, L. S. and Gilman, A.: The Pharmacological Basis of
Therapeutics. 4th Ed. p. 1479, New York: Macmillan, 1970.

Harrison, T. R., et al .: Principles of Internal Medicine, 6th ed. p. 456.
Philadelphia: Blakiston, 1970.

9. Braverman, L. E. and Ingbar, S. H.: Anomalous effects of certain
preparations of desiccated thyroid on serum protein-bound iodine,

New Eng. J. Med., 270: 439-42, 1964.

10. Green, W. L.: Guidelines for the treatment of myxedema. Med. Clin.

N. Amer.. 52:432-50, 1968.

11. Dowling, J. T.: Hypothyroidism in Current Therapy, Conn. H. F., ed.
pp. 345-7. Philadelphia: Saunders, 1964.

12. Dunn. J. T.: Excessive dose of thyroid medication in hypothyroidism,

J. Am. Med. Assn., 276:152, 1971.

13 Runyan, J. W.: Hypothyroidism and myxedema, J. Tenn. State Med.
Assn., 56:391-4, 1963.

14. Albright, E. C.: Use and abuse of thyroid hormones, comments on
treatment, Marquette University, Milwaukee, Wise.

15. Catz, B.: Ginsburg, E. and Salenger, S.: Clinically inactive thyroid
U.S.P.: a preliminary report, New Eng. J. Med., 266:136-7, 1962.

16. Bartuska, D. G.,et al.: Desiccated thyroid U.S.P. or sodium l-thyroxine?,
J. Amer. Med. Women's Assn., 27:137-9, 1966.

See next pages for prescribing information.

PATIENTS CAN BE
SUCCESSFULLY
MAINTAINED ON A
DRUG CONTAINING
THYROXINE ALONE.

CONSIDERATE
LONG-TERM THERAPY
FOR THE PATIENT.

Thyroxine (T4) is, as you know,
the major circulating hormone
produced by the thyroid gland.

T3 is also produced, in smaller
amounts, and is active at the
cellular level. For years it has been
a working hypothesis among
endocrinologists that T4 is
converted by the body to T3. In
1970 this process, called
“deiodination,” was demonstrated
by Braverman, Ingbar, and Sterling2.
T4 does convert to T3, though the
precise quantities are still being
studied.

The conversion has been
clinically demonstrated during the
administration of T4 to athyrotic
patients. Their thyroid status is
normalized on SYNTHROID alone,
yet the presence of T3 in these
patients has been clearly shown.

Predictable patient response, of
course, is more important than
price. You do get complete clinical
response with the single-entity
synthetic, SYNTHROID. And, at a
reasonable cost to the patient.

In some short term situations, T3
drugs can be useful but, in long
term therapy, the smooth road
provided by SYNTHROID may be
the better route.

SYNTHROID, with its smooth
road to complete thyroid
replacement therapy, has been
selected for more patients in the
United States and Canada than any
other brand of thyroid medication.

2. Braverman, L. E., Ingbar, S. H., and

Sterling, K.: Conversion of Thyroxine (T4) to
Triiodothyronine (T3) in Athyreotic Human
Subjects, J. Clin. Invest. 49:855-64, 1970.

AS WITH ANY
THYROID
PREPARATION,
CAUTIOUS
OBSERVATION OF TH
PATIENT DURING TH
BEGINNING OF
THERAPY WILL ALER
THE PHYSICIAN TO
ANY UNTOWARD
EFFECTS.

t'Hiyi

12.5

Side effects, when they do occi
are related to excessive dosage
Caution should be exercised in
administering the drug to patien
with cardiovascular disease. Re
the accompanying prescribing
information for additional data
write Flint Laboratories.

Qtfoose

tt\e Smootii

R°ai ... to tfiyroid replacement tljerapy '

FREE TAB-MINDER medicati
dispensers— color-coded in 4 d(
age strengths— get patients off
a good start and encourage r<
ular habit patterns. Contain fi
4-weeks’ supply of SYNTHRO
and are reusable for maintenan
dosage.

0.2 mg.

APPROXIMATE DOSAGE EQUIVALENTS*

Animal Gland

CYTOMEL

(Sodium liothyronine)
Synthetic T3

EUTHROID**
(Liotrix)
Synthetic T3-T4

THYROLAR***
(Liotrix)
Synthetic T3-T4

Desiccated
(Thyroid, USP)
Cow, sheep or hog
thyroid

PROLOID
(thyroglobulin)
Frozen hog thyroid

SYNTHROID
(Sodium levothyroxine)
Synthetic T4

Unscored 5 meg.

N.A.

N.A.

unscored !4 gr.

Va gr.

0.025 mg.

N.A.

1/2

y2

unscored % gr.

y2 gr.

0.05 mg.

25 meg.

1

1

unscored 1 gr.

1 gr.

0.1 mg.

N.A.

N.A.

N.A.

N.A.

iy2 gr.

0.15 mg.

50 meg.

2

2

unscored 2 gr.

, 2 gr.

0.2 mg.

N.A.

3

3

unscored 3 gr.

3 gr.

0.3 mg.

N.A.

N.A.

N.A.

unscored 5 gr.

5 gr.

0.5 mg.

N.A.

N.A.

N.A.

N.A.

N.A.

Injectable 500 meg.

N.A.= Not Available Commercially

r Equivalents shown are chemical, and do not take into
consideration individual patient variables. Clinical
effect is approximate and should be monitored when
converting a patient to SYNTHROID. This is particu-
larly important in patients previously on desiccated
thyroid. In these patients, lower doses of
SYNTHROID may produce the same metabolic effect.
**Euthroid (#1 tablet) contains 60 meg. of T4 and
15 meg. of T3.

**Thyrolar (#1 tablet) contains 50 meg. of T4 and
12.5 meg. of T3.

Synthroid

(sodium levothyroxine)

Indications; SYNTHROID (sodium levothyroxine) is specific replacement therapy for diminished or
absent thyroid function resulting from primary or secondary atrophy of the gland, congenital de-
fect, surgery, excessive radiation, or antithyroid drugs. Indications for SYNTHROID (sodium levo-
thyroxine) Tablets include myxedema, hypothyroidism without myxedema, hypothyroidism in preg-
nancy, pediatric and geriatric hypothyroidism, hypopituitary hypothyroidism, simple (nontoxic)
goiter, and reproductive disorders associated with hypothyroidism. SYNTHROID (sodium levo-
thyroxine) for Injection is indicated for intravenous use in myxedematous coma and other thyroid
dysfunctions where rapid replacement of the hormone is required. The injection is also indicated
for intramuscular use in cases where the oral route is suspect or contraindicated due to existing
conditions or to absorption defects, and when a rapid onset of effect is not desired.

Precautions: As with other thyroid preparations, an overdosage may cause diarrhea or cramps,
nervousness, tremors, tachycardia, vomiting and continued weight loss. These effects may begin
after four or five days or may not become apparent for one to three weeks. Patients receiving the
drug should be observed closely for signs of thyrotoxicosis. If indications of overdosage appear,
discontinue medication for 2-6 days, then resume at a lower dosage level. In patients with diabetes
mellitus, careful observations should be made for changes in insulin or other antidiabetic drug
dosage requirements. If hypothyroidism is accompanied by adrenal insufficiency, as Addison’s Dis-
ease (chronic subcortical insufficiency), Simmonds’s Disease (panhypopituitarism) or Cushing’s
syndrome (hyperadrenalism), these dysfunctions must be corrected prior to and during SYNTHROID
(sodium levothyroxine) administration. The drug should be administered with caution to patients
with cardiovascular disease; development of chest pains or other aggravations of cardiovascular
disease requires a reduction in dosage.

Contraindications: Thyrotoxicosis, acute myocardial infarction. Side effects: The effects of SYN-
THROID (sodium levothyroxine) therapy are slow in being manifested. Side effects, when they do
occur, are secondary to increased rates of body metabolism; sweating, heart palpitations with or
without pain, leg cramps, and weight loss. Diarrhea, vomiting, and nervousness have also been
observed. Myxedematous patients with heart disease have died from abrupt increases in dosage of
thyroid drugs. Careful observation of the patient during the beginning of any thyroid therapy will
alert the physician to any untoward effects.

In most cases with side effects, a reduction of dosage followed by a more gradual adjustment
upward will result in a more accurate indication of the patient’s dosage requirements without the
appearance of side effects.

Dosage and Administration: The activity of a 0.1 mg. SYNTHROID (sodium levothyroxine) TABLET
is equivalent to approximately one grain thyroid, U.S.P. Administer SYNTHROID tablets as a single
daily dose, preferably after breakfast. In hypothyroidism without myxedema, the usual initial adult
dose is 0.1 mg. daily, and may be increased by 0.1 mg. every 30 days until proper metabolic bal-
ance is attained. Clinical evaluation should be made monthly and PBI measurements about every
90 days. Final maintenance dosage will usually range from 0.2-0.4 mg. daily. In adult myxedema,
starting dose should be 0.025 mg. daily. The dose may be increased to 0.05 mg. after two weeks
and to 0.1 mg. at the end of a second two weeks. The daily dose may be further increased at two-
month intervals by 0.1 mg. until the optimum maintenance dose is reached (0.1-1.0 mg. daily).
Supplied: Tablets: 0.025 mg., 0.05 mg., 0.1 mg., 0.15 mg., 0.2 mg., 0.3 mg., 0.5 mg., scored and
color-coded, in bottles of 100, 500, and 1000. Injection: 500 meg. lyophilized active ingredient
and 10 mg. of Mannitol, N.F., in 10 ml. single-dose vial, with 5 ml. vial of Sodium Chloride Injec-
tion, U.S.P., as a diluent. SYNTHROID (sodium levothyroxine) for Injection may be administered
intravenously utilizing 200-400 meg. of a solution containing 100 meg. per ml. If significant im-
provement is not shown the following day, a repeat injection of 100-200 meg. may be given.

THE FACTS ARE
CLEAR AND HERE
IS OUR OFFER.

Synthetic thyroid drugs are an
improvement over animal gland
products. Patients, even athyrotic
ones, can be completely
maintained on SYNTHROID (T4)
alone. Thyroid function tests are
easy to interpret since they are
predictably elevated when the
patient adheres to SYNTHROID.
Of all synthetic thyroid drugs,
SYNTHROID is the most
economical to the patient.

FUNT LABORATORIES

DIVISION OF TRAVENOL LABORATORIES. INC
Morton Grove, Illinois 60053

I 1

OFFER:

Free TAB-MINDER medication
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£MSmS ill actio il

‘ Dear staff,

I would like to be
an anaestheologisb ’

By Judith Marr
Managing Editor

The MSMS staff would find life a dull business
without the interesting (and often amusing) re-
quests for information regularly directed its way.

The MSMS Departments of Communications,
Economics and Governmental Affairs are the re-
cipients of many earnest, amusing, sometimes mis-
guided, and often misspelled, queries for informa-
tion. The writers range from elementary school
students to doctoral candidates.

Persons often write for “everything you have” on
cancer, drug abuse, heart disease, and even more
impossible, the entire field of medicine.

“Dear staff,” wrote a Lansing-area sixth grader.

“I am thinking about my career. I would like to be
an anaestheologish (forgive my spelling). It sounds
like fun work and I would like to be one.”

Not all the chuckles come from children.

One secretary, responding to an MSMS request
for materials, replied, “We are not quite sure what
you need, but we hope you can gleem the neces-
sary info from this letter.”

Amid the hundreds of requests for materials on
physician assistants, the SAMA-MECO project, the
numbers of physicians needed in Michigan, the
MSMS doctor-of-the-week project and the status
of proposed medical legislation, there come re-
quests like the one from the new mother of a
three-week-old baby who wanted to know what
products contain hexachloraphene and whether she
should avoid using them for her baby.

Imagine the consternation of non-medically-
trained staff members when a mother-to-be asks
about the technique of amniocentesis, a gentleman
calls wondering why he can’t use Compound W on
his warts if he’s a diabetic or suffers from impaired
circulation; still another woman wants to know if
she can get a license to pierce ears in Michigan.

And then there was the woman who had in mind
the birth control pill when she asked about the
AMA pamphlet “The Pill that Could Change Amer-
ica.”

The MSMS staff does not know quite why, but
another day it received a letter from a young girl
student — Joyce — in Chicago, asking, “Could you
please send me some information on different types
of bones and their structions — like bones of ani-
mals, humans, plants.”

MSMS PG series
suspended this spring

Plans for the 1972 MSMS spring and fall post-
graduate meeting series have been suspended
until more is known from Phase II of the Alexander
Grant Company study of membership attitudes to-
ward state society PG programs.

Phase II, not yet published, contains data on
Michigan physicians’ attitudes toward state society
PG programs. The data have been turned over
tentatively to the MSMS Planning and Priorities
Committee, so that a firm policy can be establishd.

In the meantime, the MSMS Budget Committee
has approved the PG Committee’s request for funds
matching those allowed in 1971.

New Research Bulletin
published by MSMS Bureau

The MSMS Bureau of Economic Information has
created its own Research Bulletin, a two-page
newsletter which is mailed periodically to MSMS
delegates and Council members, to county medical
society presidents and secretaries, and to members
of the Council of Medical Specialties. The bulletin
reports data and recent findings from various
economic studies of interest to medicine, some of
them conducted by the Bureau itself.

232 MICHfGAN MEDICINE MARCH 1972

Try Eutrorron a stubborn diastolic

pargyline hydrochloride 25 mg. and methyclothiazide 5 mg.

When you’re not satisfied with your patient’s diastolic
“end point’’ under present treatment , consider a trial of Eutron.
It will often bring further reduction of blood pressure ,
even in severe diastolic hypertension .

Special Characteristics of Eutron :

Course of therapy usually is smooth, with
blood pressure reducing gradually over one to
three weeks.

Around-the-clock effect from a single daily dose.

Provides diuresis when edema accompanies
hypertension.

Free of central depressant action.

Lower doses of pargyline hydrochloride are
made possible because of the methyclothiazide
component.

TM— Trademark

Special Restrictions (see back of page) :

Tyramine-containing foods (e.g. aged cheese)
should be avoided. (For further listing of foods,
see back of page.)

If alcohol is used, it should be used cautiously
and in reduced amounts.

Patients should be warned against the concurrent
use of non-prescription medications (particularly
cold preparations and antihistamines), or
prescription drugs without physician’s consent.

Discontinue Eutron at least two weeks prior to
elective surgery.

Before prescribing Eutron, see prescribing
information in package insert. A brief
summary appears on next page. 201353

Brief Summary
EUTRON™

pargyline hydrochloride and methyclothiazide

Filmtab®

INDICATIONS. EUTRON (pargyline hydrochloride and methyclothiazide) is indicated in the
treatment of patients with moderate to severe hypertension, especially those with severe
diastolic hypertension. It Is not recommended for use in patients with mild or labile hypertension
amenable to therapy w th sedatiues and/or thiazide diuretics alone.

Because of the potent diuretic properties of methyclothiazide, the combination is particularly
suited for use when congestive heart failure or other conditions requiring diuretic therapy
coexist with hypertension, or when edema attributable to antihypertensive therapy develops.

As discussed in regard to dosage and administration, it is desirable to establish the dosage
requirements for EUTRON by the administration of Eutonyl and Enduron separately.

CONTRAINDICATIONS. 1. Pargyline therapy is contraindicated in patients with pheo-
chromocytoma, paranoid schizophrenia, hyperthyroidism and advanced renal failure.

2. Pargyline should not be administered to those with malignant hypertension, or to children
under twelve years of age because significant clinical information concerning the use of the
drug in these conditions is not available.

3. In general, the following drugs or agents are contraindicated in patients receiving pargyline
hydrochloride:

a. Centrally acting sympathomimetic amines such as amphetamine and its derivatives (also
found in anorectic preparations).

Peripherally acting sympathomimetic drugs such as ephedrine and its derivatives (also
found in nasal decongestants, hay fever preparations and cold remedies).

b. Aged and natural cheese (e g., Cheddar, Camembert, and Stilton), and other foods (e g.,
pickled herring, Chianti wine, pods of broad beans, chicken livers, chocolate and yeast
products), which require the action of bacteria or molds for their preparation or preserva-
tion, because of the presence of pressor substances such as tyramine Banana peels are
also contraindicated. Cream cheese, processed cheese, and cottage cheese can be allowed
in the diet during EUTRON therapy, since their tyramine content is inconsequential.

In some patients receiving EUTRON, tyramine may precipitate an abrupt rise in blood
pressure accompanied by some or all of the following: severe headache, chest pain, profuse
sweating, palpitation, tachycardia or bradycardia, visual disturbances, stertorous breath-
ing, coma, and intracranial bleeding (which could be fatal). A phenothiazine derivative or
phentolamine may be administered parenterally for treatment of such an acute hyper-
tensive reaction.

c. Parenteral administration of reserpine or guanethidme may cause hypertensive reactions
from sudden release of catecholamines. Parenteral use of these drugs is contraindicated
during, and for at least one week following, treatment with EUTRON.

d. Imipramine, amitriptyline, desipramine, nortriptyline, or their analogues should not be
used with pargyline. The use of these drugs with monoamine oxidase inhibitors has been
reported to cause vascular collapse and hyperthermia which may be fatal. A drug-free
interval (about two weeks) should separate therapy with EUTRON and use of these agents.

e. Methyldopa or dopamine, which may cause hyperexcitability in patients receiving pargyline,
should not be given.

f. Other monoamine oxidase inhibitors should not be added to a EUTRON regimen since
they may augment the effects of pargyline.

4. Methyclothiazide is contraindicated in patients with a known sensitivity to methyclothiazide
and/or other thiazide diuretics. It should not be used in patients with severe renal disease
(except nephrosis) or complete renal shutdown. Thiazide diuretics should not be used in the
presence of severe liver disease and/or impending hepatic coma. Hepatic coma has been
reported as a consequence of hypokalemia in patients receiving thiazide diuretics.

WARNINGS

A PATIENTS

1. PATIENTS SHOULD BE WARNED AGAINST THE USE OF ANY OVER-THE-COUNTER
PREPARATIONS, PARTICULARLY "COLD PREPARATIONS" AND ANTIHISTAMINES
OR PRESCRIPTION DRUGS WITHOUT THE KNOWLEDGE AND CONSENT OF THE
PHYSICIAN.

2. PATIENTS SHOULD BE CAUTIONED ON THE USE OF CHEESE (SEE CONTRAINDICA-
TIONS) AND ALCOHOLIC BEVERAGES IN ANY FORM,

3. PATIENTS SHOULD BE WARNED ABOUT THE LIKELIHOOD OF THE OCCURRENCE OF
ORTHOSTATIC HYPOTENSION.

4 PATIENTS SHOULD BE INSTRUCTED TO REPORT PROMPTLY THE OCCURRENCE OF
SEVERE HEADACHE OR OTHER UNUSUAL SYMPTOMS.

5. PATIENTS WITH ANGINA PECTORIS OR CORONARY ARTERY DISEASE SHOULD
BE ESPECIALLY WARNED NOT TO INCREASE THEIR PHYSICAL ACTIVITIES IN
RESPONSE TO A DIMINUTION IN ANGINAL SYMPTOMS OR AN INCREASE IN WELL-
BEING OCCURRING DURING TREATMENT WITH EUTRON.

B. PHYSICIANS

1. WHEN INDICATED THE FOLLOWING SHOULD BE CAUTIOUSLY PRESCRIBED IN
REDUCED DOSAGES:

a. ANTIHISTAMINES

b. HYPNOTICS, SEDATIVES OR TRANQUILIZERS

c. NARCOTICS (MEPERIDINE SHOULD NOT BE USED)

2. DISCONTINUE EUTRON AT LEAST TWO WEEKS PRIOR TO ELECTIVE SURGERY.

3. IN EMERGENCY SURGERY THE DOSE OF NARCOTICS OR OTHER PREMEDICATIONS
SHOULD BE REDUCED TO 1/4 TO 1/5 THE USUAL AMOUNT. CLINICAL EXPERIENCE
HAS SHOWN THAT RESPONSE TO ALL ANESTHETIC AGENTS CAN BE EXAGGERATED
IN PATIENTS RECEIVING EUTRON THEREFORE THE DOSE OF THE ANESTHETIC
SHOULD BE CAREFULLY ADJUSTED.

4. PARGYLINE HYDROCHLORIDE MAY INDUCE HYPOGLYCEMIA.

5. CARE SHOULD BE EXERCISED IN USING EUTRON IN PATIENTS WITH ADVANCED

RENAL FAILURE.

The possibility of sensitivity reactions to methyclothiazide or pargyline should be considered
in patients with a history of allergy or bronchial asthma.

There have been several reports published and unpublished, concerning nonspecific small
bowel lesions consisting of stenosis with or without ulceration, associated with the administra-
tion of enteric-coated thiazides with potassium salts. These lesions may occur with enteric-
coated potassium tablets alone or when they are used with nonenteric-coated thiazides, or
certain other oral diuretics.

These small bowel lesions have caused obstruction, hemorrhage and perforation. Surgery
was frequently required and deaths have occurred.

Available information tends to implicate enteric-coated potassium salts although lesions
of this type also occur spontaneously. Therefore, coated potassium-containing formulations
should be administered only when adequate dietary supplementation is not practical, and
should be discontinued immediately if abdominal pain, distention, nausea vomiting or gas-
trointestinal b'eeding occurs.

The possibility of exacerbation or activah i ; ystemic lupus erythematosus has been
reported for sulfonamide derivatives, including thiazides.

EUTRON does not contain added potassium.

USE IN PREGNANCY

Pargyline Hydrochloride. Safe use of pargyline during pregnancy or lactation has not yet
been established. Before prescribing pargyline in pregnancy, in lactation, or in women of
childbearing age, the potential benefits of the drug should be weighed against its possible
hazard to mother and child.

Methyclothiazide. Thiazides should be used with caution in pregnant women and nursing
mothers since they cross the placental barrier and appear in cord blood and in breast milk.
The use of thiazides may result in fetal or neonatal jaundice, bone marrow depression and
thrombocytopenia, altered carbohydrate metabolism in newborn infants of mothers showing
decreased glucose tolerance, and possible other adverse reactions which have occurred in
the adult. When the drug is used in women of childbearing age, the potential benefits of the
drug should be weighed against the possible hazards to the fetus.

PRECAUTIONS

Pargyline Hydrochloride. The therapeutic response to a variety of drugs may be changed,
or exaggerated, in patients receiving a monoamine oxidase inhibitor such as pargyline hydro-
chloride. Caffeine, alcohol, antihistamines, barbiturates, chloral hydrate, and other hypnotics,
sedatives, tranquilizers and narcotics (meperidine should not be used), should be used
cautiously and at reduced dosage in patients who are taking pargyline.

Pargyline has not been shown to damage the kidney or liver. However, laboratory studies
including complete blood counts, urinalyses, and liver function tests should be performed
periodically. The drug should be used with caution in the presence of liver disease. All patients
with impaired circulation to vital organs from any cause including those with angina pectoris,
coronary artery disease, and cerebral arteriosclerosis should be closely observed for symptoms
of orthostatic hypotension. If hypotension develops in these patients, EUTRON dosage should
be reduced or therapy discontinued since severe and/or prolonged hypotension may precipitate
cerebral or coronary vessel thromboses.

The hypotensive effect of pargyline may be augmented by febrile illnesses. It may be advisa-
ble to withdraw the drug during such diseases.

Since pargyline is excreted primarily in the urine, patients with impaired renal function
may experience cumulative drug effects. Such patients should also be watched for elevations
of blood urea nitrogen and other evidence of progressive renal failure. If such alterations
should persist and progress, the drug should be discontinued.

An increased response to central depressants may be manifested by acute hypotension
and increased sedative effect. Pargyline also may augment the hypotensive effects of anesthetic
agents and surgery. For this reason, the drug should be discontinued from at least two weeks
prior to surgery.

In the event of emergency surgery smaller than usual doses (1/4 to 1/5) of narcotics,
analgesics, sedatives, and other premedications should be used. If severe hypotension should
occur, this can be controlled by small doses of a vasopressor agent such as levarterenol.

Pargyline therapy should not be used in individuals with hyperactive or hyperexcitable
personalities, as some of these patients show an undesirable increase in motor activity with
restlessness, confusion, agitation and disorientation. Clinical studies have shown that par-
gyline may unmask severe psychotic symptoms such as hallucinations or paranoid delusions
in some patients with pre-existing serious emotional problems. This can usually be controlled
by judicious administration of chlorpromazine intramuscularly, or other phenothiazines, the
patient remaining supine for one hour after administration.

Pargyline should be used with caution in patients with Parkinsonism, as it may increase
symptoms. In addition, great care is required if pargyline is administered in conjunction with
anti parkinsonian agents.

In experience to date, pargyline has not been associated with eye changes or optic atrophy
as reported with the use of some hydrazine monoamine oxidase inhibitors. However, patients
receiving this drug for prolonged periods should be examined for any changes in color per-
ception, visual fields, fundi, and visual acuity.

Clinical reports state that certain individuals receiving pargyline for a prolonged period of
time are refractory to the nerve-blocking effects of local anesthetics, e.g., lidocaine.
Methyclothiazide. Thiazide therapy should be used with caution in patients with severely
impaired renal function because of the possibility of cumulative effects. Caution is also nec-
essary in patients with severely impaired hepatic function or progressive liver disease.

Thiazide drugs may reduce response to levarterenol. Accordingly, the dosage of vasopressor
agents may need to be modified in surgical patients who have been receiving thiazide therapy.

Thiazide drugs may increase the responsiveness to tubocurarine.

The antihypertensive effect of the drug may be enhanced in the svmpathectomized patient.

All patients should be observed for clinical signs of fluid or electrolyte imbalance, including
hyponatremia ("low-salt” syndrome). These include thirst, dryness of the mouth, lethargy
and drowsiness.

Hypokalemia may occur during therapy with methyclothiazide. In such cases supplemental
potassium may be indicated. Potassium depletion can be hazardous in patients taking digitalis.
Myocardial sensitivity to digitalis is increased in the presence of reduced serum potassium
and signs of digitalis intoxication may be produced by formerly tolerated doses of digitalis.
Hypochloremic alkalosis may occur following intensive or prolonged thiazide therapy. Re-
placement of chloride may be indicated in such cases.

Thiazides may decrease serum P B I . levels without signs of thyroid disturbance.
ADVERSE REACTIONS. Generally side effects should not be severe or serious when the
recommended dosages are used, and necessary precautions are observed. If side effects
are severe or persist in spite of symptomatic treatment, the dosage should be reduced or the
drug withdrawn. See also Warnings and Precautions.

Pargyline Hydrochloride. The most frequently occurring side effects are those associated
with orthostatic hypotension (dizziness, weakness, palpitation, or fainting). These usually
respond to a reduction of dosage Patients should be warned against rising to a standing
position too quickly, especially when getting out of bed. Severe and persistent orthostatic
hypotension should be avoided by reduction in dosage and/or discontinuation of therapy.

Mild constipation, fluid retention with or without edema, dry mouth, sweating, increased
appetite, arthralgia, nausea and vomiting, headache, insomnia, difficulty in micturition, night-
mares, impotence and delayed ejaculation, rash and purpura, have also been encountered.
Hyperexcitability, increased neuromuscular activity (muscle twitching) and other extra-pyra-
midal symptoms have been reported. Gain in weight may be due either to edema or increased
appetite. Drug fever is extremely rare. In some patients reduction of blood sugar has been
noted. Although the significance of this has not been elucidated, the possibility of hypo-
glycemic effects should be borne in mind. Congestive heart failure has been reported in patients
with reduced cardiac reserve.

Methyclothiazide. Side effects that may accompany thiazide therapy include anorexia,
nausea, vomiting, diarrhea, headache, dizziness, paresthesias, weakness, skin rash, photo-
sensitivity. Jaundice and pancreatitis also have been reported.

Blood dyscrasias, including thrombocytopenia with purpura, agranulocytosis and aplast'C
anemia, have been reported with thiazide drugs.

Thiazides have been reported, on rare occasions, to have elevated serum calcium to hyper-
calcemic levels. The serum calcium levels have returned to normal when the medication has
been stopped. This phenomenon may be related to the ability of the thiazide diuretics to
lower the amount of calcium excreted in the urine

Elevations of blood urea nitrogen, serum uric acid, and blood sugar have occurred with the
use of thiazide drugs. Symptomatic gout may be induced.

Although not established as an adverseeffect of methyclothiazide, it has been reported that
thiazide diuretics may produce a cutaneous vasculitis in elderly patients.

^FILMTAB— Film-sealed tablets, Abbott. TM— Trademark

204364

Here are the answers
to your questions about

MSMS foundations

By Robert C. Prophater, MD
Chairman, MSMS Committee
on Utilization Review
and Health Insurance Problems

As recommended by the House of Delegates The
Council through its Committee on Utilization Re-
view and Health Insurance Problems has- revised
the Articles of Incorporation and Bylaws for the
proposed MSMS Foundation.

The Council will present draft number 7 of these
documents to the House of Delegates for approval
at the Spring Meeting (March 20-21, 1972) at the
Detroit Hilton Hotel.

Presented below are answers to the most fre-
quent questions raised by delegates concerning the
need for a foundation.

1. What is a Foundation?

The word “Foundation” has no universally ac-
cepted definition and their purposes, structures,
etc. vary. Generally a “Foundation for Medical
Care” is a separate corporation sponsored by a
state or county medical society. Some founda-
tions offer peer review services to insurance
carriers and governmental agencies and are
usually referred to as the “Hennepin” or “Mis-
souri” type. Others also perform claims process-
ing and pay claims, and are referred to as the
“San Joaquin” or “California” type.

2. What type of “Foundation" is being proposed
for MSMS?

The primary function of the proposed MSMS
Foundation will be peer review and it will not
operate as an insurance carrier nor will it proc-
cess claims. It is closely modeled after the
Health Care Foundation of Missouri, which is

Harry Schwartz
tells of foundations

“The fastest growing innovation in American
medicine today is the medical foundation,” Harry
Schwartz writes in the New York Times. Accord-
ing to Schwartz, before the 1970’s are ended
millions of Americans will look to such organiza-
tions— “essentially a loose form of group practice”
— for their medical care. About 50 foundations are
now functioning or being formed, a number that is
expected to rise to 200 a year from now.

controlled jointly by the governing boards of
both the Missouri State Medical Association and
the Missouri Association of Osteopathic Physi-
cians and Surgeons. The Michigan Foundation’s
corporate body and board of Trustees will be
composed of both MDs and DOs on a basis pro-
portionate to each group’s percentage of total
physicians in the state.

3. Why should the Michigan State Medical So-
ciety join with the Michigan Association of
Osteopathic Physicians and Surgeons, Inc. in
forming a Foundation?

All of the proposals before Congress which
deal with the provision and financing of health
care contain provisions for cost and quality con-
trol of health care services through peer review.
Senator Bennett has offered an amendment to
H.R. 1, the Social Security Amendments of 1971,
requiring the establishment of professional stand-
ards review organizations throughout the United
States. Under the amendment, membership of
the qualifying organization must be voluntary and
open to all doctors of medicine or osteopathy
licensed to engage in the practice of medicine
or surgery in the area without requirement of
membership in or payment of dues to any or-
ganized medical society or association. As a
further condition, the qualifying organization may
not restrict the eligibility of any member for
services as an officer of the PSRO or eligibility
for an assignment to duties of such PSRO.

Review activity of the organization would en-
compass the use of provider, patient and practi-
tioner profiles and regional norms as review
checkpoints. The PSRO would be responsible for
determining whether: (1) health care services
were medically necessary; (2) whether the qual-
ity of services meets professionally recognized
standards; and (3) whether the proposed hospital
or other health care facility services could, con-
sistent with the provision of appropriate medical
care, be provided more economically on an out-
patient basis or in a different type of inpatient
facility.

4. Why is it necessary for MSMS to form a
Foundation to do peer review when MSMS
already has a peer review program in exist-
ence?

The proposed MSMS Foundation will have the
added capacity to contract with insurance car-
riers and governmental agencies. Moneys re-
ceived can be used to compensate physicians
and to hire necessary staff without jeopardizing
the Michigan State Medical Society’s tax-exempt
status. The New Mexico Foundation is now do-
ing peer review for the State of New Mexico’s
Medicaid program, and the Florida Foundation
has signed an agreement to provide peer review
services for Blue Shield of Florida, Inc. Both
Michigan Blue Shield and the Michigan De-
partment of Social Services have indicated ver-
bally a willingness to discuss the possibilities
(Continued on page 240)

MICHIGAN MEDICINE MARCH 1972 235

In acute gonorrhea

(urethritis, cervicitis, proctitis when due
to susceptible strains of N. gonorrhoeae)

Sterile Trobicin®

(spectinomycin dihydrochloride pentahydrate)— For Intramuscu-
lar injections, 2 gm vials containing 5 ml when reconstituted
with diluent. 4 gm vials containing 10 ml when reconstituted with
diluent.

An aminocyclitol antibiotic active in vitro against most strains of
Neisseria gonorrhoeae (MIC 7.5 to 20 mcg/ml). Definitive in vitro
studies have shown no cross resistance of N. gonorrhoeae be-
tween Trobicin and penicillin.

indications: Acute gonorrheal urethritis and proctitis in the male
and acute gonorrheal cervicitis and proctitis in the female when
due to susceptible strains of N. gonorrhoeae.

Contraindications: Contraindicated in patients previously
found hypersensitive to Trobicin. Not indicated for the treatment

of Syphilis. ®i972 The Upjohn Company

Warnings: Antibiotics used to treat gonorrhea may mask or
delay the symptoms of incubating syphilis. Patients should be
carefully examined and monthly serological follow-up for at
least 3 months should be instituted if the diagnosis of syphilis is
suspected.

Safety for use in infants, children and pregnant women has not
been established.

Precautions: The usual precautions should be observed with
atopic individuals. Clinical effectiveness should be monitored to
detect evidence of development of resistance of N. gonorrhoeae.

Adverse reactions: The following reactions were observed
during the single-dose clinical trials: soreness at the injection site,
urticaria, dizziness, nausea, chills, fever and insomnia.

During multiple-dose subchronic tolerance studies in normal
human volunteers, the following were noted: a decrease in hemo-

236 MICHIGAN MEDICINE MARCH 1972

Trobicin

sterile spectinomycin dihydrochloride
penta hydrate, Upjohn

single-ac muscular treatment

High cure rate:* 96% of 571 males, 95% of 294 females

Dosages, sites of infection, and criteria for diagnosis and cure are defined below.)**

Assurance of a single-dose, physician-controlled treatment schedule

No allergic reactions occurred in patients with an alleged history of penicillin sensitivity
when treated with Trobicin, although penicillin antibody studies were not performed

Active against most strains of Neisseria gonorrhoeae in vitro (M I C. 75 20 mcg/ml)

A single two-gram injection produces peak serum concentrations averaging about
100 mcg/ml in one hour (average serum concentrations of 15 mcg/ml present 8 hours after dosing)

Note: Antibiotics used in high doses for short periods of time to treat gonorrhea may mask or delay the
symptoms of incubating syphilis. Since the treatment of syphilis demands prolonged therapy with any
effective antibiotic, and since Trobicin is not indicated in the treatment of syphilis, patients being treated for
gonorrhea should be closely observed clinically. Monthly serological follow-up for at least 3 months should
be instituted if the diagnosis of syphilis is suspected. Trobicin is contraindicated in patients previously found
hypersensitive to it.

Data compiled from reports of 14 investigators. **Diagnosis was confirmed by cultural identitication of N. gonorrhoeae on Thayer-
Martin media in all patients. Criteria for cure: negative culture after at least 2 days post-treatment in males and at least 7 days post-
treatment in females. Any positive culture obtained post-treatment was considered evidence of treatment failure even though the
follow-up period might have been less than the periods cited above under “criteria for cure" except when the investigator determined
that reinfection through additional sexual contacts was likely. Such cases were judged to be reinfections rather than relapses or
failures. These cases were regarded as non-evaluafab!e and were not included. JA72 1B48'6

globin, hematocrit and creatinine clearance; elevation of alka-
line phosphatase, BUN and SGPT. In single and multiple-dose
studies in normal volunteers, a reduction in urine output was
noted. Extensive renal function studies demonstrated no con-
sistent changes indicative of renal toxicity.

Dosage and administration: Keep at 25°C and use within
24 hours after reconstitution with diluent.

Male- single 2 gram dose (5 ml) intramuscularly. Patients with
gonorrheal proctitis and patients being re-treated after failure
of previous antibiotic therapy should receive 4 grams (10 ml). In
geographic areas where antibiotic resistance is known to be pre-
valent, initial treatment with 4 grams (10 ml) intramuscularly is
preferred.

Female — single 4 gram dose (10 ml) intramuscularly.

How supplied: Vials, 2 and 4 grams — with ampoule of Bacterio-

satic Water for Injection with Benzyl Alcohol 0.9% w/v. Recon-
stitution yields 5 and 10 ml respectively with a concentration of
spectinomycin dihydrochloride pentahydrate equivalent to 400
mg spectinomycin per ml. For intramuscular use only.
Susceptibility Powder — for testing in vitro susceptibility of N.
gonorrhoeae.

Human pharmacology: Rapidly absorbed after intramuscular
injection. A two-gram injection produces peak serum concentra-
tions averaging about 100 mcg/ml at one hour with 15 mcg/ml
at 8 hours. A four-gram injection produces peak serum concen-
trations averaging 160 mcg/ml at two hours with 31 mcg/ml at
8 hours.

For additional product information, see your Upjohn representa-
tive or consult the package insert. med-b-i-s (lwbi

Upjohn

The Upjohn Company, Kalamazoo, Michigan 49001

MICHIGAN MEDICINE MARCH 1972 237

(fMicliigaii medisceqe

March 12 — Michigan Academy of Family Physicians,
board meeting, MSMS Headquarters, contact:
Louis R. Zako, MD, MAFP president, 7720 Allen
Road, Allen Park, 48101

March 15-17 — "Three days of electrocardiography
for physicians,” Towsley Center, U-M, sponsored
by U-M Department of Postgraduate Medicine,
contact: Chairman, Department of Postgraduate
Medicine, Towsley Center, Ann Arbor, 48104

March 19 — The Council, Sheraton Cadillac Hotel,
Detroit, contact: Warren F. Tryloff, MSMS Head-
quarters

March 20-21 — Spring Session, MSMS House of
Delegates, Detroit Hilton Hotel, contact: Richard
Campau, MSMS Headquarters

March 22 — Symposium on Approaching Death, Mich-
igan Cancer Foundation, 7 p.m., Regina High
School Auditorium, 20200 Kelly Road, Harper
Woods, contact: Miss Joan H. Kolodziej, Public
Information Director, MCF, 4811 John R Street,
Detroit, 48201

March 26 — Michigan State Medical Assistants So-
ciety, board meeting, 11 a.m., MSMS Head-

quarters, contact: Mrs. Betty L. Boers, president,
MSMAS, 1116 Sheridan, Kalamazoo, 49001

March 29 — Muskegon Trauma Day, Holiday Inn,
Muskegon, contact: Guida Anessa, MD, 205 Med-
ical Center, Muskegon

March 29-30 — Annual Michigan Conference on Ma-
ternal and Perinatal Health, Olds Plaza Hotel,
Lansing, contact: Joseph L. Sheets, MD, 2909 E.
Grand River, Lansing, or Helen Schulte, MSMS
Headquarters

March 31-April 2 — American Association of Suicidol-
ogy, Detroit Hilton, contact: Bruce L. Danto, MD,
466 Fisher Bldg., Detroit, 48202

April 3 — Annual Beaumont Lecture — Wayne County
Medical Society, Detroit, contact: William Blod-
gett, MD, Wayne County Medical Society, 1010
Antietam, Detroit, 48207

April 5-8 — 49th Annual Meeting, American Ortho-
psychiatric Association, Cobo Hall, Detroit, con-
tact: Sylvia F. Gruggett, AOA, 1790 Broadway,
New York, N.Y., 10019

April 8 — Health Careers Day, Michigan State Uni-
versity, sponsored by MSU and Michigan Health
Council, contact: John A. Doherty, MHC, 712
Abbott, East Lansing, 48823

April 12 — Great Lakes Health Manpower Confer-
ence, Kellogg Center, East Lansing, contact: John
A. Doherty, executive vice president, Michigan
Health Council, 712 Abbott, East Lansing, 48823

April 13-15 — Michigan Heart Association Heart
Days, Cobo Hall, Detroit, contact: Harold Arnow,
publicity director, MHA, 13100 Puritan, Detroit,
48227

April 19 — Woman’s Auxiliary to MSMS, Legislative
Day, Olds Plaza, Lansing, contact: Mrs. R. J.
Westerhoff, 2458 Maplewood, SE, Grand Rapids,
49506

April 19-20 — Woman's Auxiliary to MSMS, spring
conference, Hospitality Inn, Lansing, contact:
Mrs. Charles Schoff, 5209 Sunset Drive, Midland,
48640

April 21 — Annual Conference on Medical Aspects of
Michigan High School Sports, University of Mich-
igan, contact: Herbert A. Auer, MSMS Headquar-
ters

April 23-26 — MSU College of Human Medicine
Workshop, “The Community: A Base for Under-
graduate Medical Education,” Park Place Motor
Inn, Traverse City, contact: Andrew D. Hunt, Jr.,
MD, Dean, College of Human Medicine, MSU,
East Lansing, 48823

April 26 — The Council, MSMS Headquarters, con-
tact: Warren F. Tryloff, Director, MSMS Head-
quarters, Box 950, East Lansing, 48823

April 27-30 — Annual Convention, American Associa-
tion of Medical Assistants, State of Michigan,
Holiday Inn, Crosstown Parkway, Kalamazoo,
contact: Mrs. Betty Boers, president, 1116 Sher-
idan, Kalamazoo, 49001

April 30-May 5 — American Nurses Association Bi-
ennial Convention, Cobo Hall, Detroit, contact:
Miss Virginia Stone, executive director, Detroit
district, Michigan Nurses Association, 396 Fisher
Building, Detroit, 48202

April 28-29 — Cancer symposium, Michigan Division,
American Cancer Society, and Wayne State Uni-
versity, “Early Carcinoma of the Breast,” at the
university, contact: Bob Hillcoat, University Rela-
tions, WSU, Detroit, 48202

May 10-12 — Annual meeting, Michigan Public
Health Association, Park Place Motor Inn,
Traverse City, contact: Ralph Lewis, Department
of Postgraduate Medicine, Towsley Center, The
University of Michigan, Ann Arbor, 48104

May 13 — 17th Annual all-day scientific meeting,
Michigan Society of Anesthesiologists, Sheraton-
Cadillac Hotel, Detroit, contact: Ralph E. Bauer,
MD, MSA secretary-treasurer, Henry Ford Hos-
pital, Detroit, 48202

May 18-19 — Annual Gull Lake meeting, MSMS Com-
mittee on Maternal and Perinatal Health, Kellogg
Biological Station, Gull Lake, contact: Helen
Schulte, MSMS Headquarters, Box 950, East Lan-
sing, 48823

May 18-19 — Fifteenth Annual Clinic Days, emphasis
“Team Medicine,” Children’s Hospital of Mich-
igan and Wayne State University School of Med-
icine, at the hospital, contact: Larry E. Fleisch-
mann, MD, chairman, 3901 Beaubien, Detroit,
48201

May 19-20 — 11th annual Kidney Disease Sympo-
sium, sponsored by Kidney Foundation of Mich-
igan, at Mercy College Conference Center, De-
troit, contact: Sidney Baskin, MD, chairman, 3378
Washtenaw Ave., Ann Arbor, 48104.

May 20-27 — Michigan Week

May 22-23 — Michigan chapter meeting and scien-
tific session, American College of Emergency
Physicians, Shanty Creek, Bellaire, contact: Gai-
us Clark, MD, 865 Pebblebrook Lane, East Lan-
sing, 48823

May 24-26 — Annual Medical Staff-Trustee-Adminis-
trator Forum, sponsored by Michigan Hospital

238 MICHIGAN MEDICINE MARCH 1972

Something new
inampicillin
therapy:

low cost

FOUNDATIONS/ Continued

10 MSMS members
now on RAG
of MARMP

Ten MSMS members are newly-elected to the
Regional Advisory Group, the 34-member policy-
making agency of the Michigan Association for
Regional Medical Programs (MARMP).

They include William G. Birch, MD, Kalamazoo;
John B. Bryan, MD, Royal Oak; William Chavis,
MD, Detroit; John Gronvall, MD, Ann Arbor; D.
Bonta Hiscoe, MD, Lansing; Andrew D. Hunt, Jr.,
MD, East Lansing; John C. Peirce, MD, Grand
Rapids; R. Gerald Rice, MD, Lansing, and Lewis
Simoni, MD, Flint.

of contracting for peer review services with a
MSMS sponsored Foundation.

5. How will the Michigan Foundation operate?

Article II, Sec. 4 b of the proposed Bylaws
describe the operation of the Foundation as fol-
lows:

Peer Review assignments and contracts ob-
tained by the corporation will be whenever
possible, delegated to and carried out at the
appropriate county or regional or local levels
by review panels of doctors locally so desig-
nated with such concerned specialist support
as the review may require. An appeal pro-
cedure will be established for the appeal
throughout all levels of the decisions, deter-
minations or rulings to the Peer Review Com-
mittee of the Board of Trustees. The corpora-
tion will retain administrative and fiscal
responsibility therefore and it will foster all peer
review work within the ethical concepts of the
American Medical Association and of the
American Osteopathic Association, and within
the Guidelines of the Michigan State Medical
Society and the Michigan Association of Os-
teopathic Physicians and Surgeons. Consistent
with that latter purpose, the corporation will
endeavor to promote uniformity of procedures
and guidelines for peer review procedures
within the State.

240 MICHIGAN MEDICINE MARCH 1972

Welcome

Members of the Michigan State Medical Society
join in welcoming the following new members into
a progressive state medical organization. MSMS is
dedicated to promoting the science and art of
medicine, the protection of the public health, and
the betterment of the medical profession. Each new
member is encouraged to join with other MSMS
members at both the local and the state levels in
achieving these goals.

Edward Alpert, MD, 2301 Huron Parkway, Ann
Arbor 48104

Jagdish B. Bhagat, MD, 6071 W. Knoll Drive, Flint
48705

E. R. Cleveland, MD, 1500 Weiss St., Saginaw
48602

Edward D. Coppola, MD, Dept, of Surgery — Mich.

State Univ., East Lansing 48823
Jack W. DeLong, MD, 144 W. 26th St., Holland
49423

K. C. Demetropoulos, MD, VA Hospital, Ann Arbor
48105

James A. Greene, MD, 1521 Gull Rd., Kalamazoo
49001

John R. Gruca, MD, 108 S. Christine Circle, Mt.
Clemens 48043

Owen G. Haig, MD, 1521 Gull Rd., Kalamazoo
49001

Fikria E. Hassan, MD, Mott Children’s Hlth. Center,
Flint 48503

Thelma M. Hernandez, MD, 18044 Edgefield Dr.,
Fraser 48026

Paul J. Hettle, MD, 2301 Center, Bay City 48706

David Katz, MD, 3001 Plymouth Rd., Ann Arbor
48105

Jerald B. Maltzman, MD, Sinai Hospital, Detroit
48235

Douglas McLearon, MD, 2149 W. Grand River,
Howell 48843

Lance E. Nelson, MD, 575 Robbins Rd., Grand
Haven 49417

Elizabeth L. Schmitt, MD, Mercy Hospital, Monroe
48161

Albert J. Silverman, MD, Univ. Medical Center,
Ann Arbor 48104

Martin I. Schock, MD, 26657 Woodward Ave.,
Huntington Woods 48070

Gloria M. Strutz, MD, 27827 Thirty Mile Rd., Rich-
mond 48062

Ralph Ten Have, Jr., MD, 425 Cherry St., S.E.,
Grand Rapids 49502

Richard S. Traul, MD, 216 Bronson Medical Ctr.,
Kalamazoo 49001

Carl Van Appledorn, MD, Dept, of Urology — Univ.
Medical Center, Ann Arbor 48104

The treatment of

impotence

\ due to androgenic deficiency in the American male.

The concept of chemotherapy plus the
Jhk Physician’s psychological support is confirmed
w wm as effective therapy.

Android

(thyroid-androgen) tablets

The Treatment of Impotence
with Methyltestosterone Thyroid
(100 patients — Double Blind Study)
T. Jakobovits

Fertility and Sterility, January 1970
Official Journal of the
American Fertility Society

’atient:

hoice of 4 strengths:

norold Androtd-HP

Android-* Android-Plus

ch yellow tablet contains:
thy! Testosterone ..2.5 mg.
rroid Ext. (1/6 gr.) . .10 rag.

itamic Acid 50 mg.

amine HCL 10 mg.

se: 1 tablet 3 times daily.
ailable:

ttles of 100, 500, 1000.

HIGH POTENCY

Each red tablet contains:
Methyl Testosterone . .5.0 mg.
Thyroid Ext. (Va gr.) ... 30 rag.

Glutamic Acid 50 mg.

Thiamine HCL ... 10 mg.

Dose: 1 tablet 3 times daily.
Available:

Bottles of 100, 500, 1000.

EXTRA HIGH POTENCY

Each orange tablet contains:
Methyl Testosterone .12.5 mg.
Thyroid Est. (1 gr.) ....64 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 or 2 tablets daily.
Available:

Bottles of 60, 500.

WITH HIGH POTENCY
B-C0MPLEX AND VITAMIN C

Each white tablet contains :
Methyl Testosterone ..2.5 mg.
Thyroid Ext. ('/4 gr.) ...15 mg.
Ascorbic Acid (Vit. C) .250 mg.

Thiamine HCL 25 mg.

Glutamic Acid 100 mg.

Pyridoxine HCL 5 mg.

Niacinamide 75 mg.

Calcium Pantothenate . 10 mg.

Vitamin B-12 2.5 meg.

Riboflavin 5 mg.

Dose: 2 tablets daily.
Available: Bottles of 60, 500.

100 patients suffering from impotence. Of
the patients receiving the active medication
(Android) a favourable response was seen
in 78%. This compares with 40% on
placebo. Although psychotherapy is indi-
cated in patients suffering from functional
impotence the concomitant role of chemo-
therapy (Android) cannot be disputed.

Contraindications: Android is contraindicated in patients with prostatic carcinoma, severe cardiorenal
disease and severe persistent hypercalcemia, coronary heart disease and hyperthyroidism. Occasional
cases of jaundice with plugging biliary canal iculi have occurred with average doses of Methyl Testos-
terone. Thyroid is not to be used in heart disease and hypertension.

Warnings: Large dosages may cause anorexia, nausea, vomiting abdominal pain, diarrhea, headache,
dizziness, lethargy, paresthesia, skin eruptions, loss of libido in males, dysuria, edema, congestive heart
failure and mammary carcinoma in males.

Precautions: If hypothyroidism is accompanied by adrenal insufficiency the latter must be corrected prior
to and during thyroid administration.

Adverse Reactions: Since Androgens, in general, tend to promote retention of sodium and water, patients
receiving Methyl Testosterone, in particular elderly patients, should be observed for edema.

Hypercalcemia may occur, particularly in immobilized patients: use of Testosterone should be discontinued
as soon as hypercalcemia is detected.

References: 1. Montesono, P., and Evangelista, I. Methyltestosterone-thyroid treatment of sexual
impotence. Clin Med 12:69, 1966. 2. Dublin, M. F. Treatment of impotence with methyltestosterone-
thyroid compound. West Med 5:67, 1964. 3. Titeff, A. S. Methvltestosterone-thyroid in treating impotence
Gen Prac 25:6, 1962. 4. Heilman, L., Bradlow, H. L., Zumoff, B., Fukushima, D. K., and Gallagher, T. F.
Thyroid-androgen interrelations and the hypocholesteremic effect of androsterone. J Clin Endocr 19:936,
1959. 5. Farris. E. J., and Colton, S. W. Effects of L-thyroxine and liothyronine on spermatogenesis.
J Urol 79.863, 1958. 6. Osol, A., and Farrar, G. E. United States Dispensatory (ed. 25). Lippincott, Phila-
delphia. 1955, p. 1432. 7. Wershub, L. P. Sexual Impotence in the Male. Thomas, Springfield,

III., 1959, pp. 79-99.

9 lor literature and samples: THE BROWN PHARMACEUTICAL CO., INC. 2500 West 6th Street, Los Angeles, California 90057

MICHIGAN MEDICINE MARCH 1972 241

WAYNE STATE UNIVERSITY
SCHOOL OF MEDICINE
ALUMNI ASSOCIATION

PFIZERPEN
DOSAGE FORMS

104th ANNUAL
CLINIC DAY

and

REUNION BANQUET
Wednesday,

May 10, 1972

Detroit Hilton Hotel

General Theme:

CONTRACEPTION

featuring

• • • leading researchers and

experts in many aspects
of contraception

• • • presentation of distin-

guished alumni awards

Orange-flavored

Pfizerpen VK for Oral Solution

(potassium phenoxymethyl penicillin)

1 25 mg. (200,000 units)/ 5 cc.:
bottles of 100 cc. and 1 50 cc.

250 mg. (400,000 units)/ 5 cc.:
bottles of 1 00 cc. and 1 50 cc.

Pfizerpen VK Tablets

(potassium phenoxymethyl penicillin)

250 mg. (400,000 units): bottles of 100.
500 mg. (800,000 units): bottles of 100.

Butterscotch-caramel-flavored
Pfizerpen G Powder for Syrup
(potassium penicillin G)

400.000 units/ 5 cc.:

bottles of 1 00 cc. and 200 cc.

Pfizerpen G Tablets
(potassium penicillin G)

200.000 units: bottles of 1 00 and 500.

250.000 units-, bottles of 1 00.

400.000 units: bottles of 100 and 1000,
and unit-dose pack of 100 (10 x 10's).

800.000 units: bottles of 100.

ftiiWTb LABORATORIES DIVISION

PFIZER INC NEW YORK N V 10017

242 MICHIGAN MEDICINE MARCH 1972

Now there are two ways to cut the cost of brand-name penicillin therapy.

Pfizerpen VK now joins Pfizerpen G (potassium penicillin G) for true economy in brand-name
penicillin therapy.

When you write penicillin VK, it's for acid stability, solubility and rapid absorption. But when
you write Pfizerpen VK, you add economy. Pfizerpen VK, more economical than the two lead-
ing brand-name penicillin VK products. G or VK. Just make sure it's Pfizerpen.

Tablets and Powder for Syrup

, PFIZERPEN VK ,

(POTASSIUM PHENOXYMETHYL PENICILLIN)

GORVK. JUST
MAKE SURE IT’S PFIZERPEN.

Physician assistants were the major
topics at the annual Mid-Winter Ed-
ucational Seminar Jan. 29-30 of the
American Association of Medical. As-
sistants, the State of Michigan. On the
panel was Robert E. Rice, MD, Green-
ville, center, who appreciated the
seminar program shaped like a doc-
tor’s bag. Chairmen of the seminar
were Mrs. Jean McCray, left, and Mrs.
Patricia Voke, both of Battle Creek,
where the seminar took place.

Michigan’s
medical assistants
hold educational meet

Five members of the Michigan med-
ical assistants’ association are mem-
bers of national committees. They are,
from left, Miss Margaret Broadwell,
Detroit, Legislative Committee; Mrs.
Patricia Austin, Ann Arbor, Nominating
Committee; Mrs. Claire E. Van Dam,
Stevensville, Education Committee;
Mrs. Betty Lou Willey, Port Huron,
Committee on Professional Advance-
ment, and Mrs. Betty Boers, Kalama-
zoo, Constitution and Bylaws Com-
mittee.

IP gTj

A special guest at the medical assist-
ants’ seminar was Miss Laura L. Lock-
hart, Akron, Ohio, vice speaker of the
AAMA House of Delegates. She was
met by Mrs. Betty Boers, Kalamazoo,
state president.

Also on the seminar program that day in Battle
Creek were, from left, Donald Foy, Chicago, exec-
utive with the AMA Hea’th Manpower Commit-
tee; George Mallinson, PhD, Dean, College of
Graduate Studies, Western Michigan University,
and George W. Slagle, MD, Battle Creek, mem-
ber of the AMA Council of Medical Services.

244 MICHIGAN MEDICINE MARCH 1972

(diefhylpropion hydrochloride, N.F.)

When girth gets out of control, TEPANIL can provide sound
support for the weight control program you recommend.
TEPANIL reduces the appetite — patients enjoy food but eat
less. Weight loss is significant— gradual — yet there is a rela-
tively low incidence of CNS stimulation.

Contraindications: Concurrently with MAO inhibitors, in patients hypersensitive to
this drug; in emotionally unstable patients susceptible to drug abuse.

Warning: Although generally safer than the amphetamines, use with great caution in
patients with severe hypertension or severe cardiovascular disease. Do not use dur-
ing first trimester of pregnancy unless potential benefits outweigh potential risks.
Adverse Reactions: Rarely severe enough to require discontinuation of therapy, un-
pleasant symptoms with diefhylpropion hydrochloride have been reported to occur
in relatively low incidence. As is characteristic of sympathomimetic agents, it may
occasionally cause CNS effects such os insomnia, nervousness, dizziness, onxiety,
and jitteriness. In contrast, CNS depression has been reported. In a few epileptics
an increase in convulsive episodes has been reported. Sympathomimetic cardio-
vascular effects reported include ones such as tachycardia, precordial pain,

arrhythmia, palpitation, and increased blood pressure. One published report
described T-wave changes in the ECG of a healthy young male after ingestion of
diefhylpropion hydrochloride; this was an isolated experience, which has not been
reported by others. Allergic phenomena reported include such conditions as rash,
urticaria, ecchymosis, and erythema. Gastrointestinal effects such as diarrhea,
constipation, nausea, vomiting, and abdominal discomfort have been reported.
Specific reports on the hematopoietic system include two each of bone marrow
depression, agranulocytosis, and leukopenia. A variety of miscellaneous adverse
reactions have been reported by physicians. These include complaints such as dry
mouth, headache, dyspnea, menstrual upset, hair loss, muscle pain, decreased
libido, dysuria, and polyuria.

Convenience of two dosage forms: TEPANIL Ten-tab tablets: One 75 mg. tablet
daily, swallowed whole, in midmorning (10 a.m.); TEPANIL: One 25 mg. tablet three
times daily, one hour before meals. If desired, an additional tablet may be given in
midevening to overcome night hunger. Use in children under 12 years of age is not
recommended. 1-3325 (2876)

S N MERRELL- NATIONAL LABORATORIES

( Merrell ) Division of Richardson- Merrell Inc.

V y Cincinnati, Ohio 45215

Painful
night leg
cramps...

unwelcome bedfellow
for any patient-
including those with arthritis,
diabetes or PVD

■ t=

□ Prevents painful night
leg cramps

□ Permits restful sleep

□ Provides simple
convenient dosage —
usually just one tablet
at bedtime

f N mi

( Merrell J ov

Quinamm

(quinine sulfate 260 mg aminophylline 195 ma.l

Prescribing Information — Composition: Each white, beveled, compressed tablet
contains: Quinine sulfate, 260 mg., Aminophylline, 195 rog. Indications: For the
prevention and treatment of nocturnal and recumbency leg muscle cramps, includ-
ing those associated with arthritis, diabetes, varicose veins, thrombophlebitis,
arteriosclerosis and static foot deformities. Contraindications: Quinamm is con-
traindicated in pregnancy because of its quinine content. Precautions/ Adverse
Reactions: Aminophylline may produce intestinal cramps in some instances, and
quinine may produce symptoms of cinchonism, such as tinnitus, dizziness, and gas-
trointestinal disturbance. Discontinue use if ringing in the ears, deafness, skin rash,
or visual disturbances occur. Dosage: One tablet upon retiring. Where necessary,
dosage may be increased to one tablet following the evening meal and one tablet
upon retiring. Supplied: Bottles of 100 and 500 tablets.
MERREll-NATIONAL LABORATORIES i-ssoksoso)

Merrell ) Division of Richardson-Merrell Inc.

Cincinnati, Ohio 45215 Trademark: Quinamm

Specific therapy for night leg cramps.

On the next two pages:
An important announcement
for you and your patients.

New from Colgate:

Superior Gram negative*

ANTI -BACTERIAL DEODORANT SOAP

— - — — — —

Effective against Gram positive bacteria

and Gram negative bacteria.

As mild as any other toilet soap.
With unsurpassed substantivity for
long-lasting antibacterial action.

Active ingredients: 3, 4', 5-tribromosalicylanilide and 4, 2',4'-trichloro-2-hydroxy diphenyl ether.
Together these agents produce a synergistic effect that provides broad spectrum protection
against skin bacteria. (P-300 does not contain hexachlorophene.)

The new all-purpose soap for homes, offices, hospitals, schools,
restaurants, food processing plants, laboratories, etc.

P-300: Superior protecti

racteriostasis in a bar soap.

P-300 -superior to other antibacterial bar soaps. Proven
effective against 25 of 31 cultures representing bacteria of
major concern in nosocomial infections and cross - infections.*

A.T.C.C.

BACTERIA

No.

P-300

Soap “D”

Soap “S”

Gram Positive

Staphylococcus aureus

8094

9 ®9

•

•

Staphylococcus aureus

11371

• ••

9

9

Staphylococcus aureus

8096

• ••

9

•

Staphylococcus aureus

10390

• ••

•

9

Staphylococcus aureus

6342

999

•

9

Staphylococcus epidermidis

17917

999

•

9

Staphylococcus sp.

13565

• ••

•

99

Mycobacterium smegmatis

19420

• • •

9 9

99

Listeria monocytogenes

13932

• ••

9 ®

9 99

Streptococcus pyogenes

7958

•

•

9

Streptococcus mitis

903

•

•

®

Streptococcus sp.

12403

•

9

9

Bacillus anthracis

14578

9

• •

9 9

Gram Negative

Alcaligenes tolerans

19359

• ••

#9

99 9

Neisseria gonorrhoeae

19424

• •

•

•

Neisseria menigitidis

13077

• ••

•

Proteus vulgaris

8427

• ••

•

O

Escherichia coli

10536

9

o

O

Escherichia coli

11229

•

o

o

Escherichia coli

11698

•

o

o

Klebsiella pneumoniae

12833

•

o

o

Salmonella typhi

9993

9

o

o

Salmonella typhi

6539

9

o

o

Salmonella typhimurium

13311

9

o

o

Herellea sp.

11959

•

o

o

Pseudomonas aeruginosa

10145

o

o

o

Pseudomonas aeruginosa

7700

’ O

o

o

Pseudomonas aeruginosa

9027

o

o

o

Pseudomonas aeruginosa

14210

o

o

o

Proteus rettgeri

9250

o

o

o

Proteus morganii

9237

° 1

. O

o

KEY: ZONE OF INHIBITION

• >• = 18.0 mm or larger

Test Method:

The three antibacterial soaps-were evaluated by

• 12.0 mm to 17.9 mm means of the standarcUfproteiri Adsorption Test, conducted by a

• = Less than 11.9 mm recognized independent laboratory, using A.T.C.C. organisms.

u _ ino inmomon *The bacteria were those most frequently named in a nationwide

survey of 334 hospitals. ,;

or you and yourpatients.

For samples of P~300 and product literature,

please write:

Professional Services Department
COLGATE-PALMOLIVE COMPANY
740 North Rush Street
Chicago, Illinois 6061 1

After 1 1/2 hours in the tunnel,
‘ we were glad to be out f

(Prepared with the aid of the Port Huron Times
Herald.)

Within 15 minutes from the time the disaster
alert was sounded, 30 physicians were standing
ready to treat casualties from the Detroit Metro-
politan Water System tunnel explosion near Port
Huron Dec. 11.

Medical staff, administrators, volunteers and
others responded at Port Huron, Port Huron Mercy
and St. Clair River District hospitals when their
disaster plans went into effect. Emergency crews
from St. Clair, Lapeer and Sanilac counties, in-
cluding 25 ambulances, were dispatched to the
scene.

And four local physicians actually went to the
tunnel entrance on the shore of Lake Huron at
Lakeport. Two went down to the bend in the tunnel
where the dead and injured were found, to help re-
lieve the suffering of the workers trapped 238 feet
below the surface.

“We needed those doctors,” said St. Clair County
Undersheriff Norman L. Ludy, who conducted the
rescue operation. “The men trapped in the tunnel
needed them.”

The first word Port Huron Hospital had of the
disaster was that it should prepare to receive from
40 to 60 casualties. Within 15 minutes of their calls
to the physicians, 30 doctors were at the hospital,
ready to help, according to Charles McKinley, ad-
ministrator.

“We had pediatricians, obstetricians and psy-
chiatrists— fellows who just came in because they
have compassion for their fellow human beings in
times like this,” said Mr. McKinley. “The attitude
and response of the medical staff in handling the

casualties reflected a beautiful community spirit
and dedication.”

The final count was 21 dead and nine injured in
the tunnel blast. All but one were brought to Port
Huron Hospital.

Following is the personal account of the disaster
by one of the two physicians to enter the tunnel:

Dr. E. D. Shoudy’s
eyewitness account
of Port Huron
tunnel disaster

By Elmore D. Shoudy, MD

Port Huron

At about 3 P.M. on December 11, 1971, an explo-
sion occurred, possibly of methane gas, in a tunnel
a few miles north of Port Huron, Michigan. Two
hours later I was on my way down into the tunnel.

This tunnel is being built under the lake by the
Detroit Metropolitan Water Works to bring water
to the Detroit area. The tunnel is to be connected
to a water intake cofferdam in Lake Huron about
5 to 6 miles from shore.

I was covering calls for two of my general prac-
tice colleagues and myself on this nice Saturday
afternoon.

As I called into the hospital regarding a patient,
the operator notified me that our disaster plan was
in effect for the hospital and that all physicians
were to come to the Port Huron General Hospital.

Doctors and a volunteer fireman bring another body into Port Huron General
Hospital Dec. 12 following the water tunnel explosion north of the city.

World Wide Photos

MICHIGAN MEDICINE MARCH 1972 251

TUNNEL DISASTER/Continued

We have two hospitals in town with a 400 bed
capacity but the General is the largest and we
have a new addition recently completed that in-
cludes an emergency care section.

At the hospital, numbers of physicians were on
hand. All sections had been alerted under the di-
rection of Mr. McKinley, our administrator. No
patients had arrived as yet but preparations were
in progress.

Our big problem seemed to be communication.
The variation in estimated numbers of injuries and
fatalities ranged to 60 persons. We were notified
that men were trapped in the tunnel and some
couldn’t be brought to the surface for four to five
hours.

Many of the physicians waited and then went
to their homes to await further call. After seeing
some patients in the hospital, I returned to the
Emergency Room.

A call from the sheriff on the scene requested
an MD volunteer to go into the tunnel and give
pain relief to the trapped injured men. Our chief
of staff asked for a volunteer, but I suggested two
because of the possible number of casualties. Gor-
don Rady, a local pediatrician, and I volunteered
and quickly arranged a small collection of things
we might need.

Within minutes a city police car was at the hos-
pital door and we were on our way. The harrow-
ing ride in the police car kept us on the edge of our
seats and didn’t allow us time to think of the up-
coming task. But the smoothness of the handling
of the situation by police, firemen, and workers at
the tunnel eased our fears. At the site, the elevator
awaited us. We passed a blur of people on either
side — they were the families and friends awaiting
the injured and possibly dead.

We rode the elevator down the 230-foot shaft.
At the base we could see the tunnel. It was about
16 feet wide, with covered concrete walls, and
was lighted by multiple electric bulbs. The base
had train tracks and a small train car awaited us.
We climbed on top and dressed in two gowns that
I had brought along. Men were coming out on
stretchers as we went in. The train carried us to

the edge of the debris. Here, also, the lights
stopped. Floodlights became the only lights.

The explosion had apparently occurred deeper
in the tunnel and carried the twisted ventilator
pipes (like large culverts) many feet down the
tunnel. The twisted and torn pipes almost obliter-
ated the shaft in areas.

We climbed through debris, walked on pipes and
the sides of the walls and on the tracks section
which was covered with mud and water a few
inches deep. The concrete walls were damp and
a foggy mist filled the air.

As we made our way, the workers helped us
along the route. They mentioned that this or that
piece of equipment had been 1,000 feet further
up the tunnel. Finally, after traveling what seemed
miles, we reached our destination about one mile
into the six mile tunnel.

The supervising staff was trying to clear the tun-
nel because, it was said, the gas was accumulating
and another explosion was feared. Ambulance men
and rescue workers were trying to carry the wound-
ed men on stretchers over and out of the debris, a
difficult task.

The injured men had black dirt and cement all
over them. We gave them demerol injections as
we deemed necessary, being careful to place ad-
hesive tape on their foreheads with time and dos-
age, in the old wartime fashion.

Our meager supplies couldn't handle the situa-
tion, except to relieve pain. Burns weren’t ap-
parently the largest injuries. The twisted metal
and exploding pieces had lacerated the bodies of
the living and the dead. Fractures, torn limbs and
lacerations were the prime concern.

A couple of ambulance boys had told us all the
rest were dead but we felt that we had to see if
any flicker of life remained in the large number of
bodies remaining. Most of the dead required no
close observation.

Parts of bodies were everywhere. We checked
them and counted as we returned. We counted 17
bodies but some were difficult to tell if they were
parts of one or another.

The long path back was helped by the coura-
geous rescuers. At the end of the track the
elevator awaited us and we loaded the last injured
man. Our ambulance had some minor headlight
problems as we rode to the hospital but the state
police car parted the traffic as we rode.

We had been IV2 hours in the tunnel and were
glad to be out. Gordon said the heavy office load
would seem easier after this. At the hospital the
E. R. was busy. We had called in some directions
in the ambulance and they were ready.

The response of our staff was tremendous. It
can best be shown by realizing the first men were
treated by three OB-Gyn men and one psychiatrist.
The nursing crew, O.R. crew, and entire hospital

252 MICHIGAN MEDICINE MARCH 1972

staff seemed to be there. The coffee seemed re-
freshing.

A crowd of people had been waiting, mostly
relatives. After our report, the administrator had
the unhappy task of informing the people that no
more survivors were there. A list of names had
been made of the injured. The dead were brought
up later that night and after considerable examina-
tions, a total of 21 bodies were identified, and placed
in the temporary morgue set up according to the
disaster plan.

The injured were treated accordingly, some re-
quiring major surgery, most requiring repair of
multiple lacerations and cleansing of wounds and
bodies. “Form oil” mixed with cement, dust and
dirt was almost impossible to clean off.

A later meeting of our medical staff executive
committee brought out discrepancies and problems
in our present disaster plan and in the handling
of the situation. Communications with the tunnel
site and police were definitely needed. In the fu-
ture, two-way communications and police monitor-
ing equipment will be available at the hospital. We
have decided an observer, perhaps a physician,
should be sent to the site to determine the number
and type of injuries that we may encounter. In this
way other hospitals, burn centers, etc., could be

prepared. The observing physician that is to offer
treatment at the scene should have a shoulder bag
similar to the army medics’ equipment.

We believe for the handling of casualties, our
triage screening should be improved, and possibly
a scribe assigned to each patient-case to keep a
chart. Our tagging system didn’t seem to work
well. An overall disaster leader was suggested to
make alterations and assignments so that physi-
cian direction could best be utilized. Many un-
authorized personnel, such as newsmen, etc., com-
plicated activities in the emergency suite. Plans
for advising the families and news media need im-
provement.

Our morgue was adequate for the number of
bodies, but a larger disaster may have over-
whelmed it. It has become evident that a disaster
plan should include more of the community and
the community's facilities.

In all, our physician, nursing and personnel re-
sponse was tremendous and we are proud of the
hospital’s response.

Last and not least, we couldn’t be more proud
of the community people that helped. The fire de-
partment, ambulance crews, sheriff, police and in-
dividual workers showed that a city can and did
respond wholeheartedly in the disaster.

Established 1924

MERCYWOOD HOSPITAL

4038 Jackson Road Conducted by Sisters of Mercy Ann Arbor, Michigan

Telephone — 313 663-8571

Mercywood Hospital is a private neuropsychiatric hospital
licensed by the Michigan Department of Mental Health.
Mercywood specializes in intensive, multi-disciplinary
treatment for emotional and mental disorders.

Accredited by the Joint Commission on Accreditation of
Hospitals and the National League of Nursing. A full Blue
Cross participating hospital.

Certified for : Medicare and M.A.A. programs

Robert J. Bahra, M.D.

Dean P. Carron, M.D.
Francis M. Daignault, M.D.
Gordon C. Dieterich, M.D.
James R. Driver, M.D.

‘Active & Associate)

Robert L. Fransway, M.D.
Stuart M. Gould, Jr., M.D.
Sydney Joseph, M.D.
Hubert Miller, M.D.

Jacob J. Miller, M.D.
Rudolf E. Nobel, M.D.

Gerard M. Schmit, M.D.
Joseph J. Tiziani, M.D.
Prehlad S. Vachher, M.D.
Richard D. Watkins, M.D.
Robert M. Zimmerman, M.D.

MICHIGAN MEDICINE MARCH 1972 253

°Iil small doses

Eleven

Michigan MDs
serving AMA

Eight Michigan physicians have been reappointed
to serve on councils or committees of the American
Medical Association. Another two have been newly
appointed, while one has retired.

Harold F. Falls, MD, Ann Arbor, has retired from
his service with the AMA Council on Health Man-
power. Robert E. Rice, MD, Greenville, is a new
appointee to the Council on Rural Health, and
Everett R. Harrell, MD, Ann Arbor, to the Commit-
tee on Cutaneous Health and Cosmetics.

Reappointed are Herbert A. Raskin, MD, South-
field, chairman and Maurice H. Seevers, MD, Ann
Arbor, Committee on Alcoholism and Drug Depend-
ence; Starling D. Steiner, MD, Detroit, Council on
Occupational Health; Bertram D. Dinman, MD, Ann
Arbor, Committee on Occupational Toxicology;
Donald N. Sweeny, Jr., MD, Detroit, Disability In-
surance Claims Review Committee; William W.
Jack, MD, Grand Rapids, Committee on Maternal
and Child Care; Richard C. Schneider, MD, Ann
Arbor, Committee on Medical Aspects of Sports,
and Alexander H. Hirschfeld, MD, Detroit, chairman,
Joint Committee on Mental Health in Industry.

The new dean of the WSU School of Medicine,
Robert D. Coye, MD, told the press soon after
his appointment that he sees the role of the
WSU medical school in “making our interest
that of medical care for the entire community.
This ... is a new direction for medical educa-
tion.” He meets with, from left above, Lawrence
M. Weiner, PhD, acting associate dean; Paul J.
Pentecost, director of WSU Information Services,
and George E. Gullen, Jr., acting WSU president.

Richard C. Bates, MD, Lansing,

is a new appointee, pending Senate confirma-
tion, to the Advisory Commission on Drug Abuse
and Alcoholism for a term expiring Feb. 1, 1974.
Doctor Bates, who was appointed by Gov. Wil-
liam G. Milliken, is chairman of the MSMS Com-
mittee on Alcohol and Drug Dependence and is
director of the Alcoholism Treatment Unit at
E. W. Sparrow Hospital, Lansing.

Henry Green, MD, Detroit

director of the Cardiac Care Surveillance Project
of the Michigan Heart Association, led a study
group which has just published guidelines on the
safe use of electronic equipment in hospitals.
The study group was a part of the Inter-Society
Commission for Heart Disease Resources and
based its recommendations on studies of 19 hos-
pital surveys in Detroit. The recommendations
were published in Circulation, a scientific jour-
nal of the American Heart Association.

Jose J. Uinas, MD, Lansing,

director of the Tri-County Mental Health Service
serving Ingham, Clinton and Eaton counties, is
author of a new column on mental health and
understanding which has been appearing in the
weekly Clinton County News since January. Doc-
tor Llinas is also writer of a monthly column on
mental health for the bulletin of the Ingham
County Medical Society.

Stevo Julius, MD, Ann Arbor,

an associate professor of internal medicine at
the University of Michigan, is a new member of
the Medical Advisory Board of the Council for
High Blood Pressure of the American Heart Asso-
ciation. He is the second practicing physician
from Michigan to be named to the board.

R. G. Lynch, MD, Grosse Pointe Park,

is new director of employee medical services for
the Parke Davis Company. He succeeds H. C.
Bruckner, MD, who resigned.

Harold J. Meier, MD, Coldwater,

is the outstanding citizen of the year in his com-
munity. He was named at the annual president’s
ball of the Coldwater Chamber of Commerce.
Doctor Meier, an orthopedic surgeon in Cold-
water since 1936, is a former chairman of The
MSMS Council, and former recipient of the
MSMS Certificate of Commendation.

Russell F. Salot, MD, Mt. Clemens,

received 1,000 birthday cards from grateful pa-
tients on his 70th birthday Jan. 4. Doctor Salot
was chief surgeon at Mt. Clemens’ St. Joseph
Hospital for many years. The city’s mayor pro-
claimed Jan. 3-9 as Dr. Russell F. Salot Week
in honor of the surgeon who is so loved by his
community.

(Continued on page 256)

254 MICHIGAN MEDICINE MARCH 1972

IMSOMLAN

ISOXSUPR1E HCI)

he compatible vasodilator

• no interference with diabetic control . . . does not alter
carbohydrate metabolism.1

• conflicts have not been reported with diuretics,
corticosteroids, antihypertensives or miotics.

There are no known contraindications in recommended
oral doses other than it should not be given in the presence
of frank arterial bleeding or immediately postpartum.

Ithough not all clinicians agree on the value of vasodilators in vascular disease, several investigators ?'5 have reported favorably on the effects
' isoxsuprine. Effects have been demonstrated both by objective measurement 2,5 and observation of clinical improvement.2’*
idications : Cerebrovascular insufficiency, arteriosclerosis obliterans, diabetic vascular diseases, thromboangiitis obliterans (Buerger’s disease),
aynaud’s disease, postphlebitic conditions, acroparesthesia, frostbite syndrome and ulcers of the extremities (arteriosclerotic, diabetic, throm-
Jtic). Composition: VasodTlan tablets, isoxsuprine HCI 10 mg. and 20 mg. Dosage: Oral — 10 to 20 mg. t.i.d. or q.i.d. Contraindications and
autions: There are no known contraindications to recommended oral dosage. Do not give immediately postpartum or in the presence of
rterial bleeding. Side Effects: Occasional palpitation and dizziness can usually be controlled by dosage reduction. Complete details available
i product brochure from Mead Johnson Laboratories. References: (1) Samuels, S. S., and Shaftel, H. E. : J. Indiana
led. Ass. 5^:1021-1023 (July) 1961. (2) Clarkson, I. S., and LePere, D. M. : Angiology 7/ :190-192 (June) 1960.

3) Horton, G. E., and Johnson, P. C., Jr.: Angiology 75:70-74 (Feb.) 1964. (4) Dhrymiotis, A. D., and Whittier, J. R. :
urr.Ther. Res. hl24-128 (April) 1962. (5) Whittier, J. R. : Angiology 75:82-87 (Feb.) 1964.

1971 MEAD JOHNSON 9 COMPANY • EVANSVILLE, INDIANA 47721 U.S.A.

LABOR ATO R I E S

194771

SMALL DOSES/Continued

Harvey V. Sparks, MD, Ann Arbor,

associate professor of physiology, has been
granted $24,310 by the National Heart and Lung
Institute for research on “Dynamics of Metabolic
Control of Muscle Blood Flow.”

Garfield Tournev, MD, Grosse Pointe,

is new chief of the Department of Psychiatry at
Harper Hospital, Detroit. He has responsibility
also as co-chairman of the Department of Psy-
chiatry at the WSU School of Medicine.

Daniel J. Wilhelm, MD, Port Huron,

is the outstanding young man of his community.
A Port Huron pediatrician since 1966, Doctor
Wilhelm was named by the local Jaycees at a
recent banquet. Doctor Wilhelm is a member of
the MSMS House of Delegates. He was first
chairman of the Human Development Committee
of the Port Huron Area School District, and is
on the boards of the local Anonymous Informa-
tion on Drugs program, the Rehabilitation Action
Program, the Port Huron YMCA and the Catholic
Social Services.

Charles C. Vincent, MD, Detroit,

is new secretary of the Board of Trustees of the
Detroit Department of Hospitals. Doctor Vincent
was appointed last month to a four-year term on
the board. He also serves as a member of the
Mayor’s Health Care Advisory Commission, on
the Detroit Board of Health and on the faculty
of Wayne State University School of Medicine.

Two Michigan physicians

were re-elected to the board of directors of the
American College of Emergency Physicians at
the ACEP annual meeting in Miami recently.
They are Eugene C. Nakfoor, MD, Lansing, chief
of staff of St. Lawrence Hospital there; and John
H. van de Leuv, MD, Lake Orion, editor of the
ACEP journal and a founding member.

“Your dinner was
perfect — from soup
to 'Dicarbosil’.”

Dicarbosil.

ANTACID

Write for Clinical Samples

ARCH LABORATORIES

319 South Fourth Street. St. Louis, Missouri 63102

Doctors Reizen ,

Driver and Tobin
on review board

Three MSMS members are among the nine per-
sons named by Gov. William G. Milliken to a board
to review requests by hospitals, nursing homes
and other health care institutions that they be al-
lowed to exceed the 6 per cent price limit estab-
lished by the U. S. Price Commission.

The price commission has asked all U. S. gov-
ernors to appoint such a board.

New Michigan board members, named from the
Comprehensive State Health Planning Advisory
Council, are Maurice S. Reizen, MD, Okemos, di-
rector, Michigan Department of Public Health;
Julien Priver, MD, Detroit, president, Michigan Hos-
pital Association, and James Tobin, MD, Ishpeming.

SOME PHYSICIANS KNOW what to do with
their patients who are alcoholics or problem
drinkers.

SOME PHYSICIANS WISH they knew what
to do with them.

Have you thought of the Alcoholism
Services of the Battle Creek Sanitarium
Hospital? Since 1965 we have maintained
an enviable record in the rehabilitation
of the alcoholic or problem drinker.

A full range of services and specialties.

Give us a call

616-964-7121 Ext. 588 or 589

Battle Creek Sanitarium and Hospital
197 N. Washington Avenue
Battle Creek, Michigan 49016

256 MICHIGAN MEDICINE MARCH 1972

“The biggest gathering ever” participated in the
special meeting called recently in Ann Arbor for
interested medical students by the Michigan Acad-
emy of Family Physicians. The crowd of more than

700 included students from the three medical schools
and the 160 GPs who were enrolled in the week-
long GP course at Towsiey Center.

National president
of family physicians
visits Ann Arbor

Jerome J. Wildgen, MD, left, presi-
dent of the National Academy of Family
Physicians, who gave the major address
to the students and GPs, confers with
George A. Dean, MD, Southfield, the
Michigan GP public relations chairman.

Roy J. Gerard, MD, left, tells two students about
the general practice residency program he directs
at Saginaw.

The president of the Michigan Academy of Family
Physicians, Joseph V. Fisher, MD, standing, Chelsea,
stops during the Ann Arbor meeting to visit with
some students to urge them to consider careers in
family practice.

MICHIGAN MEDICINE MARCH 1972 257

Couqty" scenes

Ingham’s ‘Medicina’
has wide distribution
in January

Circulation of the January issue of Medicina,
the bulletin of the Ingham County Medical Society,
was double the usual distribution figure. That bul-
letin contained a succinct, informative explanation
of the aims and issues of the proposed MSMS
foundation, written by John (Jack) Kantner, ICMS
executive director. MSMS ordered 500 copies of
that Medicina and distributed them to all dele-
gates, alternate delegates and selected committee
members. The Oakland County Medical Society re-
printed the article in their February issue.

Oakland society growing

The Oakland County Medical Society member-
ship has increased to 736 physicians, which allows
it to have an additional delegate and alternate
delegate to MSMS. The Oakland delegates and
alternates now total 15 each. The membership rose
from 724 last year to 736 in 1972.

Eight senior doctors
honored by Kent

Each year the members of the Kent County Med-
ical Society honor senior members for their serv-
ices to society and the practice of the science of
medicine. At this year’s annual Kent Society meet-
ing Jan. 12 the physicians recognized Ruth Her-
rick, MD; Aleksandrs Kalnins, MD; Cornetta G.
Moen, MD; Arthur M. Moll, MD; Arthur H. Mollmann,
MD; Cullen E. Sugg, MD; John Ten Have, MD, and
Athol B. Thompson, MD.

“Voltlamp” donated
to WCMS Beaumont Room

The Beaumont Room of the Wayne County Med-
ical Society, which contains a historical collection
of medical books and memorabilia has added a
“Voltlamp” to its attractions. The “Voltlamp” was
popular in the 1920’s to produce faradic and gal-
vanic currents. The Beaumont Room’s model was
donated by Mrs. Carleton Fox, widow of a late
Birmingham dentist. Its manufacturer stated that
“Electricity cures. We do not claim, that of itself
electricity will cure every and all forms of human
weakness and disease. But we do claim that, prop-
erly used, electricity is one of the best possible
curative agents known to man: that of all the re-
markable achievements of this great and myste-
rious force, the greatest is its wonderful power to
alleviate pain, to cure disease and to save life.”

Pre-Sate ®

(chlorphentermine HC1)

CAUTION: Federal law prohibits dispensing without
prescription.

Indications: Pre-Sate (chlorphentermine hydrochlo-
ride) is indicated in exogenous obesity, as a short
term ( /' . e . , several weeks) adjunct in a regimen of
weight reduction based upon caloric restriction.
Contraindications: Glaucoma, hyperthyroidism, phe-
ochromocytoma, hypersensitivity to sympathomi-
metic amines, and agitated states. Pre-Sate
(chlorphentermine hydrochloride) is also contrain-
dicated in patients with a history of drug abuse or
symptomatic cardiovascular disease of the following
types: advanced arteriosclerosis, severe coronary
artery disease, moderate to severe hypertension, or
cardiac conduction abnormalities with danger of ar-
rhythmias. The drug is also contraindicated during
or within 14 days following administration of mona-
mine oxidase inhibitors, since hypertensive crises
may result.

Warnings: When weight loss is unsatisfactory the
recommended dosage should not be increased in
an attempt to obtain increased anorexigenic effect;
discontinue the drug. Tolerance to the anorectic
effect may develop. Drowsiness or stimulation may
occur and may impair ability to engage in potenti-
ally hazardous activities such as operating ma-
chinery, driving a motor vehicle, or performing
tasks requiring precision work or critical judgment.
Therefore, such patients should be cautioned ac-
cordingly. Caution must be exercised if Pre-Sate
(chlorphentermine hydrochloride) is used concom-
itantly with other central nervous system stimu-
lants. There have been reports of pulmonary hyper-
tension in patients who received related drugs.

Drug Dependence: Drugs of this type have a poten-
tial for abuse. Patients have been known to increase
the intake of drugs of this type to many times the
dosages recommended. In long-term controlled
studies with high dosages of Pre-Sate, abrupt ces-
sation did not result in symptoms of withdrawal.
Usage tn Pregnancy: The safety of Pre-Sate (chlor-
phentermine hydrochloride) in human pregnancy has
not yet been clearly established. The use of ano-
rectic agents by women who are or who may be-
come pregnant, and especially those in the first
trimester of pregnancy, requires that the potential
benefit be weighed against the possible hazard to
mother and child. Use of the drug during lactation
is not recommended. Mammalian reproductive and
teratogenic studies with high multiples of the human
dose have been negative.

Usage In Children: Not recommended for use in
children under 12 years of age.

Precautions: In patients with diabetes mellitus there
may be alteration of insulin requirements due to
dietary restrictions and weight loss. Pre-Sate (chlor-
phentermine hydrochloride) should be used with
caution when obesity complicates the management
of patients with mild to moderate cardiovascular
disease or diabetes mellitus, and only when dietary
restriction alone has been unsuccessful in achieving
desired weight reduction, in prescribing this drug
for obese patients in whom it is undesirable to in-
troduce CNS stimulation or pressor effect, the phy-
sician should be alert to the individual who may be
overly sensitive to this drug. Psychologic disturb-
ances have been reported in patients who concomi-
tantly receive an anorexic agent and a restrictive
dietary regimen.

Adverse Reactions: Central Nervous System: When
CNS side effects occur, they are most often mani-
fested as drowsiness or sedation or overstimulation
and restlessness. Insomnia, dizziness, headache,
euphoria, dysphoria, and tremor may also occur.
Psychotic episodes, although rare, have been noted
even at recommended doses. Cardiovascular: tachy-
cardia, palpitation, elevation of blood pressure.
Gastrointestinal: nausea and vomiting, diarrhea, un-
pleasant taste, constipation. Endocrine: changes
in libido, impotence. Autonomic: dryness of mouth,
sweating, mydriasis. Allergic: urticaria. Genitouri-
nary: diuresis and, rarely, difficulty in initiating
micturition Others: Paresthesias, sural spasms.
Dosage and Administration: The recommended adult
daily dose of Pre-Sate (chlorphentermine hydrochlo-
ride) is one tablet (equivalent to 65 mg chlorphen-
termine base) taken after the first meal of the day.
Use in children under 12 not recommended.
Overdosage: Manifestations: Restlessness, confu-
sion, assaultiveness, hallucinations, panic states,
and hyperpyrexia may be manifestations of acute in-
toxication with anorectic agents. Fatigue and de-
pression usually follow the central stimulation.
Cardiovascular effects include arrhythmias, hyper-
tension, or hypotension and circulatory collapse.
Gastrointestinal symptoms include nausea, vomiting,
diarrhea, and abdominal cramps. Fatal poisoning
usually terminates in convulsions and coma.
Management: Management of acute intoxication with
sympathomimetic amines is largely symptomatic and
supportive and often includes sedation with a bar-
biturate. If hypertension is marked, the use of a
nitrate or rapidly acting alpha-receptor blocking
agent should be considered. Experience with he-
modialysis or peritoneal dialysis is inadequate to
permit recommendations in this regard.

How Supplied: Each Pre-Sate (chlorphentermine
hydrochloride) tablet contains the equivalent of
65 mg chlorphentermine base; bottles of 100 and
1000 tablets.

Full information available on request.

WARNER-CHILCOTT

Division, Warner-Lambert Company
Morris Plains, New Jersey 07950

258 MICHIGAN MEDICINE MARCH 1972

(chlorphentermine

iifjV 1

the trend is
toward our kind
of anorectic

Not a controlled drug under the Comprehensive
Drug Abuse Prevention and Control Act

• low potential for abuse

• less CNS stimulation than with d-amphetamine
or phenmetrazine

of caloric restriction and diet re-education

• weight loss comparable to d-amphetamine and
phenmetrazine, superior to placebo

• convenient one-a-day dosage

Pre-Sate® (chlorphentermine HCl)...the increasingly practical appetite suppressant

makes ' Deprof useful for
depressed geriatric
makes it useful

8en

as well

helps ease mild to moderate nonpsychotic
depression and related anxiety
helps assure a good night’s rest

The middle-aged housewife
who can’t stop feeling “blue,”
who worries about losing her
attractiveness yet neglects
her appearance; reports
vague aches and pains, dif-
ficulty sleeping, loss of
appetite.

indications: Useful in the management of depression, both acute
(reactive) and chronic; particularly useful in the less severe depressions
and where the depression is accompanied by anxiety, insomnia, agitation,
or rumination; also useful for management of depression and associated
anxiety accompanying or related to organic illnesses.
CONTRAINDICATIONS: Benactyzine hydrochloride: Glaucoma and
previous allergic or idiosyncratic reactions to benactyzine hydrochloride
or related compounds. Meprobamate: Acute intermittent porphyria and
allergic or idiosyncratic reactions to meprobamate or related compounds
such ascarisoprodol, mebutamate, tybamate, carbromal.

WARNINGS: The following information on meprobamate pertains to
'Deprol' (meprobamate + benactyzine hydrochloride): Meprobamate:
Drug Dependence: Physical and psychological dependence and abuse
have occurred. Chronic intoxication, from prolonged use and usually
greater than recommended doses, leads to ataxia, slurred speech, vertigo.
Carefully supervise dose and amounts prescribed, and avoid prolonged
use, especially in alcoholics and addiction-prone persons. Sudden with-
drawal after prolonged and excessive use may precipitate recurrence of
pre-existing symptoms (e.g., anxiety, anorexia, insomnia) or withdrawal
reactions (e.g., vomiting, ataxia, tremors, muscle twitching, confusional
states, hallucinosis; rarely convulsive seizures, more likely in persons
with CNS damage or pre-existent or latent convulsive disorders). There-
fore, reduce dosage gradually (1-2 weeks) or substitute a short-acting

barbiturate, then gradually withdraw. Potentially Hazardous Tasks: Drivi
a motor vehicle or operating machinery. Additive Effects: Possible aH
tive effects between meprobamate, alcohol, and other CNS depressaii
or psychotropic drugs. Pregnancy and Lactation: Safe use not establish*
weigh potential benefits against potential hazards in pregnancy, nursi •.
mothers, or women of childbearing potential. Animal data at five tirr
the maximum recommended human dose show reduction in litter s
due to resorption. Meprobamate appears in umbilical cord blood at
near maternal plasma levels, and in breast milk at levels 2-4 times tt 1
of maternal plasma. Children Under Six: Drug not recommended.
PRECAUTIONS: Meprobamate: To avoid oversedation, use lowest eff 1
tive dose, particularly in elderly and/or debilitated patients. Consider p • !
sibility of suicide attempts; dispense least amount of drug feasible at a j
one time. To avoid excess accumulation, use caution in patients with cc
promised liver or kidney function. Meprobamate may precipitate seizur r
in epileptics.

adverse REACTIONS: Nausea, dry mouth, other g.i. symptoms; sj
cope; one case each of severe nervousness and loss of power of cone
tration.The following side effects, which have occurred after ad ministrati
of its components alone, have either occurred or might occur when t
combination is taken. Benactyzine hydrochloride: Benactyzine hyc
chloride alone, particularly in high dosage, may produce dizziness, thouf :
blocking, a sense of depersonalization, aggravation of anxiety, or dist

The junior executive
crushed by his repeated
failure to be promoted
and anxious about
the future; complains
to you of listlessness,
early-morning
awakening.

The young widow whose
grief has persisted too
long, is pessimistic and
fearful about what lies
ahead, has lost interest in
everything; is preoccupied
with vague physical ail-
ments, has crying spells.

When mild depression
and associated anxiety
interfere with living

(meprobamate 400 mg +
benactyzine hydrochloride 1 mg)

ance of sleep patterns, and a subjective feeling of muscle relaxation,
here may also be anticholinergic effects such as blurred vision, dryness
f mouth, or failure of visual accommodation. Other reported side effects
ave included gastric distress, allergic response, ataxia, and euphoria,
/leprobamate: Central Nervous System: Drowsiness, ataxia, dizziness,
lurred speech, headache, vertigo, weakness, paresthesias, impairment of
isu'al accommodation, euphoria, overstimulation, paradoxical excite-
ment, fast EEG activity. Gastrointestinal: Nausea, vomiting, diarrhea. Car-
liovascular: Palpitations, tachycardia, various forms of arrhythmia, tran-
;ient ECG changes, syncope; also, hypotensive crises (including one fatal
:ase). Allergic or Idiosyncratic: Usually after 1-4 doses. Milder reactions:
tchy, urticarial, or erythematous maculopapular rash (generalized or
:onfined to groin). Others: leukopenia, acute nonthrombocytopenic pur-
>ura, petechiae, ecchymoses, eosinophilia, peripheral edema, adenopa-
hy, fever, fixed drug eruption with cross reaction to carisoprodol, and
:ross sensitivity between meprobamate/mebutamate and meprobamate/
:arbromal. More severe, rare hypersensitivity: hyperpyrexia, chills, angio-
leurotic edema, bronchospasm, oliguria, anuria, anaphylaxis, erythema
nultiforme, exfoliative dermatitis, stomatitis, proctitis, Stevens-Johnson
.yndrome; bullous dermatitis (one fatal case after meprobamate plus
mrednisolone). Stop drug, treat symptomatically (e.g., possible use of
spinephrine, antihistamines, and in severe cases corticosteroids). Hema-
ologic: Agranulocytosis and aplastic anemia (rarely fatal), but no causal

relationship established. Rarely, thrombocytopenic purpura. Other: Exac-
erbation of porphyric symptoms.

USUAL ADULT DOSAGE: One tablet three or four times daily, which may
be increased gradually to six tablets daily and gradually reduced to main-
tenance levels upon establishment of relief. Doses above six tablets daily
are not recommended.

OVERDOSAGE: Overdosage of ‘Deprol’ (meprobamate + benactyzine
hydrochloride) has not differed substantially from meprobamate over-
dosage: Meprobamate: Suicidal attempts with meprobamate, alone or
with alcohol or other CNS depressants or psychotropic drugs, have pro-
duced drowsiness, lethargy, stupor, ataxia, coma, shock, vasomotor and
respiratory collapse, and death. Empty stomach, treat symptomatically;
cautiously give respiratory assistance, CNS stimulants, pressor agents as
needed. Meprobamate is metabolized in the liver and excreted by the
kidney. Diuresis and dialysis have been used successfully. Carefully moni-
tor urinary output; avoid overhydration; observe for possible relapse due
to incomplete gastric emptying and delayed absorption. rev. 10/71

Before prescribing, consult package circular or latest PDR information.

WALLACE PHARMACEUTICALS, Cranbury, N.J. 08512 Wi

Rapid onset of action for
the up-tight back in pain

(including intervertebral disc)

Indications: For symptomatic relief in conditions characterized
by skeletal muscle spasm and mild to moderate pain.
Contraindications: Acute intermittent porphyria and allergic or
idiosyncratic reactions to carisoprodol or related compounds
such as meprobamate, mebutamate, tybamate.

Warnings: Idiosyncratic Reactions: Rarely, first dose has been
followed by extreme weakness, transient quadriplegia, dizziness,
ataxia, temporary vision loss, diplopia, mydriasis, dysarthria, agi-
tation, euphoria, confusion, disorientation. Symptoms usually
subside during the next several hours. Supportive and sympto-
matic therapy, including hospitalization, may be necessary.
Pregnancy and Lactation: Safe use not established; weigh poten-
tial benefits against potential hazards in pregnancy, nursing

mothers, or women of childbearing potential. Children Under I
Five: Drug not recommended. Potentially Hazardous Tasks: Driv- :|
ing a motor vehicle or operating machinery. Additive Effects: Pos- I
sible additive effects between carisoprodol, alcohol, and other
CNS depressants or psychotropic drugs. Drug Dependence: Use j
cautiously in addiction-prone patients.

Precautions: To avoid excess accumulation, use caution in pa- ;
tients with compromised liver or kidney function.

Adverse Reactions: Central Nervous System: Drowsiness, dizzi- I
ness, vertigo, ataxia, tremor, agitation, irritability, headache, de- I
pressive reactions, syncope, insomnia. Allergic or Idiosyncratic:
Usually seen after 1-4 doses in patients not previously exposed, ,
e.g., rash, erythema multiforme, pruritus, eosinophilia, fixed drug

Relax muscle spasm

Relieve associated mild-to-moderate pain

Reduce stiffness

resume

Usual adult dosage: one 350 mg tablet q.i.d

eruption with cross reaction to meprobamate. More severe mani-
festations: asthma, fever, weakness, dizziness, angioneurotic
edema, smarting eyes, hypotension, anaphylactoid shock. Stop
drug, treat symptomatically (e.g., possible use of epinephrine,
antihistamines, and in severe cases corticosteroids). Cardiovas-
cular: Tachycardia, postural hypotension, facial flushing. Gastro-
intestinal: Nausea, vomiting, hiccup, epigastric distress. Hema-
tologic: Leukopenia and pancytopenia (on carisoprodol plus
other drugs).

Usual Adult Dosage: One 350 mg tablet three times daily and at

bedtime.

Overdosage: Has produced stupor, coma, shock, respiratory de-
pression, and, very rarely, death. Overdosage of carisoprodol plus

alcohol or other CNS depressants or psychotropic drugs can be
additive. Empty stomach, treat symptomatically; cautiously give
respiratory assistance, CNS stimulants, pressor agents as needed.
Carisoprodol is metabolized in the liver and excreted by the kid-
ney. Diuresis and dialysis have been used successfully with
related drug meprobamate. Carefully monitor urinary output;
avoid overhydration; observe for possible relapse due to incom-
plete gastric emptying and delayed absorption. rev. 10/71

WALLACE PHARMACEUTICALS /Cranbury, N.J. 08512

if skin is infected,
or open to infection •••

choose the topicajs
that give your patient-

n broad antibacterial activity against
susceptible skin invaders
% lowallergenic risk— prompt clinical response

Special Petrolatum Base

Neosporin' Ointment

(polymyxin B-bacitracin-neomycin)

Each gram contains: Aerosporin® brand polymyxin B sulfate, 5000 units; J

zinc bacitracin, 400 units; neomycin sulfate 5 mg. (equivalent to 3.5 mg.
neomycin base); special white petrolatum q. s.

In tubes of 1 oz. and V2 oz. for topical use only.

\anishin£ Cream Base

Neosporinf-G Cream

(polymyxin B-neomycin-gramicidin)

Each gram contains: Aerosporin''5 brand polymyxin B sulfate, 10,000 j

units; neomycin sulfate, 5 mg. (equivalent to 3.5 mg. neomycin base); |
gramicidin, 0.25 mg., in a smooth, white, water-washable vanishing
cream base with a pH of approximately 5.0. Inactive ingredients: liquid
petrolatum, white petrolatum, propylene glycol, polyoxyethylene
polyoxypropylene compound, emulsifying wax, purified water, and 0.25%
methylparaben as preservative.

In tubes of 15 g. if

||||

NEOSPORIN for topical infections due to susceptible organisms, as in
impetigo, surgical after-care, and pyogenic dermatoses.

Precaution: As with other antibiotic preparations, prolonged use may
result in overgrowth of nonsusceptible organisms and/or fungi. Appropriate
measures should be taken if this occurs. Articles in the current medical
literature indicate an increase in the prevalence of persons allergic to
neomycin. The possibility of such a reaction should be borne in mind.

Contraindications: Not for use in the external ear canal if the eardrum is
perforated. These products are contraindicated in those individuals who
have shown hypersensitivity to any of the components.

Complete literature available on request from Professional Services

Specifically formulated with
vitamins and minerals important
in the treatment of anemia

PHASE 1

Enhanced Absorption

Each tablet provides 1 1 5 mg
elemental iron as the highly
absorbable ferrous fumarate plus 600
mg of Vitamin C.

PHASE 2

Erythrocyte Formation

Each tablet provides Vitamin B12
(25 meg) and Folic Acid (1 mg) to
replace deficiencies.

PHASE 3

Premature Hemolysis

Each tablet provides Vitamin E, which
may be involved in lessening red
blood cell fragility.

For common anemias
as well as problem ones

HEMATINIC TABLETS

Tri-Phasic Hematinic with 600 mg Vitamin C PLUS Vitamin E

Each tablet contains:
Vitamin C (Ascorbic Acid)

600 mg.

Vitamin B12 (Cobalamin
Concentrate, N.F.)

25 meg.

Intrinsic Factor Concentrate

75 mg.

Folic Acid

1 mg.

Vitamin EfcZ-AlphaTocopheryl
Acid Succinate)

30 Int. Units

Elemental Iron (as present in
350 mg. of
Ferrous Fumarate)

115 mg.

Dioctyl Sodium
Sulfosuccinate U.S.P.

50 mg.

Dosage: One Tablet Daily.
Available in Bottles of 30 Tablets.
On Your Prescription Only.

Precautions: Some patients affected with pernicious anemia may not respond to orally
administered Vitamin B12 with intrinsic factor concentrate and there is no known way to
predict which patients will respond or which patients may cease to respond. Periodic
examinations and laboratory studies of pernicious anemia patients are essential and
recommended. If any symptoms of intolerance occur, discontinue drug temporarily or
permanently. Folic acid, especially in doses above 1 mg. daily, may obscure pernipious
anemia, in that hematologic remission may occur while neurological manifestations re-
main progressive.

Adverse Reactions: G.I.: nausea, vomiting, diarrhea, abdominal pain. Skin rashes may
occur. Such reactions may necessitate temporary or permanent changes in dosage or
usage. Allergic sensitization has been reported following both oral and parenteral admin-

HEMATINIC TABLETS

Tri-Phasic Hematinic with 600 mg Vitamin C PLUS Vitamin E

Specifically formulated with vitamins and minerals
important in the treatment of anemias, plus a stool
softener to counteract the constipating effects of iron.

LEDERLE LABORATORIES

A Division of American Cyanamid Company, Pearl River, New York 1 0965 421-1

INTRODUCING

Alelhol-50

the new USV brand of
phenformin HCI

Meltrol-50 (phenformin HCI)

50 mg. timed-disintegration capsules

also MeItrol-100™

(100 mg. timed-disintegration capsules) /

Meltrol-25™(25 mg. tablets) //

/ FROM
/ THE NEW

(1SV)

USV PHARMACEUTICAL CORP.,Tuckahoe,N.Y.10707

When irritable colon feels like this

. . . in the presence of spasm or hypermotility,
gas distension and discomfort, KiNESED®
provides more complete relief :

□ belladonna alkaloids— for the hyperactive bowel
n simethicone— for accompanying distension and pain due to gas
D phenobarbital— for associated anxiety and tension

Composition: Each chewable, fruit-flavored, scored tab-
let contains: 16 mg. phenobarbital (warning: may be
habit-forming); 0.1 mg. hyoscyamine sulfate; 0.02 mg.
atropine sulfate; 0.007 mg. scopolamine hydrobromide;
40 mg. simethicone.

Contraindications: Hypersensitivity to barbiturates or
belladonna alkaloids, glaucoma, advanced renal or he-
patic disease.

Precautions: Administer with caution to patients with
incipient glaucoma, bladder neck obstruction or uri-

nary bladder atony. Prolonged use of barbiturates may
be habit-forming.

Side effects: Blurred vision, dry mouth, dysuria, and
other atropine-like side effects may occur at high doses,
but are only rarely noted at recommended dosages.
Dosage: Adults: One or two tablets three or four times
daily. Dosage can be adjusted depending on diagnosis
and severity of symptoms. Children 2 to 12 years: One
half or one tablet three or four times daily. Tablets may
be chewed or swallowed with liquids.

s

STUART PHARMACEUTICALS I Pasadena, California 91109 | Division of ATLAS CHEMICAL INDUSTRIES, INC.

(from the Greek kinetikos,
to move,

and the Latin sedatus,
to calm)

KINESED"

antispasmodic/sedative/antiflatulent

Spring peeper (tree frog, Hyla crucifer):
this small amphibian can expand
its throat membrane with air until it is
twice the size of its head.

MICHIGAN MEDICINE MARCH 1972 271

County in the spotlight

Its membership at the helm,

Genesee County Medical Society changes tack

By Jeanne Smith

Assistant, Department of Communication

New courses are being charted by the Genesee
County Medical Society as the result of detailed,
in-depth responses to a membership survey cover-
ing the society’s services to its members and the
community.

The survey came as a result of work of an ad
hoc committee to seek solutions to poor partici-
pation in society activities and lack of effective
action by what many called “paper” committees.

The membership survey was conducted last
summer under the direction of James F. Dooley,
MD, 1970-71 GCMS president, and Frederick Van-
Duyne, MD, reorganization committee chairman,
and a detailed, 26-page report of 'findings issued
in November to all members.

Here are hints
for reorganization

Support of county society membership,
both in appropriating necessary funds and in
personal participation, are absolute necessi-
ties in collecting reliable data on views of
members.

Once this support is gained and study
guidelines established on the breadth of a
study, it is time for a hard-working commit-
tee to take over and move forward.

Realistic planning to avoid unnecessary de-
lay and loss of interest is always advisable.

Assistance such as the Genesee County
Medical Society received from the General
Motors Institute is extremely helpful in plan-
ning and conducting a broad survey. The
Michigan State Medical Society Bureau of
Economic Information will assist county so-
cieties in planning surveys.

Early preparation of a report and its dis-
tribution to all participants means early action
on implementation.

Under the direction of Richard L. Rapport, MD,
now president of the society, changes are con-
tinuing toward goals expressed by the membership.

Society reorganization is progressing to gain
greater representation and participation by mem-
bers.

The former system of presidential appointment
of committees has been changed. For the first
time, members have been asked to volunteer for
service on committees in which they have a par-
ticular interest. Committee chairmen for 1972 were
elected rather than appointed by the president.

Articles of incorporation have been filed to
create a corporation to provide new services to
the community as well as to society members, a
move gaining the approval of 62 per cent of the
membership in the survey.

The society has taken on more active leader-
ship in attacking drug problems in the Flint area.

Indications for future action not only on the ac-
tivities of the Genesee County Medical Society but
on the role of the society in the community are
clearly indicated in the membership survey report.

The questionnaire, developed with the aid of the
General Motors Institute in Flint, included 80 ques-
tions covering these areas: Attitudes Toward the
Genesee County Medical Society, Services of the
Society to its Members, Services of the Society to
the Community, Society Reorganization and Future
Trends.

Membership support was shown by an appropria-
tion of $2,500 to cover cost of the survey and
participation by more than 70 per cent of the so-
ciety’s 370 members.

Questionnaires were completed in interviews
conducted by Flint public school teachers em-
ployed by the medical society and trained by the
General Motors Institute. Doctor VanDuyne’s com-
mittee made appointments for the hour-long inter-
views at each physician's convenience. The Hos-
pital Computer Center of Flint computerized sur-
vey responses for incorporation into the report in
percentage figures.

Both multiple choice and open end questions
were included, the latter specifically to provide
opportunity for expressing new ideas.

272 MICHIGAN MEDICINE MARCH 1972

IN ASTHMA optional

in EMPHYSEMA therapy

All Mudranes are bronchodilator-mucolytic in action, and
are indicated for symptomatic relief of bronchial asthma,
emphysema, bronchiectasis and chronic bronchitis. MU-
DRANE tablets contain 195 mg. potassium iodide; 130 mg.
aminophylline; 21 mg. phenobarbital (Warning: may be
habit-forming); 16 mg. ephedrine HC1. Dosage is one tablet
with full glass of water, 3 or 4 times a day. Precautions are
those for aminophylline-phenobarbital-ephedrine combina-
ations. Iodide side-effects: May cause nausea. Very long
use may cause goiter. Discontinue if symptoms of iodism
develop. Iodide contraindications: Tuberculosis; preg-
nancy (to protect the fetus against possible depression of
thyroid activity). MUDRANE-2 tablets contain 195 mg.
potassium iodide; 130 mg. aminophylline. Dosage is one tablet
with full glass of water, 3 or 4 times a day. Precautions are
those for aminophylline. Iodide side-effects and contra-
indications are listed above. MUDRANE GG tablets
contain 100 mg. glyceryl guaiacolate; 130 mg. aminophylline;
21 mg. phenobarbital (Warning: may be habit-forming);
16 mg. ephedrine HC1. Dosage is one tablet with full glass of
water, 3 or 4 times a day. Precautions are those for amino-
phylline-phenobarbital-ephedrine combinations. MUDRANE
GG-2 tablets contain 100 mg. glyceryl guaiacolate; 130 mg.
aminophylline. Dosage is one tablet with full glass of water,
3 or 4 times a day. Precautions: Those for aminophylline.
MUDRANE GG Elixir. Each teaspoonful (5 cc) contains
26 mg. glyceryl guaiacolate; 20 mg. theophylline; 5.4 mg.
phenobarbital (Warning: may be habit-forming); 4 mg. ephe-
drine HC1. Dosage: Children, 1 cc for each 10 lbs. of body
weight; one teaspoonful (5 cc) for a 50 lb. child. Dose may
be repeated 3 dr 4 times a day. Adult, one tablespoonful, 4
times daily. All doses should be followed with H to full glass
of water. Precautions: See those listed above for Mudrane
GG tablets.

MUDRANE— original formula

First choice

MUDRANE-2

When ephedrine is too exciting
or is contraindicated

MUDRANE GG

During pregnancy or when K.I. is
contraindicated or not tolerated

MUDRANE GG-2

A counterpart for Mudrane-2

MUDRANE GG ELIXIR

For pediatric use

or where liquids are preferred

Clinical specimens
available to physicians.

WILLIAM P. PO YTHRESS & COMPANY, INC , RICHMOND, VIRGINIA 23217

. CfCa ,!^^Aal?naceu/i<xzA-

MICHIGAN MEDICINE MARCH 1972 273

Zip code 48823

Doctor Hayes responds
to January MM article
on state’s medicaid program

To the Editor:

It was with a great deal of interest that I read,
“Here is Definitive Summary of Current Status of
Michigan Medicaid Program” in the January is-
sue of Michigan Medicine.

We, at Michigan Blue Shield, were particularly
pleased by Mr. Paterson’s statement that “at no
time was the ability or integrity of either individ-
uals of Blue Cross and Blue Shield or the organ-
ization as a whole questioned in any way.”

The article was concise and factual; however, it
was not complete. Since MSMS felt that Mr. Pater-
son’s remarks were important enough to be trans-
mitted to all members, we feel that they would also
be interested in further clarification of the Program
from the Michigan Blue Shield point of view. Ac-
cordingly, we request that you publish this letter in
your next issue of Michigan Medicine.

Following is some additional information and
some points of clarification:

Program Cost

An omission in the article was the failure to iden-
tify a basic cause of the rapid rise in cost of the
Medicaid Program in Michigan. We cannot speak
to the issue of hospital and nursing home costs.
However, in medical costs:

The increase was not due to the cost per serv-
ice, the frequency of service per beneficiary or in-
creased administrative cost; all these costs were
low in comparison with other states and were de-
clining during the period of Blue Shield’s adminis-
tration.

Costs did rise because of a significant increase
in beneficiaries; from the onset of the Program to
the end of 1971, the beneficiaries increased ap-
proximately 130%.

An additional cost factor was the expansion of
payable benefits to chiropractic physicians.

Information Lack

From the onset of the Program, a monthly mag-
netic tape identifying all claims paid as well as
providers and beneficiaries has been provided to
the Department of Social Services. This would
scarcely constitute a “lack of information.”
(Continued on page 276)

Group

Professional Management Offices
In These Cities

ANN ARBOR, BATTLE CREEK, BERKLEY, DETROIT,
FLINT, GRAND RAPIDS, KALAMAZOO, LANSING,
MUSKEGON, SAGINAW AND TRAVERSE CITY.

Black and Skaggs Associates
PUft System s. Incorporated

^81 North Avenue PM BUILDING Battle Creek, Michigan 49017

274 MICHIGAN MEDICINE MARCH 1972

This symbol means
both the patient and the doctor
will always be treated right.

The double-pointed red arrow is
the symbol for Blue Shield’s new
Reciprocity system. It’s a national
concept for paying claims for out-of-
area subscribers. Usual, customary
and reasonable payment will be made
directly to you only by your local Blue
Shield Plan no matter where the pa-
tient is from.

Reciprocity eliminates the need
for billing subscribers or Blue Shield
Plans from another area. No unfa-

miliar claims forms. No unnecessary
wait for payment.

Recognize Blue Shield’s Reci-
procity symbol. It points the way to
faster and more efficient payment,
because now we make the payment
first. The paperwork comes later, and
we’ll take care of that.

For complete details on just how
Reciprocity works, contact your local
Blue Shield Plan’s Professional Re-
lations Department.

Blue Shield

MICHIGAN MEDICINE MARCH 1972 275

ZIP CODE 48823/Continued

The Provider Manual proposed by the Depart-
ment of Social Services is not new; such a manual
had been developed and distributed to physicians
by Blue Shield.

The billing seminars proposed by the Department
of Social Services have been an integral part of
Blue Shield’s service to physicians.

Start Up Cost

The initial $300,000 budget item for the Touche-
Ross study does not represent the total start up
cost for the Department of Social Services. There
have been additional billings that have been con-
tested.

The already incurred start up costs are greatly
in excess of the Blue Shield start up cost, even
inclusive of modifications and improvements made.
In addition, Blue Shield was highly contributory to
the Touche-Ross study.

Fiscal Agent Choice

It is not often that a carrier finds itself in the
position of submitting a bid to an agency that is
also a bidder for a role as a fiscal agent.

A May 1971 letter to Blue Shield clearly indi-
cated that it would be the most likely carrier.

What better forum for your ideas is there
than Michigan Medicine, which monthly
reaches over 8,000 physicians? Instead of let-
ting your flashes of insight, gripes and full-
blown theories end with the hospital staff
meeting or colleagues gathered over coffee,
develop them, put them on paper and mail
them to Michigan Medicine.

Maybe you can move mountains.

Official notification of the Department of Social
Services intent was not received until approxi-
mately 10 days after the decision had been made
and was public knowledge.

Savings

$150,000 is identified as a savings anticipated by
elimination of a duplicate subscriber eligibility file.
Had the Department of Social Services established
a means of timely update direct to Blue Cross and
Blue Shield, there would have been no need for a
duplicate file.

$550,000 is identified as the anticipated savings
because of improved provider enrollment and im-
proved invoice processing. It is difficult to under-
stand how the creation of a duplicate professional
relations department for the Medicaid Program
only would result in savings. In view of our low
claims processing cost in comparison with other
Plans administering Medicaid Programs, it is diffi-
cult to understand their anticipated savings in that
activity.

Claims are made for an additional savings of
$300,000 without identification of means; this repre-
sents a large “miscellaneous” item.

Elements of the New System

The 30-day payment to physicians promised by
the Department of Social Services has already been
accomplished by Blue Shield.

The cost of the 30-day payment time will be a
3% discount of physicians’ bills.

The provider code identification on claims and
payments had already been accomplished by Blue
Shield.

Miscellaneous

We note there is no commitment to the fixed fee
schedule preferred by MSMS.

We note there is a commitment to the AMA-CPT;
what is not known is that the Department of Social
Services is also studying other procedure coding
systems.

A recent decision has been made to use the
NABSP-71-coding and nomenclature.

Improvement in any activity is desirable and nec-
essary. No group or company can survive without
such improvement. If the decision by the State to
act as its own fiscal agent in the Medicaid Program
results in quality service to needy people at low
cost, we at Michigan Blue Shield are heartily in
favor of the decision and are doing everything we
can to cooperate in a smooth transition. We wish
them well.

Sincerely,

Louis F. Hayes, MD

Senior Vice President

Medical Affairs Division

276 MICHIGAN MEDICINE MARCH 1972

Here's final word
from critics
of Halothane article

To The Editor:

We believe that some further comments are war-
ranted in reply to Drs. McDonald and Climie’s let-
ter1 of response to our criticism2 of their paper3.

Table 4 of the National Halothane Study4 does
indeed show an incidence of 1.02 per 10,000 Mas-
sive Hepatic Necrosis following Halothane anes-
thesia. It also shows an incidence of 1.7 per 10,-
000 following cyclopropane anesthesia, and an
overall incidence of 0.96 per 10,000 following any
anesthetic agent. But these are crude data. When
corrected by the authors, 73 of the total 82 cases
of Massive Hepatic Necrosis found, were attributed
to causes other than anesthesia, leaving 9 to be
accounted for. Of these 9, 7 had received Halo-
thane, and 4 of the 7 had received it within 6
weeks of the final operative procedure. The total
Halothane administrations screened was 254,989,
so at worst the incidence was 1 per 35,000. This
figure compares favorably with Slater et al’s5 1 per
32,238 Hepatic dysfunction following general anes-
thesia.

Gall6 does not imply that hepatic necrosis can be
“attributed directly to the anesthetic agent”1 indeed
his thoughtful paper poses three questions in the
summary which put such a conclusion in consider-
able doubt. Babior and Davidson7 likewise state
“through the preceding figures imply that Halo-
thane may be a cause of Massive Hepatic Necrosis
the method of case selection introduced a statis-
tical bias of unknown size that could have favored
this hypothesis. Thus the evidence for an etiolog-
ical role of Halothane, although suggestive, is by
no means conclusive.”

The papers quoted, Herber and Specht8, Keeri-
Szanto and Lafleur9, Gingrich and Virtue10 and De-
Backer and Longnecker11 all proceed the National
Halothane Study. It was in an attempt to answer
the questions raised by these and many other
authors about this time that the National Halothane
Study was instigated.

The paper by Aach12 is an example of the type
of ‘conclusion’ we are concerned about. The pa-
tient in question had two bouts of quite prolonged
hypotension, peritonitis, oliguria, atelectasis, con-
gestive cardiac failure as well as cyclopropane
anesthesia and yet Halothane is singled out as the
culprit. This despite Babior and Davidson’s7 as-
sertion that liver necrosis is most commonly as-
sociated with vascular insult. Peters et al13 include
patients who had not received Halothane in their
series. Klatskin and Kimberg14 paper concerning
the anesthetist has been ably criticized by Simp-
son, Strunin and Walton15 while both Dykes et al16
and Burns17 have reported the sequences Halo-
thane— liver dysfunction — further Halothane — no
damage.

We do not deny that “Halothane Hepatitis” is a
possibility. Indeed the studies of Van Dyke and
Chenoweth18 and several subsequent reports19’20’-
21,22,23 leave room for much speculation. However
we do not accept it as a proven entity whilst the
case is still subjudice. An excellent review of the
present position is given in “Anesthesia and the
Liver”24 edited by Dykes, wherein hepatologists,
internists, anesthesiologists, a pharmacologist and
a lawyer all evaluate the data.

As stated in our letter2 “we wish to be informed
in the published literature of any toxic or other
properties discovered” but we believe that pon-
tifications such as “Two cases are described to
illustrate the hepatotoxic potential of Halothane
and Methoxyflurane.3” when this property is by no
means proven, fail to clarify the true position.
Categoric statements of this kind tend to encour-
age edicts in patients charts forbidding Halothane
when it may be the drug of choice in prevailing
circumstances; edicts which neither help the pa-
tient nor improve inter specialty relations.

Respectfully,

T. David Seigne, MD
Henry J. Zukowski, MD
A. Michael Prus, MD
Elmer J. Seim, MD
Peter A. DelGiudice, MD
Thomas S. Morley, MD
Anesthesia Services, P.C.

4160 John R Street
Detroit 48201

REFERENCES

1. McDonald, J. M., and Climie, A. R. W., Mich-
igan Medicine, 70:1128 and 1163, 1971.

2. Seigne, T. D. et al. Michigan Medicine, 70:-
1030-1035, 1971.

3. McDonald, J. M., Nam, S. H., and Climie,
A. R. W.: “Halothane, Methoxyflurane and Hep-
atic Necrosis.” Michigan Medicine, 70:815-
820, 1971.

4. Subcommittee on the National Halothane Study
of the Committee on Anesthesia, National
Academy of Science — National Research
Council: “Summary of the National Halothane
Study. Possible Association between Halo-
thane Anesthesia and Postoperative Hepatic
Necrosis.” JAMA, 197:775-778, 1966.

5. Slater, E. M., Gibson, J. M., Dykes, M. H. M.
et al: “Postoperative Hepatic Necrosis — Its
Incidence and Diagnostic Value in Association
with the Administration of Halothane,” New
Eng. J. Med., 270:983-987, 1964.

6. Gall, E. A.: “Report of the Pathology Panel —
National Halothane Study.” Anesthesiology,
29:233-248, 1968.

7. Babior, B. M., and Davidson, C. S.: “Post-
operative Massive Liver Necrosis.” New Eng.
J. Med., 276: 645-652, 1967.

8. Herber, R. and Specht, N. W.: “Liver Necrosis
Following Anesthesia.” Arch. Intern. Med., 115:
266-272, 1965.

MICHIGAN MEDICINE MARCH 1972 277

ZIP CODE 48823/Continued

9. Keeri-Szanto, M. and Lafleur, F.: “Post anes-
thetic Liver Complications in a General Hos-
pital: A Statistical Study.” Can. Anaes. Soc. J.,
10:531-538, 1963.

10. Gingrich, T. F. and Virtue, R. W.: “Postoper-
ative Liver Damage: Is Anesthesia Involved?”
Surgery, 57:241-243, 1965.

11. DeBacker, L. J. and Longnecker, D. S.: “Pro-
spective and Retrospective Searches for Liver
Necrosis Following Halothane Anesthesia.”
JAMA, 195:157-160, 1966.

12. Aach, R. (Discussant): “Halothane and Liver
Failure.” JAMA, 211:2145-2147, 1970,

13. Peters, R. L., Edmondson, H. A., Reynolds,
T. B. et al: “Hepatic Necrosis Associated with
Halothane Anesthesia.” Am. J. Med., 47:748-
764, 1969.

14. Klatskin, G. and Kimberg, D. V.: "Recurrent
Hepatitis Attributable to Halothane Sensitiza-
tion in an Anesthetist.” New Eng. J. Med.,
280:515-522, 1969.

15. Simpson, B. R., Strunin and Walton, B.: “The
Halothane Dilemma: A Case for the Defence.”
Brit. Med. J. 4:96-100, 1971.

16. Dykes, M. H. M., Walzer, S. G., Slater, E. M.,
Gibson, J. M., and Ellis, D. S., JAMA, 193, 339,
1965.

17. Burns, T. H. S., British Medical Journal, 2,
523, 1971.

18. Van Dyke, R. A., Chenoweth, M. B.: “The Me-
tabolism of Volatile Anesthetics II in Vitro
Metabolism of Methoxyflurane and Halothane
in Rat Liver Slices and Cell Fractions.” Bio-
chem. Pharmacol. 14:604-609, 1965.

19. Van Dyke, R. A., Chenoweth, M. B.: “Metab-
olism of Volatile Anesthetics” Anesthesiology
26:348-367, 1965.

20. Cascorbi, H. F., Blake, D. A.: “Trifluroethanol
and Halothane Biotransformation in Man.”
Anesthesiology 35:493-495, 1971.

21. Cascorbi, H. F., Blake, D. A., Helrich, M.:
“Differences in Biotransformation of Halothane
in Man.” Anesthesiology 32: 119, 123, 1970.

22. Rehder, K., Forbes, J., Alter, H. et al: Halo-
thane Biotransformation in Man. A Quantitative
Study. Anesthesiology 28: 711-715, 1967.

23. Brown, B. R., Jr.: “The Diphasic Action of
Halothane on the Oxidation Metabolism of
Drugs by the Liver.” Anesthesiology 35:241-
246, 1971.

24. “Anesthesia and the Liver,” edited Dykes,
M. H. M. Boston Little, Brown & Co. 1970.

Carolina doctor
seeks contributions
to his book

To the Editor:

I am editing a book on the role of faith or reli-
gion in healing from a physician’s standpoint. Any

physician interested in contributing to this book,
please write to the following address:

Claude A. Frazier, MD

4-C Doctors Park

Ashville, N. C. 28801

Sincerely,

Claude A. Frazier, MD

How about
Michigan artwork
on MM cover?

To the Editor:

I was reviewing the most recent issue of Mich-
igan Medicine when the thought occurred to me
that we could do something to deter the emigra-
tion of medical graduates from the State of Mich-
igan through Michigan Medicine.

Couldn’t you run a feature cover story several
times a year using either a color photo or a black
and white scene that might be either typical or
unique in Michigan? The potential is endless; col-
lege campus scenes, skiing, iron or copper mines,
Greenfield Village, salt mines, etc.

Michigan Medicine can be found in hospital li-
braries, interns’ quarters, doctors’ offices, etc. Who
knows, this could attract some doctor to Michigan
who might otherwise go to Florida or California.

May I commend you on the fine publication.

Sincerely,

W. S. Jones, Jr., MD

Ed. Note: Current plans are for the May issue of
Michigan Medicine to feature a Michigan cover.

Doctor Moench
has praise

for Michigan Medicine

To the Editor:

I wish to express my appreciation for the priv-
ilege of receiving this excellent publication, Mich-
igan Medicine, especially for the medical profes-
sion.

I appraise Michigan Medicine as one of the most
successful examples of teamwork on the part of
the Publication Committee, the editorial staff and
all concerned with serving the profession with up-
to-date, concise, time-saving information and facts
in these swiftly-changing times.

I wish all of you continued success in your ef-
fort. Keep up the good work.

Sincerely,

G. Frederick Moench, MD

147 Center St.

Sanford, Mich. 48657

278 MICHIGAN MEDICINE MARCH 1972

Burroughs Wellcome Co.

Research Triangle Park
North Carolina 27709

fe/,g">C0/n

°f On?' tra, ?"<*,
Co/*'Z*'Sei
S/V.

A gratifying
announcement about
Empirin Compound
with Codeine

You may now specify up to five refills
within six months when you prescribe
Empirin Compound with Codeine
(unless restricted by state law).

It is significant in this era of increased
regulation, that Empirin Compound with Co-
deine has been placed in a less restrictive category.
You may now wish to consider Empirin with
Codeine even more frequently for its predictable
analgesia in acute or protracted pain of moderate
to severe intensity.

Empirin Compound with Codeine No. 3 contains
codeine phosphate* (32.4 mg.) gr. Vi. No. 4
contains codeine phosphate* (64.8 mg.) gr. 1.
*(' Warning— may be habit-forming.) Each tablet
also contains: aspirin gr. 3 Vi, phenacetin gr. 2 Vi,
caffeine gr. V2.

When you select this familiar antibiotic for
IV infusion you have available a broad dosage range]
that hospitalized patients may need.

Intravenous Lincocin (lincomycin
hydrochloride, Upjohn), with its 1.2 to
8 grams/ day dosage range, covers many
serious and even life-threatening
infections. Lincocin is effective in
infections due to susceptible strains of
streptococci, pneumococci, and
staphylococci. Lincocin IV therefore
can be as useful in your hospitalized
patients as its IM use has proved to be in
your office patients. As with all
antibiotics, in vitro susceptibility studies
should be performed.

1.2 to 8 grams/ day IV dosage

Most hospitalized patients with
uncomplicated pneumonias respond
satisfactorily to 1 .2 to 1 .8 grams/ day of
Lincocin IV. These doses may have to
be increased for more serious infections.

In life-threatening situations as much
as 8 grams/ day has been administered
intravenously to adults.

In usual IV doses, Lincocin (lincomycin
hydrochloride, Upjohn) should be
diluted in 250 ml or more of normal
saline solution or 5% glucose in water.
But when 4 grams or more per day is
given, Lincocin should be diluted in not
less than 500 ml of either solution,
and the rate of administration should
not exceed 100 ml/hour. Too rapid
intravenous administration of doses
ceeding 4 grams may result in
tension or, in rare instances,
cardiopulmonary arrest.

Effective gram-positive antibiotic:

Lincocin IV is effective in respiratory
tract, skin and soft-tissue, and bone

tifections caused by susceptible strains
f pneumococci, streptococci, and
taphylococci, including penicillin-
esistant strains. Staphylococcal strains
esistant to Lincocin (lincomycin
ydrochloride, Upjohn) have been
ecovered. Before initiating therapy,
ulture and susceptibility studies should
e performed. Lincocin has proved
aluable in treating patients hyper-
ensitive to penicillin or cephalosporins,
ince Lincocin does not share
ntigenicity with these compounds,
lowever, hypersensitivity reactions
ave been reported, some of these in
atients known to be sensitive to
enicillin.

Veil tolerated at infusion site: Lincocin
itravenous infusions have not
roduced local irritation or phlebitis,
'hen given as recommended. Lincocin
> usually well tolerated in patients who
re hypersensitive to other drugs.
Nevertheless, Lincocin should be used
autiously in patients with asthma or
ignificant allergies.

n patients with impaired renal function,
tie recommended dose of Lincocin
hould be reduced to 25—30% of
tie dose for patients with normal
idney function. Its safety in
regnant patients and in infants
jss than one month of age has
ot been established.

Jncocin may be used with other
ntimicrobial agents: Since Lincocin

5 stable over a wide pH range, it is
uitable for incorporation in
itravenous infusions; it also may be

administered concomitantly with other
antimicrobial agents when indicated.
However, Lincocin should not be used
with erythromycin, as in vitro antagonism
has been reported.

Lincocirr

Sterile Solution (300 mg per ml)

(lincomycin hydrochloride, Upjohn)

For further prescribing information, please see following page.

(lincomycin hydrochloride, Upjohn)

Up to 8 grams per day by IV infusion for
hospitalized patients with life-threatening infections.

Lincocin is effective in infections due to
susceptible strains of streptococci, pneumococci,
and staphylococci. As with all antibiotics,
in vitro susceptibility studies should be performed.

Each Lincomycin

preparation hydrochloride

contains: monohydrate

equivalent to
lincomycin base

250 mg Pediatric Capsule 250 mg

500 mg Capsule 500 mg

*Sterile Solution per 1 ml 300 mg

Syrup per 5 ml 250 mg

'“'Contains also: Benzyl Alcohol 9 mg; and,
Water for Injection — q.s.

Lincocin (lincomycin hydrochloride) is in-
dicated in infections due to susceptible strains
of staphylococci, pneumococci, and strepto-
cocci. In vitro susceptibility studies should
be performed. Cross resistance has not been
demonstrated with penicillin, ampicillin,
cephalosporins, chloramphenicol or the tet-
racyclines. Some cross resistance with eryth-
romycin has been reported. Studies indicate
that Lincocin does not share antigenicity
with penicillin compounds.

CONTRAINDICATIONS: History of prior
hypersensitivity to lincomycin or clindamy-
cin. Not indicated in the treatment of viral
or minor bacterial infections.

BEEN REPORTED FOLLOWING PA-
RENTERAL THERAPY . A careful inquiry
should be made concerning previous sensi-
tivities to drugs or other allergens. Safety
for use in pregnancy has not been estab-
lished and Lincocin (lincomycin hydrochlo-
ride) is not indicated in the newborn. Reduce
dose 25 to 30% in patients with severe im-
pairment of renal function.

PRECAUTIONS: Like any drug, Lincocin
should be used with caution in patients
having a history of asthma or significant
allergies. Overgrowth of nonsusceptible or-
ganisms, particularly yeasts, may occur and
require appropriate measures. Patients with
pre-existing monilial infections requiring
Lincocin therapy should be given concomi-
tant antimoniHal treatment. During pro-
longed Lincocin therapy, periodic liver
function studies and blood counts should be
performed. Not recommended (inadequate
data) in patients with pre-existing liver dis-
ease unless special clinical circumstances in-
dicate. Continue treatment of /3-hemolytic
streptococci infections for 10 days to
diminish likelihood of rheumatic fever or
glomerulonephritis.

mines available for emergency treatmei
Skin and mucous membranes— Skin rashtl
urticaria, vaginitis, and rare instances of el
foliative and vesiculobullous dermatitis ha|
been reported. Liver— Although no direct
lationship to liver dysfunction is establish
jaundice and abnormal liver function
(particularly serum transaminase) have bej
observed in a few instances. Cardiovascull
—Instances of hypotension following pare
teral administration have been reporte
particularly after too rapid IV administr
tion. Rare instances of cardiopulmonary a
rest have been reported after too rapid I
administration. If 4.0 grams or more admi
istered IV, dilute in 500 ml of fluid ai
administer no faster than 100 ml per hoi
Special senses— Tinnitus and vertigo ha1
been reported occasionally. Local reaction
—Excellent local tolerance demonstrated
intramuscularly administered Lincoc
(lincomycin hydrochloride). Reports of pa
following injection have been infrequer
Intravenous administration of Lincocin
250 to 500 ml of 5% glucose in distills
water or normal saline has produced r
local irritation or phlebitis.

WARNINGS: CASES OF SEVERE AND
PERSISTENT DIARRHEA HAVE BEEN
REPORTED AND HAVE AT TIMES
NECESSITATED DISCONTINUANCE
OF THE DRUG. THIS DIARRHEA HAS
BEEN OCCASIONALLY ASSOCIATED
WITH BLOOD AND MUCUS IN THE
STOOLS AND HAS AT TIMES RE-
SULTED IN AN ACUTE COLITIS. THIS
SIDE EFFECT USUALLY HAS BEEN
ASSOCIATED WITH THE ORAL DOS-
AGE FORM BUT OCCASION ALLY HAS

ADVERSE REACTIONS: Gastrointestinal
—Glossitis, stomatitis, nausea, vomiting. Per-
sistent diarrhea, enterocolitis, and pruritus
ani. Hemopoietic— Neutropenia, leukopenia,
agranulocytosis, and thrombocytopenic pur-
pura have been reported. Hypersensitivity
reactions— Hypersensitivity reactions such
as angioneurotic edema, serum sickness, and
anaphylaxis have been reported, sometimes
in patients sensitive to penicillin. If allergic
reaction occurs, discontinue drug. Have
epinephrine, corticosteroids, and antihista-

HOW SUPPLIED: 250 mg and 500 n
Capsules— bottles of 24 and 100. Steri
Solution. 300 mg per ml— 2 and 10 ml via
and 2 ml syringe. Syrup, 250 mg per 5 t
—60 ml and pint bottles.

For additional product information, consu
the package insert or see your Upjoh
representative.

MED B-6-S (K.ZL-7) JA71-163

The Upjohn Company
Kalamazoo, Michigan 49001

MOVE-OUT STICKY MUCUS .

In asthma, bronchitis . . .

"Many physicians use iodides intravenously when they suspect that the main
reason for airway obstruction is sticky mucus but oral iodides are more
likely to exert an expectorant action.’’1

"For the viscid sputum, potassium iodide (...preferable as enteric coated
tablets) may be best."2

Provide tastefree, well-tolerated KI in convenient SLOSOL coated tablets —

IODO- NIACIN

Each SLOSOL coated tablet contains potassium
iodide 135 mg. and niacinamide hydroiodide 25 mg.

COLE

please see next page for prescribing information —

Promote Productive Cough-

"The productive cough
serves the necessary
purpose of removing
excess mucus from
the bronchial tree.”3

”... there is clear evidence
that the loosening of the bronchial mucus
blanket must begin from within the under-
lying mucus glands where it is anchored
and not from the surface. Complications
of iodides are too occasional to avoid the
use of this valuable medication.”3

Rx Information:

INDICATIONS: The primary indication for lodo-Niacin is in any clinical
condition where iodide therapy is desired. All of the usual indications for the
iodides apply to lodo-Niacin and include:

RESPIRATORY DISEASE: The use of lodo-Niacin is indicated whenever an
expectorant action is desired to increase the flow of bronchial secretion and
thin out tenacious mucus as seen in bronchial asthma, and other chronic
pulmonary disease. lodo-Niacin has also proven of value in sinusitis, bron-
chitis, bronchiectasis, and other chronic and acute respiratory diseases
where the expectorant action of iodide is desired.

THYROID DISEASE: lodo-Niacin is indicated in any thyroid disorder due to
iodine deficiency, such as endemic goiter or hypoplastic goiter, and where
hypothyroidism is secondary to iodine deficiency. lodo-Niacin will suppress
mild hyperthyroidism completely, and partially suppress more severe hyper-
thyroid states, lodo Niacin is also of value in suppressing the symptoms of
hyperthyroidism and decreasing the size and vascularity of the thyroid gland
prior to thyroidectomy.

ARTERIOSCLEROSIS: Iodides have been reported as relieving some of the
symptoms associated with arteriosclerosis. The mechanism of action is un-
known, but the effects are documented.

OPHTHALMOLOGY: lodo-Niacin has been reported to be of value in retinal and
vitreous hemorrhages. The mechanism of action is unknown, but absorption

of the hemorrhagic areas has been observed following use of this drug. It is
also reported to be of value in reducing or removing vitreous floaters.

SIDE EFFECTS: Serious adverse side effects from the use of lodo-Niacin are
rare. Mild symptoms of iodism such as metallic taste, skin rash, mucous
memDrane ulceration, salivary gland swelling, ana gastric distress have
occurred occasionally. These generally subside promptly when the drug is
discontinued. Pulmonary tuberculosis is considered a contraindication to
the use of iodides by some authorities, and the drug should be used with cau-
tion in such cases. Rare cases of goiter with hypothyroidism have been
reported in adults who had taken iodides over a prolonged period of time,
and in newborn infants whose mothers had taken iodides for prolonged
periods. The signs and symptoms regressed spontaneously after iodides were
discontinued. The causal relationship and exact mechanism of action of
iodides in this phenomenon are unknown. Appropriate precautions should be
followed in pregnancy and in individuals receiving lodo-Niacin for prolonged
periods.

DOSAGE: The oral dose for adults is two tablets after meals taken with a
glass of water. For children over eight years, one tablet after meals with
water. The dosage should be individualized according to the needs of the
patient on long-term therapy

HOW SUPPLIEO: Cole's lodo-Niacin tablets are available in bottles of 100,
500 and 1,000. Slosol coated pink. NDC 55-6458

10 DO-NIACIN*

Each SLOSOL tablet contains potassium iodide 135 mg. and
niacinamide hydroiodide 25 mg. Sig. j'j tabs, t.i.d. p.c.

References: 1. Itkin, I H., Am Fam. Phys. 4:83, 1971. 2. Feinberg, S. M., Consultant
Sept., 1971, pg. 32. 3. Bookman, R., Ann. Allerg. 29:367, 1971.

COLE

PHARMACAL CO. INC.

St. Louis, Mo. 63108

the compound analgesic
thatcalms instead of caffeinates

In addition to pain, this patient has experienced anxiety,
fear, embarrassment, anger, and frustration. It's very
likely that these psychic factors actually accentuated his
perception of pain. Surely the last thing he needs is an
analgesic containing caffeine. A much more logical
choice is Phenaphen with Codeine. It provides a quarter
grain of phenobarbital to take the nervous "edge" off,
so the rest of the formula can control the pain more
effectively. It's no accident that the Phenaphen formu-
lations contain a sedative rather than a stimulant. Don't
you agree, Doctor, that psychic overlay is an important
factor in most of the accident cases you see?

A. H. Robins Company, Richmond, Va. /I-H-ROBINS

Phenaphen*
with Codeine

Phenaphen with Codeine Nos. 2, 3, or 4 contains: Phenobarbital
CA gr.), 16.2 mg. (warning: may be habit forming); Aspirin (2'k
gr.), 162.0 mg.; Phenacetin (3 gr.), 194.0 mg.; Hyoscyamine sulfate,
0.031 mg.; Codeine phosphate, ’A gr. (No. 2), Vi gr. (No. 3) or 1 gr.
(No. 4) (warning: may be habit forming).

Indications: Provides relief in severer grades of pain, on low
codeine dosage, with minimal possibility of side effects. Its use
frequently makes unnecessary the use of addicting narcotics.
Contraindications: Hypersensitivity to any of the components.
Precautions: As with all phenacetin-containing products, exces-
sive or prolonged use should be avoided. Side effects: Side effects
are uncommon, although nausea, constipation and drowsiness
may occur. Dosage: Phenaphen No. 2 and No. 3 — 1 or 2 capsules
every 3 to 4 hours as needed; Phenaphen No. 4 — 1 capsule every
3 to 4 hours as needed. For further details see product literature.

/TJj Phenaphen with Codeine is now classified in Schedule
Vil III, Controlled Substances Act of 1970. Available on pre-
scription and may be refilled 5 times within 6 months, unless
restricted by state law.

For upper respiratory allergies and infections including
the common cold, Dimetapp Extentabs® effectively relieve
the stuffiness, drip and congestion all night and all day
long on just one Extentab every 1 2 hours. For most patients
drowsiness or overstimulation is unlikely. /FHDOBINS

prescribing information appears on next page

A.H. Robins Company
Richmond, Va 23220

Dimetapp

Extentabs

Dimetane" (brompheniramine maleate), 12 mg . phenyl-
ephrine HCI, 15 mg ; phenylpropanolamine HCI, 15 mg

°Iq memoriam

Dimetapp Extentabs®

INDICATIONS: Dimetapp Extentabs are
indicated for symptomatic relief of aller-
gic manifestations of upper respiratory
illnesses, such as the common cold, sea-
sonal allergies, sinusitis, rhinitis, con-
junctivitis and otitis. In these cases it
quickly reduces inflammatory edema,
nasal congestion and excessive upper
respiratory secretions, thereby affording
relief from nasal stuffiness and postnasal
drip.

CONTRAINDICATIONS: Hypersensitivity
to antihistamines of the same chemical
class. Dimetapp Extentabs are contrain-
dicated during pregnancy and in children
under 12 years of age. Because of its dry-
ing and thickening effect on the lower
respiratory secretions, Dimetapp is not
recommended in the treatment of bron-
chial asthma. Also, Dimetapp Extentabs
are contraindicated in concurrent MAO
inhibitor therapy.

WARNINGS: Use in children: In infants
and children particularly, antihistamines
in overdosage may produce convulsions
and death.

PRECAUTIONS: Administer with care to
patients with cardiac or peripheral vascu-
lar diseases or hypertension. Until the
patient’s response has been determined,
he should be cautioned against engaging
in operations requiring alertness such as
driving an automobile, operating ma-
chinery, etc. Patients receiving antihista-
mines should be warned against possible
additive effects with CNS depressants
such as alcohol, hypnotics, sedatives,
tranquilizers, etc.

ADVERSE REACTIONS: Adverse reac-
tions to Dimetapp Extentabs may include
hypersensitivity reactions such as rash,
urticaria, leukopenia, agranulocytosis
and thrombocytopenia: drowsiness, lassi-
tude, giddiness, dryness of the mucous
membranes, tightness of the chest, thick-
ening of bronchial secretions, urinary
frequency and dysuria, palpitation, hypo-
tension/hypertension, headache, faint-
ness, dizziness, tinnitus, incoordination,
visual disturbances, mydriasis, CNS-
depressant and (less often) stimulant
effect, anorexia, nausea, vomiting, diar-
rhea, constipation, and epigastric dis-
tress

HOW SUPPLIED: Light blue Extentabs in
bottles of 100 and 500.

Martin S. Dubperneil, MD
Detroit

Martin Samuel Dubperneil, MD, Detroit physician
• for 55 years, died Jan. 24 at the age of 86.

Doctor Dubperneil was a graduate of the Uni-
versity of Louisville school of medicine and was
a former member of the Grace Hospital medical
staff.

Raul E. Flores, MD
Marquette

Raul E. Flores, MD, Marquette State Prison phy-
sician for eight years, died Jan. 17 at the age
of 51.

A native of Cuba, Doctor Flores came to the
U.S. in 1957. He formerly was a health officer with
the Hinds County Health Department in Jackson,
Miss. A graduate of the Havana University School
of Medicine, Doctor Flores practiced general medi-
cine in Cuba until 1957. He was a member of the
Wisconsin and Mississippi medical societies, as
well as MSMS.

Raymond B. Glemet, MD
Detroit

Raymond Bernard Glemet, MD, Detroit physician
for more than 50 years, died Jan. 25 at the age
of 87.

Doctor Glemet was born in France but lived in
Detroit 78 years. He was a graduate of the Detroit
College of Medicine. He was affiliated with Provi-
dence, St. Mary’s, Grace and Lincoln hospitals
but was retired in 1963.

Ray E. Goldner, MD
Lansing

Roy Edwin Goldner, MD, Lansing generalist
nearly 50 years, died Jan. 8 at the age of 72.

Doctor Goldner was a graduate of the Indiana
University School of Medicine and was affiliated
with St. Lawrence and Sparrow hospitals in Lans-
ing. He was past secretary of the Ingham County
Medical Society.

Winfred B. Harm, MD
Detroit

Winfred B. Harm, MD, a 50-year member of
MSMS and long-time Detroit physician, died Jan.
15 at the age of 78.

MICHIGAN MEDICINE MARCH 1972 287

IN MEMOR I AM /Continued

Anthony F. Stiller, MD
Kalamazoo

A graduate of the Detroit College of Medicine,
Doctor Harm was a generalist. He was past sec-
retary of the American Academy of General Prac-
titioners, past president of the Wayne County
Medical Society, former director of the Michigan
Medical Service and former chief of staff of Provi-
dence Hospital, Southfield.

Doctor Harm’s long and dedicated service had
also included service as an MSMS councillor and
editor of the Detroit Medical News.

Kenneth Conklin Miller, MD
Saugatuck

Kenneth Conklin Miller, MD, Saugatuck physician
for 26 years and past president of the Allegan
County Medical Society, died Jan. 14 at the age
of 55.

He was a graduate of Wayne State University
School of Medicine. He was affiliated with Holland
City and Douglas Community hospitals.

Dayton H. O’Donnell, MD
Bloomfield Township

Dayton H. O'Donnell, MD, a member of the staff
of Southfield’s Providence Hospital, died Feb. 6 at
the age of 69.

Doctor O’Donnell was a graduate of St. Louis
University school of medicine and was a surgeon.
He was a member of the American and Interna-
tional Colleges of Surgeons and was the son of
the late David O’Donnell, MD, one of the Provi-
dence Hospital founders.

Leo W. Slazinski, MD
Trenton

Detroit-area physician for nearly 50 years, Leo
W. Slazinski, MD, Trenton, died Jan. 21 at the
age of 77.

Doctor Slazinski was a life member of MSMS
and also belonged to the American Academy of
Family Physicians. He had been head of the gen-
eral practice department at Mt. Carmel Mercy
Hospital since 1942 and had been on the staff
of St. Joseph Mercy Hospital, Detroit, since 1926.

Anthony Francis Stiller, MD, Kalamazoo, former
medical superintendent at the Southwestern Michi-
gan Tuberculosis Sanatorium, died Dec. 22 at the
age of 63.

Doctor Stiller had been instrumental in the estab-
lishment of the sanatorium. He also was affiliated
with the Bronson Methodist Hospital in Kalamazoo.

A generalist, Doctor Stiller was a graduate of
Georgetown University medical school. He was a
former member of the MSMS TB Control Committee
and belonged to the National Tuberculosis Associa-
tion, the National and Michigan Trudeau Societies.

Wilbur D. Towsley, MD
Midland

Long-time Midland family physician, Wilbur D.
Towsley, MD, died Dec. 20 at the age of 74. He
was the brother of Harry A. Towsley, MD, recently-
retired chairman of the U-M Department of Post-
graduate Medical Education and chairman of the
MSMS Committee of Postgraduate Education.

Doctor Towsley had practiced in Midland for
48 years and in 1968 he received the MSMS Certifi-
cate of Commendation. He was a past president of
the Midland County Medical Association.

In 1962, the Midland Exchange Club awarded
Doctor Towsley its first “Book of Golden Deeds,”
citing him for having delivered more than 6,000
babies in the county and for helping children
and families in financial need.

Doctor Towsley served on the State Boxing
Commission in 1939 and was on the first board
of directors of the Midland Hospital Association.
He also served on the Midland City Charter Com-
mission.

Doctor Towsley was a graduate of the University
of Michigan Medical School.

Otto Von Renner, MD
Vassar

Otto Von Renner, MD, Vassar, one of Michigan’s
oldest practicing physicians at the time of his
retirement five years ago, died Dec. 23 at the
age of 98.

Doctor Von Renner, a general practitioner, had
practiced in Vassar since 1924. He was a former
teacher and a veteran of the Spanish-American
War. He was affiliated with St. Luke’s Hospital in
Saginaw.

Doctor Von Renner was a graduate of the Uni-
versity of Buffalo school of medicine and had the
reputation of attending more medical society meet-
ings than anyone in his local society. In his late
eighties, he drove to San Francisco to attend the
AMA convention.

288 MICHIGAN MEDICINE MARCH 1972

The Audi gets
the same kind of service
that keeps old VWs
on the road.

The Audi is serviced by the most fin-
icky mechanics around.

They're schooled and graded on brand
new Audis slated "For Classroom Use
Only."

(So you don't have to wonder whether
a mechanic is learning on your car instead
of ours.)

And their instructors are schooled and
graded to advise them of any new develop-

ments.

In fact, our mechanics can service an
Audi as well as Volkswagen mechanics
can service a VW.

Because your Porsche-Audi dealer is
part of the Volkswagen organization.

Mind you, we're not saying the Audi
will have the longevity of the Bug.

But then again, we're not saying it
won't.

The Audi®

Porsche Audi: a division of Volkswagen

Wood Imports, Inc.

15415 Gratiot, Detroit

Camp’s Cars, Inc. Williams Porsche Audi

2000 S. Saginaw Rd., Midland 2924 E. Grand River, Lansing

Northland Imports

U. S. 41 West, Marquette

Tom Sullivan Porsche Audi Co. Prestige Porsche Audi, Inc.

499 S. Hunter Blvd., Birmingham 2955 S. Division Ave., Grand Rapids

Traverse Motors, Inc.

1301 Garfield Ave., Traverse City

Socio • ecoriomic

Many materials

at state library

for blind, handicapped

Michigan physicians who treat the blind or oth-
ers unable to read ordinary printed materials be-
cause of handicaps should be aware of the wealth
of materials available for the handicapped through
the State Library in Lansing.

The library now has more than 92,000 books in
braille or large print and recorded on “talking
book” and magnetic tapes. In addition, the library
circulates nearly 90 magazines in braille or large
print and recorded.

Phase II price controls
to lower

Medicare payments

The Detroit NEWS published a recent assess-
ment of the effect of President Nixon’s price con-
trols on physicians treating Medicare patients. Fol-
lowing is the bulk of the article:

Doctors treating Medicare patients after July 1
will be reimbursed about $38 million less than
would have been the case if President Nixon’s
price controls had not been in effect.

Doctors who treat the nation’s 19.8 million Med-
icare patients are paid from a fund to which both
the patients and the government contribute $5.60
a month.

That payment will rise to $5.80 a month on July

1.

The fees which the government allows doctors to
collect for treating Medicare patients are based
on community standards, and during 1971 those
fees rose by 6.2 percent.

The 1971 fee schedules are important because
they are the base period which the government
used to decide what doctors can collect from
Medicare during the 12 months beginning July 1.

But instead of allowing the 6.2 percent increase
which actually took place during the base period,
the Price Commission — in a little publicized ruling
on Dec. 30 — decided to impose a 2.5 percent ceil-
ing on the 1971 increase.

Individuals in institutions, as well as those who
are independent, are eligible for the library's serv-
ices, all of them free. Each month, the Lansing fa-
cility circulates 23,000 books and magazines to
approximately 8,000 readers.

The library also loans more than 4,300 “talking
book” machines (record players), specially de-
signed for use by the blind and physically handi-
capped.

Another important service of the library is to
help blind and physically handicapped students lo-
cate textbooks, which it will have recorded by vol-
unteers if not already in a form the student can
use.

Braille materials are loaned to all eligible resi-
dents in Michigan. Large print and talking books
recorded on disc and tape, plus talking book ma-
chines are loaned by the Blind and Physically
Handicapped Library to eligible residents of Mich-
igan except those in Wayne County.

Those interested may contact the Michigan De-
partment of Education, State Library Services, Blind
and Physically Hadicapped Library, 735 E. Mich-
igan Ave., Lansing, 48913, or call (517) 353-1590.

Wayne residents may obtain all materials except
those in Braille from the Wayne County Public Li-
brary, Blind and Physically Handicapped Depart-
ment, 33030 Van Born Road, Wayne, 48184, or tele-
phone (313) 722-3000.

The handicapped person is required to apply
for the services with a certified statement of elig-
ibility.

Here's ratio
of physicians/ patients
in 10 biggest states

Since 1960, the population of the United States has
increased 12%, while the number of physicians has
increased by 28%, according to statistics released
by the MSMS Bureau of Economic Information.

A breakdown of the 10 most populous states,
with numbers of patient care physicians and the
numbers of persons per patient care physician,
follows below:

State

Population'

Patient

Care

Physicians2

Population
Per Patient
Care Physician

California

19,981,000

31,930

628

New York

18,457,000

36,000

513

Pennsylvania

11,835,000

15,170

780

Texas

11,258,000

11,380

989

Illinois

11,084,000

13,180

841

Ohio

10,796,000

12,330

876

Michigan

8,759,000

9,520

920

New Jersey

7,251,000

8,960

809

Florida

6,473,000

7,840

826

Massachusetts

5,519,000

9,350

590

1 As of December 31, 1969

2 As of December 31, 1970 (includes hospital based
physicians)

290 MICHIGAN MEDICINE MARCH 1972

Martha Griffiths
pushes health care bill
at allergists' meeting

“Dramatic changes are coming in health care in
this country . . . they are coming within the next
two or three years ... the time is now for you,
the doctors, to speak up or hold your peace here-
after,” according to Congresswoman Martha W.
Griffiths, 17th District, Detroit.

Speaking at the Jan. 12 meeting of the Michigan
Allergy Society in Detroit’s Mercy College Student
Union Building, Mrs. Griffiths alleged that “The
system we now have is unfair, unfair to the very
people who are paying the bills, and an answer —
right or wrong — will be found. The problem is too
pressing.”

The answer, she believes, is her health care bill,
which she terms a “total bill.” It also is known as
The Kennedy Plan or The Health Security Act, and
is sponsored by Senator Edward Kennedy as well
as Congresswoman Griffiths.

Her bill seeks to establish cradle-to-grave na-
tionalized insurance coverage for every U.S. resi-
dent. It would be administered by the Social Se-
curity Administration, and would replace current
government plans. It provides for doctor bills, some
dental services, institutional care and other pro-
fessional and supporting services. Money for the
plan would come from a one per cent tax on each
citizen’s first $15,000 of income, three per cent
from employers, with the government providing the
remainder. Estimated cost would be $70 billion an-
nually, which Mrs. Griffiths says is about what is
being paid now.

She reported that one of the most consistent
pushers is chiropractic. The cult’s efforts are re-
ceiving some backing — in one case as many as
50,000 letters over a short period of time — partly
because in many rural areas chiropractors are
much more readily available than medical doctors,
she said.

Mrs. Griffiths stated that under her bill the gov-
ernment would not own hospitals, would not set
fees, and would not make determinations on what
amount of money any doctor would receive. The
money would be allocated on a regional, past per-
formance basis, i.e., the amount that had been
spent earlier in the region for health care.

“Doctors themselves would control the method
of money dispersal; they would determine whether
it would be paid on fee for service or salary plan.
There would be a peer review which would be
truly meaningful, because when doctors look at the
records they would be more able than anyone else
to make a telling decision as to whether a par-
ticular doctor deserved a certain amount of money,
or whether someone else deserved it.”

Her bill, which she said is not compulsory for
doctors, would “permit all kinds of diversity in the
way medical tasks are performed. You could have
doctors practicing singly, or in groups, but it would
reward group practice” . . . with payments as out-
lined above.

Mrs. Griffiths also feels there are too few med-
ical schools in this country, and that it is uncon-
scionable to have a situation where an entire grad-
uating class of a foreign medical school charters
a plane and comes to this country to practice.

In her closing remarks to the Michigan Allergy
Society, Mrs. Griffiths repeated that a national
health plan will become law. She asked that doc-
tors assist in developing the best, fairest, and most
workable plan possible.

“The time is now for the people with the most
expertise to speak up. You doctors should make
your opinions heard now!” (C.R.S.)

Smallpox vaccinations
law now ; but new bills
pushing change

Two bills written by the Michigan Department of
Public Health to change the requirements for small-
pox vaccinations and TB skin tests are before the
Michigan legislature.

Rep. Joseph Snyder (D-St. Clair Shores) intro-
duced the bills on Feb. 9. The first would amend
Sec. 376 of the School Code so that the smallpox
immunization and TB skin test would not be re-
quired for children entering school, and the other
would give authority to the MDPH director to say
what examination and immunization requirements
are necessary for entering school children. Under
the present law, it takes an act of the legislature
to add or delete health requirements from the
code.

John L. Isbister, MD, chief, Community Health
Bureau, MDPH, expresses hope that the two bills
will be passed in the current legislative session.

They are the result of a U.S. Public Health Serv-
ice recommendation made in October that routine
smallpox vaccinations be discontinued in this
country.

The recommendation was backed by the Amer-
ican Academy of Pediatrics Committee on Infec-
tious Diseases, with the idea that the risk is now
insufficient to justify the routine primary vaccina-
tion of infants and children.

MICHIGAN MEDICINE MARCH 1972 291

Classified Advertising

$5.00 per insertion of 50 words or less, with an additional 10 cents per word in excess of 50.

PROFESSIONAL BUILDING— Spanish motif, presently
under construction for April 1972 completion.
Located on Schoenherr and 1 U/2 Mile Road, Warren,
Michigan. Suites available for lease. Excellent oppor-
tunity for physician, dental specialist, podiatrist, or
attorney, can be partitioned to suit your needs. For
information: Call (313) 755-1410.

ANN ARBOR - YPSILANTI AREA— 3 year approved,
university affiliated, psychiatric residency at mental
health center offering comprehensive services to SE
Michigan; teaching faculty and supervisors include
University of Michigan faculty, private psychiatrists
and analysts as well as hospital staff; resident’s time
divided approximately equally between didactic semi-
nars (including supervision) and clinical experience;
first year ADM and intensive treatment units; second
and third year assigned community psychiatry and/or
OPC and/or Children’s Unit; additional experience
in psychosomatic medicine, University Mental Hy-
giene Clinic and neurology. 3 years: $12,215 to
$13,893; 5 years: $13,927 to $18,708 (4th and 5th
year salaries negotiable) . Contact: W. Bogard, M.D.,
Ypsilanti State Hospital, Ypsilanti, Michigan 48197.
An equal opportunity employer.

OFFICE SPACE: Grand Haven, Michigan, located on
Lake Michigan. A clean progressive city with steady
diversified employment, close to new hospital. A fine
place to start your practice. In the most convenient
and desirable location, to be divided to suit tennant.
For picture and description, please write: Beacon
Professional Building, Beacon Blvd., Grand Haven,
Michigan 49417, or Phone (616) 842-6530, evenings
842-4939.

PROFESSIONAL INCORPORATION PROGRAMS:
estate planning, income tax reduction, HR-10 retire-
ment plans, life insurance, disability, income, invest-
ment counsel, and practice management. If you want
the best in financial and practice counseling, phone
or write Phillip Fry and Associates, 14940 Plymouth
Road, Detroit, Michigan 48227. Phone (313) 499-9044.

A FULL TIME CYTOTECHNOLOGIST needed im-
mediately ASCP or eligible. Modern, expanding clini-
cal laboratory, 460 bed general hospital. Excellent
salary, paid vacations, insurance and holidays. Write
or call collect, Personnel Department, Mr. Thornton,
Edward W. Sparrow Hospital, 1215 E. Michigan Ave-
nue, Lansing, Michigan 48912.

PHYSICIANS WANTED: Orthopedic Surgeon, Urolo-
gist. Internist and General Practitioners to establish
independent practices in upper midwest ski mecca,
famous summer resort community. Local college and
growing, year-around population of 40,000. New
acute care, general hospital will provide moving
stipend and one year’s free rent on adjacent luxurious
office suites. Milton D. Rasmussen, Administrator
Lockwood-MacDonald Hospital, Petoskey, Michigan
49770, Phone: (616) 347-3985.

EMERGENCY ROOM PHYSICIAN needed to com-
plete full-time staff of emergency facility with 24,000
visits per year; 270 bed J.C.A.H. accredited General
Hospital; Michigan License required; $38,000.00
minimum plus 4 weeks vacation; Health, Malpractice,
Life and Disability Insurance; less than 2 hours drive
to Michigan’s winter and summer recreation spots.
Send resume to Administrator: St. Mary’s Hospital,
830 S. Jefferson Avenue, Saginaw, Michigan 48601.

OUTPATIENT SERVICE STAFF PHYSICIAN with
primary responsibility for examination of applicants
to determine medical eligibility for hospitalization
and other VA benefits. 216 bed modern general
hospital with active medical and surgical services.
Salary dependent upon qualifications. Excellent
fringe benefits. Can pay moving expenses. License
any state required. Equal opportunity employer. Con-
tact: Hospital Director, Veterans Administration Hos-
pital, Fort Wayne, Indiana 46805, or call (219)
743-5431, Ext. 310.

IMMEDIATE OPENING for OB-GYN, Internal Medi-
cine, and Orthopedic specialties to establish successful
practice with 14 man multi-specialty group. Excellent
group benefits; pension plan; modern clinic facilities;
progressive community with excellent educational
system including two colleges; city population 35,000;
good recreational facilities; each specialty must be
board eligible or certified; young man with military
obligation completed. Contact: Business Manager,

The Manitowoc Clinic, 601 Reed Avenue, Manito-
woc, Wisconsin 54220.

DOCTOR, are you tired of the urban rat race, traffic
congestion, and the grind of going to two or three
separate hospitals each day? Wouldn’t you rather
live within three minutes of your hospital and 5
minutes of your office, 4 minutes from several large
lakes, and i/2 hour from a major ski area? There is
such a place in North Central Michigan, and there
is an immediate need for a board qualified or eligible
internist, pediatrician, and anesthesiologist. Help in
starting and office space are available. If you would
like further information, please, reply to box #2,
120 West Saginaw Street, East Lansing, Michigan
48823.

FOR LEASE: In the Prairie Professional Building, lo-
cated in the City of Grandville, Michigan. With the
construction of phase 3 nearly complete, we have
choice suites available. Will be developed to your
exact requirements. Suitable for medical, dental or
related professions. Also, lower level suite available
at reduced rates. Lease rentals include heat, electric,
air conditioning, snow removal, paved parking, built-
in vacuum system, music, attractive landscaping. This
location is convenient and desirable. Reply to Prairie
St. Realty Corp., 2700 28th St., S.W., Grand Rapids,
Michigan or phone (616) 538-9000 days or evenings
(616) 457-9645.

292 MICHIGAN MEDICINE MARCH 1972

CHILD PSYCHIATRY RESIDENCIES OFFERED:
MICHIGAN— ANN ARBOR, YPSILANTI: “Where
it’s at.” New Child Psychiatry residencies offered in
an innovative, established clinical program. Com-
munity Child Psychiatry, Day Treatment, Out-Patient
and Residential Treatment offer opportunities for a
variety of treatment techniques. Crisis intervention
(“life-space” interview) ; behavioral therapy, pharma-
cotherapy; individual, group and family treatment
methods; dynamic, social and developmental psychi-
atry taught. Learning by independent study, seminars,
supervised experiences. Multi-disciplinary staff in-
cluding: six child psychiatrists, pediatrician, pediatric
neurologist, psychologists, social workers, special edu-
cation teachers, speech therapists, occupational ther-
apist, recreational therapists, etc. Program affiliated
with the University of Michigan and a variety of
clinical settings including: community mental health
centers, guidance clinics, etc. Salaries negotiable. Con-
tact: Elissa P. Benedek, M.D., York Woods Center,
Box A, Ypsilanti, Michigan 48917. Phone (313)
434-3666. An Equal Opportunity Employer.

FOR SALE: Medical Equipment suitable for use by
internist or F.M.D.: X-Ray, Diathermy, examining
tables, treatment tables, instrument and supply cab-
inets, surgical instruments, cautery, centrifuge, office
furniture, steel files and many other items. Will sell
at appraised value. Reply Box #10, 120 West Sag-
inaw St., East Lansing, Mi 48823.

W HOSPITAL-MEDICAL 1

PROFESSIONAL

r PLANNING, INC }

PERSONNEL RECRUITMENT

[Alco Universal Building
l East Lansing, Michigan <

FOR

L 48823 j

HOSPITALS CUNICS UNIVERSITIES

^ 517 332-1333 ^

Administrators, Physicians,

Dept. Heads 1

PHYSICIANS— ALL SPECIALTIES

At no financial obligation, send us your resume
if you would like a fine full-time position with
one of our Clients:

HOSPITALS: Full-time Chiefs of Services, Di-
rectors of Medical Education (General
and Specialty).

MULTI-SPECIALTY CLINICS: General Practice
and all Specialties.

SINGLE-SPECIALTY GROUPS. General Practice
and all Specialties.

MEDICAL SCHOOLS: Teaching and Research
appointments — all Disciplines.

DRUG FIRMS: Basic Science and Clinical Trials
Research

INDUSTRIAL FIRMS: Employee Health Care.
COLLEGES and UNIVERSITIES: Student Health
Care.

In addition to our service to Client organizations, we
assist physicians in considering relative merits of a va-
riety of fine opportunities. No financial obligation at any
time to the candidate. Appointments can be made as
much as a year or more in advance. Send complete
resume plus your professional objectives and geographic
preferences in confidence t© Arthur A. Lepinot.

OPPORTUNITY for Internist or Family Physician to
take over thirty year old practice in splendid loca-
tion. Hospital privileges assured. Less than ten min-
utes drive to three local hospitals. Excellent hospital
and office facilities in city of 125,000 population.
Will introduce. Retiring. Reply Box #9, 120 W.
Saginaw St., East Lansing, Mi 48823.

MEDICAL SERVICE STAFF PHYSICIAN - Board
certification in Internal Medicine preferred. 216 bed
modern general hospital with active medical and
surgical services. Salary dependent upon qualifica-
tions. Excellent fringe benefits. Can pay moving
expenses. License any state required. Equal oppor-
tunity employer. Contact: Hospital Director, Veterans
Administration Hospital, Fort Wayne, Indiana 46805,
or call (219) 743-5431, Ext. 310.

Advertisers in MICHIGAN MEDICINE are
friends of the profession. By acceptmg their adver-
tising we show confidence in them, their services
and products. They help make the journal a qual-
ity publication. Please familiarize yourself with
their services and products and let them know
that you see their advertising in MICHIGAN
MEDICINE.

INDEX TO ADVERTISERS

Abbott Laboratories 233, 234

Arch Laboratories 256

Battle Creek Sanitarium 256

Bristol Laboratories 239

Brown Pharmaceuticals 241

Burroughs Wellcome & Co 264, 279

Campbell Soup Co 223

Classified Advertising 292, 293

Cole Pharmacol Co 283, 284

Colgate-Palmolive Co 247, 248, 249, 250

Flint Laboratories 228, 229, 230, 231

Geigy Pharmaceuticals 189

Hospital Planning, Inc 293

Import Motors Limited 289

Lederle Laboratories 265, 266, 267, 268

Lilly, Eli & Co 192

Mead Johnson & Co. 255

Medical Protective Co 240

Medicenter of America, Inc 294

Mercywood Hospital 253

Merrell National Laboratories 245, 246

Michigan Medical Service 275

Pfizer Laboratories 242, 243

Poythress, Wm. P 273

Professional Management 274

Robins, A. H. Co 285, 286, 287

Roche Laboratories Cover II, 185, Cover IV

Searle, G. D. & Co 224, 225

Smith, Kline & French Laboratories 190

Stratton, Ben P. Agency Cover III

Stuart Pharmaceuticals 270, 271

Upjohn Co 236, 237, 280, 281, 282

U. S. V. Pharmaceuticals 269

Wallace Laboratories . . .226, 227, 260, 261, 262, 263

Warner-Chilcott Laboratories 258, 259

Wayne State University 242

MICHIGAN MEDICINE MARCH 1972 293

When doctors speak . . .
Medicenter listens.

Medicenters are dedicated
to the finest in sub-acute pa-
tient care for short term re-
covery from illness or injury.
We recognize and practice the
fact that each of our patients
is under the supervision of his
or her personal physician.

Based upon recommenda-
tions we've received from many
physicians, we arrange and
provide for easy transfer from
hospital to Medicenter. We’re
conveniently located close to
hospital complexes. Our forms
and charts are thorough but

simplified. We have a fully-
equipped and staffed physical
therapy department. Lab, X-
ray and pharmacy services are
available.

That’s why we say “when
doctors speak. ..Medicenter lis-
tens.” May we hear from you?

Medicenter of America

775 South Main Street
Chelsea, Michigan 48118

Doctors Park
Escanaba, Michigan 49829

420 West Fifth Street
Flint, Michigan 48503

22401 Winter Drive
Southfield, Michigan 48075

294 MICHIGAN MEDICINE MARCH 1972

GSouqd Off

Amphetamines :
another magic pill
bites the dust

By Richard C. Bates, MD

Lansing

The MSMS House of Delegates, as in a number
of other state societies, has urged Michigan phy-
sicians to stop prescribing amphetamines for obes-
ity. And so another magic pill bites the dust. What
a wonderful dream it was, that the simple act of
swallowing a few pills every day could make tub-
bies tiny.

How gullible we all have been, to perpetuate the
myth of “diet” pills all these years. A glance about
the room at any medical meeting should give
ample evidence that there is no medical solution
to obesity: If there were, there would be no “fat”
doctors.

Of “fat doctors” we have, unfortunately, had
more than enough. I originally became aware of
the breed when carloads of obese Lansing women
weekly drove a hundred miles northwest to a small
town where they loaded up with multi-colored pills,
bouyed by false hopes, camaraderie, and chemical
stimulation. Shortly, a few local entrepreneurs set
up local shops for the same purpose. One was
rumored to have six practical nurses ladling out
pills from barrels even while he sojourned in Flor-
ida.

The perpetuation of these senseless and dan-
gerous practices for so long has been a verifica-
tion of Osier’s observation about man’s credulity
in embracing a pill for every ill, another example
of the tale of the Emperor’s clothes and an un-
necessary further proof that any substance or act
that changes mood is potentially habit-forming.

Fortunately, little physical harm has been done:
a few died from the combination of amphetamines,
digitalis and thyroid. Most of the patients lost
weight for a few weeks, then regained, but con-
tinued on the medications because cessation pre-
cipitated depression. In time, most of them es-
caped serious dependency and went on to new
enthusiasms: the drinking man’s diet, the grapefruit
diet, the “Air Force” (“Mayo”) diet, intestinal short
circuits, TOPS and Weight Watchers, Inc.

Moderate damage was done to our image, first,
as we all prescribed pills that didn’t work and,
then, as a few of us unintentionally created and

Doctor Bates Mr. Bush

abetted the middle-aged, middle-class, largely-fe-
male equivalent of the speed freak.

Weil, hopefully, amphetamines in Michigan medi-
cine are dead. The dream of chemical weight re-
duction has led good physicians into stranger and
more dangerous practices before now.

All the wasted money and effort, all those false
hopes will not have been expended in vain if we
remember that if a truly safe, successful remedy
for obesity comes there will be neither “fat” doc-
tors nor “fat doctors”.

New news code
adopted by MSMS
'a bold step"

By Larry Bush
Science Editor

The Ann Arbor News

The Michigan State Medical Society passed a
resolution at its recent annual meeting which
should make it easier for newsmen, including med-
ical and science writers, to provide the reading
public with information on medicine and medical
research.

This is a bold step for a medical society in view
of such restrictions as the American College of
Surgeons’ dictum that no member should give in-
formation to the news media until after it has ap-
peared in a scientific journal and been appropriate-
ly approved for release. It also goes counter to
the view of many physicians, in the past at least,
that to have their names appear in print (not the

This article is reprinted from a recent issue of
THE ANN ARBOR NEWS. It is excerpted from Mr.
Bush’s regular column, “The Science Beat.”

MICHIGAN MEDICINE MARCH 1972 295

SOUND OFF/Continued

Doctor,

your AMA- ERF
contribution is needed!

journals of course) is “advertising” and a cardinal
sin.

It has always been easier to get news media ar-
ticles from professionals in such fields as engineer-
ing and biology, for example. From a casual ob-
server’s viewpoint, jealousy between members of
the profession, has appeared to play some role in
this restriction on news by the health professions.

Of course there have always been rugged in-
dividuals in medicine who have not cared much
what their colleagues thought or the societies ad-
vocated. Their number has been growing in recent
years and the flow of information to the public
greatly speeded up.

The medical staff at Ann Arbor’s St. Joseph
Mercy Hospital and many departments at the U-M
Medical Center, with the exception of a few in-
dividuals, have always been most cooperative with
the press. But the same hasn’t been true every-
where, and in some cases even here.

A preamble to the revised code of the Michigan
State Medical Society on relations with the com-
munications media, which was brought to my at-
tention by Louis Graff, U-M director of health sci-
ence relations, points out that “an out-of-date code
of ethics” has hindered the profession from being
seen and heard.

The resolution states: “Resolved that the Mich-
igan State Medical Society encourage all physi-
cians in the state to contact the local outlets of the
various communications media and make arrange-
ments to use these media for the advancement of
information on the present system of delivery of
medical services, its cost and efficiency, as well as
the progress medicine has made in the past sev-
eral decades in promoting and improving the high
health standards prevalent today.

“These matters to be accomplished with the con-
sent of the local medical society and in accord
with its local guidelines on the use of the media.
Original and innovative ideas in carrying out this
resolution are encouraged from all individual phy-
sicians, component medical societies and public
relations committees.”

Although it is somewhat mild mannered and still
leaves the final decision on what information can
be dispensed up to the local societies, which will
probably result in spotty medical reporting, the
resolution should open up medical reporting to
some extent. But old habits die hard and some
will probably still cling to what the society calls
“out-of-date codes,” which they feel are a form of
protection of their professional image, particularly
among their colleagues.

By Mrs. Dean Carron
Michigan AMA-ERF chairman

Dear Doctor,

When you send your annual contribution to AMA-
ERF, everyone benefits. And you may deduct the
full amount from your income tax.

We hope you will name one of the Michigan
medical schools as recipient, but you may name
any medical school in the United States or Canada.
Medical school deans like AMA-ERF money. It is
not budgeted for operational expenses and can be
directed for something special such as laboratory
equipment, program enrichment or to meet the in-
flated cost of budgeted items.

Loan Guarantee Fund requests have increased
with the reduction of prime bank interest rates.
Early borrowers are starting to repay loans. Over
1,132 Michigan students have availed themselves
of this opportunity to borrow money from a bank
with repayment guaranteed by AMA-ERF. A pilot
project is afoot in California to provide interest-free
loans to needy medical students. Perhaps your
county medical society might look into something
like this for Michigan.

This fund also guarantees loans for interns and
residents though most money is borrowed by med-
ical students. The borrower is limited to $1,500
annually. Since this is a “last resort” fund, loaned
to students who cannot provide loan security, it
may make the difference between remaining in
medical school and dropping out. All loan fund
money goes in one hopper, so do not name a
medical school for a loan fund contribution.

This year the Michigan goal is $10 a member,
though many medical families give much more. The

Your AMA-ERF contribution is
most important!

Please send it to:

Mrs. Dean P. Carron
1330 Glendaloch Circle
Ann Arbor, 48104

Auxiliary fund contributions:

June 1, 1970-May 31, 1971: $28,163.01
June 1, 1971-Dec. 31, 1971: 4,268.12

296 MICHIGAN MEDICINE MARCH 1972

response to the envelopes sent from the AMA has
resulted in more envelopes. Our overall collections,
however, are very low as compared to the past
few years for this period. Only $4,268 was collected
from June 1st to December 31st.

The women of the county medical auxiliaries
work very hard to earn money for AMA-ERF. They
sell Christmas cards, stationery, In Memoriam,
Thinking of You and In Honor contribution cards,
Med-Educator “Hello Hospital” books for children,
21 -jewel Swiss movement bracelet watches and
other useful items. They hold parties, dinners, fash-
ion shows and boutique sales. County Christmas
cards raise about 40% of our total.

Let your wife’s watch be a reminder to you to
write a check for your own special support of the
American Medical Association — Education and Re-
search Foundation. The auxiliary, which is the offi-
cial collection agency for the fund does not use
any of the money for operating expenses. It is
given in total, as you direct. Make your check pay-
able to AMA-ERF Auxiliary Fund. Send it to your
county auxiliary chairman or to me.

Here are 12
dos and don'ts
for doctors in court

By J. H. Ahronheim, MD
Jackson

That most doctors do not like to testify in court
is a well known fact; some unpleasant experience
during court proceedings on one of their own
cases may be the reason for this resentment. Un-
fortunately, no courses are given in medical school
on how a doctor should conduct himself when
called upon to testify, and whatever court ex-
perience a physician might have, is usually ac-
quired the hard way.

Thus, a few hints may be helpful.

When we are witnesses in a court case, we must
realize that our testimony is apt to be favorable
to one side and damaging to the other side, and
that the attorney for the unfavorable side will use
every courtroom tactic to discredit our testimony.
By observing certain basic rules, we should be able
to hold our own and to get out of the cross exam-
ination relatively unharmed.

The following set of rules will tell us what to do
and what not to do.

1. Stick to facts. Don’t ever suppose or pre-
sume. If you use any of these words, you will
certainly be challenged. The court is interested
only in what you know, not in what you assume.

(Continued on page 298)

Doctor Ahronheim

Community physician
needs chance to learn
latest techniques

(Editor's Note: Thomas B. Wright, MD, the im-
mediate past president of the Bay-Arenac-losco
Counties Medical Society, in a recent society Bul-
letin described his visit to the new Detroit Chil-
dren's Hospital and was impressed with the "mod-
ernity of the place.” He worried about “becoming
dated and old," and offered the following com-
ments about the constant need for continuing
medical education.)

By Thomas B. Wright, MD
Immediate Past-President
Bay-Arenac-losco Counties Medical Society

“What can a middle-aged physician do in a small
community a hundred miles from the nearest siza-
able teaching centers, and with the maximum re-
sponsibilities of a lifetime, both family and practice-
wise?

Meetings and readings are obviously not the
answer. I’d like to get in there — put down a
C.V.C., pass an umbilical arterial cannula, write
the orders, maybe even scrub in at open heart
surgery — be closely involved instead of in the
gallery.

At present, while difficult, there may be a few
opportunities to do something like this, at least
for a day or two at a time; but I do wish a way
could be found making this easily possible, if not
mandatory, for all of us.

Yes, there still is a chance to modernize, catch
up, turn back the clock, in some ways — even
though now it must be by personal sacrifice and
individual effort. However, I believe that medicine
on a local level as well as in the ivory towers
must devise an entirely new plan to make this
goal more readily and completely obtainable.”

Doctor Wright

MICHIGAN MEDICINE MARCH 1972 297

SOUND OFF/Continued

2. Be well prepared for your case. If you
testify in one of your own cases, carry your
records with you and don’t hesitate to use them.
If you testify as expert witness in a case other
than your own, be sure that you are an expert,
and are well acquainted with the pertinent liter-
ature on the subject. It is most embarrassing
if you make a statement which, minutes later,
is refuted by another physician, who cites recent
medical reports contrary to yours.

3. If you are to be a witness in a case in
which you have testified at a previous hearing,
do not fail to go over your original testimony, or
you might contradict yourself at the second
hearing.

4. Never become angry while testifying. If
you feel that your temper gets the best of you,
contain yourself and force yourself to answer
quietly and to the point. Outbursts of anger are
a strike against you.

5. Never hesitate to say that you do not know.
This is one statement which can not be chal-
lenged.

6. Often you may be asked questions during
the cross examination which seem utterly ir-
relevant. Answer them but be on the alert; the
questioning attorney is just probing and is trying
to catch a weakness in your testimony.

7. Disqualify yourself from answering a ques-
tion which pertains to a field in which you have
no, or only limited, experience.

8. Refrain from exaggerated statements as to
your experience in a particular disease entity.
You may be inclined to say that you have seen
“hundreds” of these cases, and in the cross
examination it may be brought out that a dozen
or two is closer to the truth.

9. While your testimony is apt to be favorable
to one side, do not flavor it for or against either
side; just testify to the true facts. If, prior to
the trial, an attorney asks you to testify for him,
tell him honestly, if you think that your testimony
would be damaging to his case. Do not be
guided by the promise of a high fee.

10. When discussing a case on the witness
stand, place yourself in a layman’s position and
do not forget that you speak to persons who do
not understand medical lingo. Use English
words, whenever possible. Avoid even simple
terms, such as “trauma”, if you could just as
well say “injury”. Don’t say “myocardial infarc-
tion”, but “heart attack”. Don’t say “carcinoma”

but “cancer”. Don’t say “electrolyte imbalance”
but “chemical change in the fluids and tissues
of the body”.

11. Don’t make a statement about something
of which you have no personal knowledge. For
example: Never say “The deceased had knife
wounds”; how would you know it was a knife?
Simply describe the wound as to location, size
and apparent penetration. Do not say “he was
hit by a car”; say “he was struck by a blunt
force”. You must refrain from expressing hear-
say knowledge or you will certainly be chal-
lenged.

12. Never act as if you do the court a favor
by appearing. When subpoenaed you have to
come, and they know it. Your medical degree
does not immunize you against a contempt of
court charge.

As a rule, you will find that the court officials
are most cooperative with physicians. They will see
to it that you will not waste your valuable time sit-
ting around a court room, waiting to be called to
the stand. Almost invariably, they will extend to
you the courtesy of a phone call when they get
ready for your testimony. You will find that, after
some experience, appearances in court as a wit-
ness need not be sources of harrassment and hu-
miliation.

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298 MICHIGAN MEDICINE MARCH 1972

UNOFFICIAL REPORT OF THE SPRING HOUSE OF DELEGATES MEETING

FOUNDATION FOR PEER REVIEW was approved at the spring meeting of the MSMS House of Dele-
ates , March 20-21 in Detroit. The delegates approved articles of incorporation and by-
aws for the Michigan Medical Programs, Inc., and authorized the MSMS Council to implemen
t at its discretion.

HE SEVENTH DRAFT of the proposed articles was presented to the House, revised by a refer-
nce committee, and then adopted by the delegates. The full text of the articles will
ppear in the printed proceedings. The functions of the corporation, to be formed by
SMS and the Michigan Assoc, of Osteopathic Physicians and Surgeons, shall be: "To

romote, facilitate and improve peer review (a) By compiling and distributing necessary
ata to local medical foundations; (b) By serving in an advisory capacity to any regional
oundation desirous of assistance; (c) By working with any local group on an interim
asis until such a group has set up its own foundation and it is functioning adequately;
d) By carrying on pertinent foundation functions in areas where none is in operation
nd when requested by the local medical society; (e) By acting as an appellate and/or
udicial group."

N OTHER ACTION, Delegates considered 23 proposed resolutions, ranging from changes in
nternal procedures to positions on public issues.

Y RESOLUTION the House of Delegates accepted the Relative Value Study Committee Report
or 1971 without approval of the Michigan Society of Internal Medicine.

ELEGATES ALSO ADOPTED a resolution calling for MSMS to request legislation and adminis-
rative changes necessary to provide payment for the private care of Medicaid patients
ith psychiatric diagnosis by private physicians on both in-patient and out-patient
asis. Resolutions were adopted reaffirming the MSMS request to Blue Shield for payment
or elective sterilization on an in-patient or out-patient basis and, because of dis-
atisfaction with Blue Shield Forms 968 and 5505, asking the Council to consider the
easibility of a single insurance claims form which could be adapted by all third
arty carriers. Another resolution called for peer review in disputes over necessity
f hospitalization and diagnostic procedures.

NOTHER RESOLUTION ADOPTED instructs the MSMS Council to use all possible means to ac-
omplish revision of laws to encourage employment of persons who are "mildly impaired
hysically or potentially mildly disabled" by a waiver mechanism that would protect
mployers from unfair responsibility under Workmen’s Compensation Rules and Regulations,
nother resolution calls for MSMS to remind the State Board of Education and the boards
f registration of licensed therapists that programs of diagnosis and therapy for chil-
ren with neurological disabilities evolved by local boards of education must be under
he direct supervision of physicians to be within the law. Electromyographic needle
xaminations can be performed only by a licensed physician and not by a non-physician
nd later reviewed by a licensed physician.

EVERAL RESOLUTIONS DEALING WITH UTILIZATION OF FACILITIES AND COSTS of health care
ere adopted. The MSMS Council, through the Legal Affairs Committee, was instructed

to seek changes in federal and state regulations regarding payment of extended care
costs to seek remedies to situations in which less expensive extended care facilities
and nursing home services are being denied because of regulation, wording and inter-
pretation. Delegates called for the MSMS Maternal Health Committee to study rules and
policies of other states relative to the utilization of obstetrical beds for other than
obstetrical cases and to report to the fall session.

DELEGATES APPROVED MSMS SUPPORT of the intent of a bill in the State Legislature to
allow physicians to provide contraceptive assistance and counsel to teen-agers without
parental consent and MSMS support of legislation which would change the sex education
law to allow the teaching of birth control. Delegates endorsed the concept that edu-
cational programs on family planning should be made available to interested hospitalize
patients .

THE HOUSE APPROVED A RESOLUTION calling, for submission of resolutions to be considered
at future sessions 30 days prior to the commencement of the session, but authorizing
the Speaker of the House and the Committee on Rules and Order of Business to determine
which resolutions are either urgent or important and are to be received after the
deadline for presentation. Another resolution calls for setting the first session of j
future House meetings, where practicable, on the afternoon of the first day and the
scheduling of a minimum number of evening meetings, except for the Presidential inau-
gural .

THE MSMS COUNCIL was authorized to make a recommendation to the House on a request for 1
a separate charter for Gratiot County as a component medical society. An approved by- j
laws change provides that delegates elected by component medical societies be seated
at the first regularly scheduled sessions of the House following certification by
component societies. Also approved were a provision that the certified annual audit
of the MSMS be reviewed on a yearly basis by the Ways and Means Committee at the spring
session of the House. The present system of per diem reimbursement for the legislative
Doctor of the Week was continued.

RESOLUTIONS ADOPTED BY THE HOUSE relating to the AMA provide that: "The House of

Delegates of the MSMS firmly support the position that a reassessment of the AMA
structure, function and purpose is urgent at this time, in order to better represent
the physician of this country" and "MSMS meet in open session during the 1972 annual
meeting... to take testimony regarding these matters from its members, either as indi-
viduals or organizations, and that a written summary be forwarded to the AMA Council
on Long Range Planning and Development."

March 27, 1972 Vol. 71, No. 10

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

|i

MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

UNIVERSITY OF CAL
LIBRARY SCH OF MED
THIRD £ PARNASSUS AVE
SAN FRANCISCO CAL 94122

EDITOR: HERBERT A. AUER

1972 MSMS Annual Session • Detroit Hilton Hotel • Oct. 1-5

1972 MSMS Conference on Medical Aspects of High School Athletics

■

Towsley Center , Ann Arbor April 21, 1972

MICHIGAN STATE MEDICAL SOCIETY

ORIENT ADVENTURE

Two fun-filled weeks in exotic and
colorful Japan and Hong Kong.
Our complete Orient Adventure
costs much less than round trip
tourist air fare, yet includes
direct 707 private jet flights,
deluxe hotels, gourmet meals,
all the freedom of individual travel,
plus many other exclusive features.
The Orient Adventure is departing

Detroit,
July 11, 1972

Michigan State Medical Society
P. 0. Box 950

East Lansing, Michigan 48823

Enclosed is my check for $

($100 per person) as deposit.
Name

Address.

City, State.

.Zip.

□ Please send me full color brochure.

$898

plus $45
tax and service

IN ASTHMA optional

IN EMPHYSEMA therapy

All Mudranes are bronchodilator-mucolytic in action, and
are indicated for symptomatic relief of bronchial asthma,
emphysema, bronchiectasis and chronic bronchitis. MU-
DRANE tablets contain 195 mg. potassium iodide; 130 mg.
aminophylline; 21 mg. phenobarbital (Warning: may be
habit-forming); 16 mg. ephedrine HC1. Dosage is one tablet
with full glass of water, 3 or 4 times a day. Precautions are
those for aminophylline-phenobarbital-ephedrine combina-
ations. Iodide side-effects: May cause nausea. Very long
use may cause goiter. Discontinue if symptoms of iodism
develop. Iodide contraindications: Tuberculosis; preg-
nancy (to protect the fetus against possible depression of
thyroid activity). MUDRANE-2 tablets contain 195 mg.
potassium iodide; 130 mg. aminophylline. Dosage isone tablet
with full glass of water, 3 or 4 times a day. Precautions are
those for aminophylline. Iodide side-effects and contra-
indications are listed above. MUDRANE GG tablets
contain 100 mg. glyceryl guaiacolate; 130 mg. aminophylline;
21 mg. phenobarbital (Warning: may be habit-forming);
16 mg. ephedrine HC1. Dosage is one tablet with full glass of
water, 3 or 4 times a day. Precautions are those for amino-
phylline-phenobarbital-ephedrine combinations. MUDRANE
GG-2 tablets contain 100 mg. glyceryl guaiacolate; 130 mg.
aminophylline. Dosage is one tablet with full glass of water,
3 or 4 times a day. Precautions: Those for aminophylline.
MUDRANE GG Elixir. Each teaspoonful (5 cc) contains
26 mg. glyceryl guaiacolate; 20 mg. theophylline; 5.4 mg.
phenobarbital (Warning: may be habit-forming); 4 mg. ephe-
drine HC1. Dosage: Children, 1 cc for each 10 lbs. of body
weight; one teaspoonful (5 cc) for a 50 lb. child. Dose may
be repeated 3 dr 4 times a day. Adult, one tablespoonful, 4
times daily. All doses should be followed with lA to full glass
of water. Precautions: See those listed above for Mudrane
GG tablets.

MUDRANE— original formula

First choice

MUDRANE-2

When ephedrine is too exciting
or is contraindicated

MUDRANE GG

During pregnancy or when K.I. is
contraindicated or not tolerated

MUDRANE GG-2

A counterpart for Mudrane-2

MUDRANE GG ELIXIR

For pediatric use

or where liquids are preferred

Clinical specimens
available to physicians.

WILLIAM P. PO YTHRESS & COMPANY, INC , RICHMOND, VIRGINIA 23217

CfFa orf? FI rA/saA ' ^^fy(afa?neuseu£ecaFL

MICHIGAN MEDICINE APRIL 1972 299

Our leaders

MSMS Officers and Councilors

PRESIDENT

PRESIDENT-ELECT

SECRETARY

TREASURER

ASS T SECRETARY

ASS T TREASURER

SPEAKER

VICE SPEAKER

PAST PRESIDENT

AMA DELEGATION CHAIRMAN

COUNCIL CHAIRMAN

COUNCIL VICE CHAIRMAN . . .

Sidney Adler, MD Detroit

John J. Coury, MD Port Huron

Kenneth H. Johnson, MD Lansing

John R. Ylvisaker, MD Pontiac

Ross V. Taylor, MD Jackson

Ernest P. Griffin, MD Flint

Vernon V. Bass, MD Saginaw

Janies D. Fryfogle, MD Detroit

Harold H. Hiscock, MD Flint

Donald N. Sweeny, Jr., MD Detroit

Brooker L. Masters, MD Fremont

Robert M. Leitch, MD Battle Creek

COUNCILOR
DISTRICT MAP

Second District Councilor: Ross V. Taylor, MD, Jackson
Counties: Clinton, Eaton, Hillsdale, Ingham, Jackson
Third District Councilor: Robert M. Leitch, MD, Battle Creek
Counties: Branch, Calhoun, St. Joseph
Fourth District Councilor: W. Kaye Locklin, MD, Kalamazoo
Counties: Allegan, Berrien, Cass, Kalamazoo, Van Buren
Fifth District Councilor: Noyes L. Avery, MD, Grand Rapids
Counties: Barry, Ionia-Montcalm, Kent, Ottawa
Sixth District Councilor: Ernest P. Griffin, Jr., MD, Flint
Counties: Genesee, Shiawassee

Seventh District Councilor: James H. Tisdel, MD, Port Huron
Counties: Huron, Sanilac, Lapeer, St. Clair
Eighth District Councilor: William A. DeYoung, MD, Saginaw
Counties: Gratiot-Isabella-Clare, Midland, Saginaw, Tuscola
Ninth District Councilor: Adam C. McClay, MD, Traverse City

Counties: Grand Traverse-Leelanau-Benzie, Manistee, Northern Michigan (Antrim, Charlevoix,
Cheboygan and Emmet combined), Wexford-Missaukee
Tenth District Councilor: Robert C. Prophater, MD, Bay City

Counties: Alpena-Alcona-Presque Isle, Bay-Arenac-Iosco, North Central Counties, (Otsego, Mont-
morency, Crawford, Oscoda, Roscommon, Ogemaw, Gladwin and Kalkaska, combined)

Eleventh District Councilor: Brooker L. Masters, MD, Fremont

Counties: Mason, Mecosta-Osceola-Lake, Muskegon, Newaygo, Oceana
Twelfth District Councilor: Raymond Hockstad, MD, Escanaba

Counties: Chippewa-Mackinac, Delta-Schoolcraft, Luce, Marquette-Alger
Thirteenth District Councilor: Donald T. Anderson, MD, Wakefield

Counties: Dickinson-Iron, Gogebic, Houghton-Baraga-Keweenaw, Menominee, Ontonagon
Fourteenth District Councilor: Donato F. Sarapo, MD, Adrian
Counties: Lenawee, Livingston, Monroe, Washtenaw
Fifteenth District Councilor: Sydney Scher, MD, Mount Clemens
Counties: Macomb, Oakland

First District Councilors: (Wayne County)
Edward J. Tallant, MD, Detroit
Ralph R. Cooper, MD, Detroit
Frank G. Bicknell, MD, Detroit
Brock E. Brush, MD, Detroit
Louis R. Zako, MD, Allen Park

DIRECTOR

GENERAL COUNSEL

LEGAL COUNSEL

ECONOMIC CONSULTANT
SCIENTIFIC EDITOR

Warren F. Tryloff East Lansing

Lester P. Dodd Detroit

A. Stewart Kerr Detroit

Clyde T. Hardwick, PhD Houghton

John W. Moses, MD Detroit

300 MICHIGAN MEDICINE APRIL 1972

cpr&sideqt’s page

At the spring meeting of the House of Delegates
on March 20-21, 1972, the three previously-report-
ed issues were considered:

I) The House of Delegates voted to take the
necessary steps to form a separate foundation (cor-
poration) separate from the Michigan State Med-
ical Society and to negotiate with the Michigan
Society of Osteopathic Physicians and Surgeons to
form the permanent foundation. The general con-
sensus was to limit its function to peer review. The
above decision was passed by a majority; it was
not a unanimous vote of the House of Delegates.

There was much apprehension regarding H.R. I,
the so-called Bennett Amendment. This has not
passed the Congress in its final form. Politics, be
they medical or otherwise, should not be our pri-
mary motivation or consideration. Just how much
consumer representation (if any) will be required
in its final guidelines and mechanisms is unknown
at this time.

It seems to me that we should begin slowly and
avoid many of the pitfalls that several other state
and local foundations have had (litigations, etc.).
Our goal should be to upgrade the standards of
medical care and identify the needs of the public
and the medical profession in the delivery of health
care. This will necessitate careful analysis of hos-
pital, home and office care, and will require par-
ticipation by all physicians, both on teaching and
auditing levels, to understand its many facets. The
road will be hard and arduous.

Patterns and utilization review of how medicine
is practiced must be studied. It cannot be done in
a haphazard manner. The medical profession must
be informed either by seminars or workshops on
all local levels. Medicine is not an exact science
and any “cookbook approach” might turn the long
overdue project into a “paper tiger.”

There is no longer any time to delay. Failure to
accomplish its goals leaves no position but retreat.
At present, there is no way to predict whether this
approach will reduce medical costs.

II) The House of Delegates accepted the relative
value schedule without a schedule in internal med-
icine. The schedule was stated to be merely a
“guideline.” I believe this will be a fee schedule
in a short time, as one has only to add a conver-
sion factor. The fiscal impact of the schedule was
not discussed.

The Michigan Relative Value Schedule is uniform
for all physicians regardless of training and spe-
cialty. There is no area differentiation. It seems
that a differential adjustment must be made for
interns, residents, etc. A physician’s skill, expe-
rience, capability and willingness to work should
be vital factors in making any determination of
“values.”

Ill) The report of the Alexander Grant Study,
Phase II, was referred for further consideration. It
was recommended also that an AMA team be re-
quested to review the study. This, it seems, would
give a medical flavor to a medical problem.

The recommendation of Phase II including such
things as redistricting our present councillor dis-
tricts and the duties of The Council and the officers
of MSMS are some of the major concerns in this
study. A review of the study reveals that the grass-
roots members are unhappy with the present struc-
ture and functioning of our society.

There undoubtedly will be changes. It is hoped
that it will be productive and orderly after much
deliberation.

The road ahead for all of these three vital issues
will call on all physicians to participate, hopefully
on a voluntary basis.

Our goals should be to improve the delivery of
health care to all of our patients. Poor care is more
expensive than good care to all concerned. A high
standard of care is costly, but less expensive in
the long run.

MICHIGAN MEDICINE APRIL 1972 301

Coqteqts

SCIENTIFIC ARTICLES

309 Lupus Erythematosus; Leon Herschfus, DDS

317 The need for burn care facilities in Michigan; Irving
Feller, MD; Keith H. Crane, MSE; K. E. Richards, MD;
George Koepke, MD

323 The Stokes-Adams Syndrome; Robert A. O’Rourke, MD
325 Suicides: Does our society care? Jack Halick, MD

327 Attitudes toward abortion law reform at The University
of Michigan Medical Center; Durlin Hickok, AB; Colin
Campbell, MD

SPECIAL ARTICLES

307 MSMS Conference on Medical Aspects of High School
Sports

359 How six special programs deliver health care in Mich-
igan; Herbert Mehler

370 Wayne County physicians combat drug abuse
362, 373, and 386 Picture pages

OTHER FEATURES

300

Our leaders

368

Book review

301

President's page

370

County spotlight

309

Scientific papers

374

Welcome

322

Perinatal tips

376

Ancillary

326

Monthly surveillance report

397

Socio-economic

330

Your opinion please

399

In small doses

350

MSMS in action

Michigan authors

351

Michigan mediscene

400

In memoriam

359

Medical care programs

405

Sound off

366

County scenes

Publication of Michigan Medicine is under the direction
of the Publication Committee, Michigan State Medical So-
ciety. The scientific editor is responsible for the scientific
content. The managing editor is responsible for the pro-
duction, correspondence and contents of the journal. He
and the executive editor share final responsibility of the
entire publication.

Neither the editors nor the state medical society will
accept responsibility for statements made or opinions ex-
pressed by any contributor in any article or feature pub-
lished in the pages of the journal. In editorials, the views
expressed are those of the writer and not necessarily offi-
cial positions of the society.

SCIENTIFIC EDITOR

John W. Moses, MD

EXECUTIVE EDITOR

Herbert A. Auer

MANAGING EDITOR

Judith Marr

PUBLICATION COMMITTEE

Edward J. Tallant, MD
Detroit
Chairman

Robert M. Leitch, MD
Battle Creek
Donato F. Sarapo, MD
Adrian

c ^Michigari ^Mediciqe

Devoted to the interests of the medical profession and
public health in Michigan.

INFORMATION FOR CONTRIBUTORS

1. Address scientific manuscripts to the Publication Com-
mittee, Michigan State Medical Society, 120 West Saginaw
Street, East Lansing, Michigan 48823. Submit original, double-
spaced typewritten copy and two carbon copies or photo copies
on letter size (8V2 x 11 inch) paper. On page one, include
title, authors, degrees, academic titles, and any institutional or
other credits.

2. Authors are responsible for all statements, methods, and
conclusions. These may or may not be in harmony with the
views of the Editorial Staff. It is hoped that authors may have
as wide a latitude as space available and general policy will
permit. The Publication Committee expressly reserves the right
to alter or reject any manuscript, or any contribution, whether
solicited or not.

3. Illustrations should be submitted in the form of glossy
prints or original sketches from which reproductions will be
made by Michigan Medicine.

4. Articles should ordinarily be less than four printed pages
in length (3000 words).

5. References should conform to Cumulative Index Medicus,
including, in order: Author, title, journal, volume number,
page, and year. Book references should include editors, edition,
publisher, and place of publication, as well.

6. The editors welcome, and will consider for publication,
letters containing information of interest to Michigan physi-
cians, or presenting constructive comment on current contro-
versial issues. News items and notes are welcome.

7. It is understood that material is submitted for exclusive
publication in Michigan Medicine.

MICHIGAN MEDICINE is the official organ of the Michigan
State Medical Society, published under the direction of the
Publication Committee. Published Semi-Monthly, Trimonthly
in January and December; 26 issues, by the Michigan State
Medical Society as its official journal. Second class postage
paid at East Lansing, Mich, and at additional mailing offices.
Yearly subscription rate, $9.00; single copies, 80 cents. Addi-
tional postage: Canada, $1.00 per year; Pan-American Union,
$2.50 per year; Foreign, $2.50 per year. Printed in USA. All
communications relative to manuscripts, advertising, news,
exchanges, etc., should be addressed to Judith Marr, Mich-
igan State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. Phone Area Code 517, 337-1351.
© 1972 Michigan State Medical Society.

302 MICHIGAN MEDICINE APRIL 1972

rheumatoid arthritic blowup...

Tandearil Geigy

oxyphenbutazone nf tablets of 100 mg.

Important Note: This drug is not a simple analgesic.

Do not administer casually. Carefully evaluate patients
before starting treatment and keep them under close
supervision. Obtain a detailed history, and complete
physical and laboratory examination (complete
hemogram, urinalysis, etc.) before prescribing and at
frequent intervals thereafter. Carefully select patients,
avoiding those responsive to routine measures, con-
traindicated patients or those who cannot be observed
frequently. Warn patients not to exceed recommended
dosage. Short-term relief of severe symptoms with
the smallest possible dosage is the goal of therapy.
Dosage should be taken with meals or a full glass of
milk. Patients should discontinue the drug and report
immediately any sign of: fever, sore throat, oral
lesions (symptoms of blood dyscrasia); dyspepsia,
epigastric pain, symptoms of anemia, black or tarry
stools or other evidence of intestinal ulceration or
hemorrhage, skin reactions, significant weight gain or
edema. A one-week trial period is adequate. Discon-
tinue in the absence of a favorable response. Restrict
treatment periods to one week in patients over sixty.
Indications: Acute gouty arthritis, rheumatoid arthritis,
rheumatoid spondylitis.

Contraindications: Children 14 years or less; senile
patients; history or symptoms of G.l. inflammation or
ulceration including severe, recurrent or persistent
dyspepsia; history or presence of drug allergy; blood
dyscrasias; renal, hepatic or cardiac dysfunction;
hypertension; thyroid disease; systemic edema;
stomatitis and salivary gland enlargement due to the
drug; polymyalgia rheumatica and temporal arteritis;
patients receiving other potent chemotherapeutic
agents, or long-term anticoagulant therapy.

Warnings: Age, weight, dosage, duration of therapy,
existence of concomitant diseases, and concurrent
potent chemotherapy affect incidence of toxic reac-
tions. Carefully instruct and observe the individual
patient, especially the aging (forty years and over)
who have increased susceptibility to the toxicity of the
drug. Use lowest effective dosage. Weigh initially
unpredictable benefits against potential risk of severe,
even fatal, reactions. The disease condition itself is

unaltered by the drug. Use with caution in first trimes-
ter of pregnancy and in nursing mothers. Drug may
appear in cord blood and breast milk. Serious, even
fatal, blood dyscrasias, including aplastic anemia,
may occur suddenly despite regular hemograms, and
may become manifest days or weeks after cessation
of drug. Any significant change in total white count,
relative decrease in granulocytes, appearance of
immature forms, or fall in hematocrit should signal
immediate cessation of therapy and complete hema-
tologic investigation. Unexplained bleeding involving
CNS, adrenals, and G.l. tract has occurred. The drug
may potentiate action of insulin, sulfonylurea, and
sulfonamide-type agents. Carefully observe patients
taking these agents. Nontoxic and toxic goiters and
myxedema have been reported (the drug reduces
iodine uptake by the thyroid). Blurred vision can be
a significant toxic symptom worthy of a complete
ophthalmological examination. Swelling of ankles or
face in patients under sixty may be prevented by
reducing dosage. If edema occurs in patients over
sixty, discontinue drug.

Precautions: The following should be accomplished at
regular intervals: Careful detailed history for disease
being treated and detection of earliest signs of
adverse reactions; complete physical examination
including check of patient’s weight; complete weekly
(especially for the aging) or an every two week blood
check; pertinent laboratory studies. Caution patients
about participating in activity requiring alertness and
coordination, as driving a car, etc. Cases of leukemia
have been reported in patients with a history of short-
and long-term therapy. The majority of these patients
were over forty. Remember that arthritic-type pains
can be the presenting symptom of leukemia.

Adverse Reactions: This is a potent drug; its misuse
can lead to serious results. Review detailed informa-
tion before beginning therapy. Ulcerative esophagitis,
acute and reactivated gastric and duodenal ulcer
with perforation and hemorrhage, ulceration and per-
foration of large bowel, occult G.l. bleeding with
anemia, gastritis, epigastric pain, hematemesis, dys-
pepsia, nausea, vomiting and diarrhea, abdominal

distention, agranulocytosis, aplastic anemia, hemo-
lytic anemia, anemia due to blood loss including
occult G.l. bleeding, thrombocytopenia, pancytopenia,
leukemia, leukopenia, bone marrow depression, so-
dium and chloride retention, water retention and edema,
plasma dilution, respiratory alkalosis, metabolic
acidosis, fatal and nonfatal hepatitis (cholestasis may
or may not be prominent), petechiae, purpura without
thrombocytopenia, toxic pruritus, erythema nodosum,
erythema multiforme, Stevens-Johnson syndrome,
Lyell’s syndrome (toxic necrotizing epidermolysis),
exfoliative dermatitis, serum sickness, hypersensitivity
angiitis (polyarteritis), anaphylactic shock, urticaria,
arthralgia, fever, rashes (all allergic reactions require
prompt and permanent withdrawal of the drug), pro-
teinuria, hematuria, oliguria, anuria, renal failure with
azotemia, glomerulonephritis, acute tubular necrosis,
nephrotic syndrome, bilateral renal cortical necrosis,
renal stones, ureteral obstruction with uric acid crys-
tals due to uricosuric action of drug, impaired renal
function, cardiac decompensation, hypertension,
pericarditis, diffuse interstitial myocarditis with mus-
cle necrosis, perivascular granulomata, aggravation of
temporal arteritis in patients with polymyalgia rheu-
matica, optic neuritis, blurred vision, retinal hemor-
rhage, toxic amblyopia, retinal detachment, hearing
loss, hyperglycemia, thyroid hyperplasia, toxic goiter
association of hyperthyroidism and hypothyroidism
(causal relationship not established), agitation, con-
fusional states, lethargy; CNS reactions associated
with overdosage, Including convulsions, euphoria,
psychosis, depression, headaches, hallucinations,
giddiness, vertigo, coma, hyperventilation, insomnia;
ulcerative stomatitis, salivary gland enlargement.

(B) 98-146-800-E

For complete details, including dosage, please see
full prescribing information.

GEIGY Pharmaceuticals

Division of CIBA-GEIGY Corporation

Ardsley, New York 10502

TA. 8356 -9

WHAT’S

PENALTY

TRIPPING

1)11 1 1J X I I M i U.

A personal foul against the tripper, and possibly
weeks of painful skeletal muscle spasm for the
victim.

For the skeletal muscle spasm of leg strains,
Valium® (diazepam) can be a valuable adjunct. A
dose of 2-10 mg, three or four times a day, goes to
work to help break up the cycle of spasm/ pain/
spasm. The resultant relief of skeletal muscle

spasm may permit greater
mobilization of the affected
muscles and may help the
patient resume usual activities
sooner than otherwise possible.

Sudden trauma to and unusual stress on sartorius
muscle may cause strain of muscle and tearing of
some of the fibers. The resultant muscle spasm can
make leg motion painful.

Before prescribing, please consult complete product information, a summary of
which follows:

Indications: Tension and anxiety states; somatic complaints which are concomitants
of emotional factors; psychoneurotic states manifested by tension, anxiety,
apprehension, fatigue, depressive symptoms or agitation ; symptomatic relief of
acute agitation, tremor, delirium tremens and hallucinosis due to acute alcohol
withdrawal ; adjunctively in skeletal muscle spasm due to reflex spasm to local
pathology, spasticity caused by upper motor neuron disorders, athetosis, stiff-man
syndrome, convulsive disorders (not for sole therapy).

Contraindicated: Known hypersensitivity to the drug. Children under 6 months of
age. Acute narrow angle glaucoma; may be used in patients with open angle
glaucoma who are receiving appropriate therapy.

Warnings : Not of value in psychotic patients. Caution against hazardous occupations
requiring complete mental alertness. When used adjunctively in convulsive
disorders, possibility of increase in frequency and/or severity of grand mal seizures
may require increased dosage of standard anticonvulsant medication ; abrupt
withdrawal may be associated with temporary increase in frequency and / or severity
of seizures. Advise against simultaneous ingestion of alcohol and other CNS
depressants. Withdrawal symptoms (similar to those with barbiturates and alcohol)
have occurred following abrupt discontinuance (convulsions, tremor, abdominal and
muscle cramps, vomiting and sweating). Keep addiction-prone individuals under
careful surveillance because of their predisposition to habituation and dependence.

In pregnancy, lactation or women of childbearing age, weigh potential benefit
against possible hazard.

Precautions: If combined with other psychotropics or anticonvulsants, consider
carefully pharmacology of agents employed ; drugs such as phenothiazines,
narcotics, barbiturates, MAO inhibitors and other antidepressants may potentiate
its action. Usual precautions indicated in patients severely depressed, or with latent
depression, or with suicidal tendencies. Observe usual precautions in impaired renal
or hepatic function. Limit dosage to smallest effective amount in elderly and
debilitated to preclude ataxia or oversedation.

Side Effects: Drowsiness, confusion, diplopia, hypotension, changes in libido, nausea,
fatigue, depression, dysarthria, jaundice, skin rash, ataxia, constipation, headache,
incontinence, changes in salivation, slurred speech, tremor, vertigo, urinary retention,
blurred vision. Paradoxical reactions such as acute hyperexcited states, anxiety,
hallucinations, increased muscle spasticity, insomnia, rage, sleep disturbances,
stimulation have been reported; should these occur,
discontinue drug. Isolated reports

of neutropenia, jaundice; periodic / \ Roche Laboratories

blood counts and liver function tests ( ROCHE / Division ot Hoffmann -La Roche Inc

advisable during long-term therapy. \ / Nutley. N J 07110

VALIUM (diazepam)

adjunct in skeletal muscle spasm

2-mg, 5-mg, 10-mg tablets

To get the water out
in edema*

lb lower blood pressure
in hypertension*

lb spare potassium
in both

There’s

Dyazide

of triamterene) and 25 mg. of hydrochlorothiazide.

Before prescribing, see complete prescribing information in
SK&F literature or PDR.

'Indications: Edema associated with congestive heart
failure, cirrhosis of the liver, the nephrotic syndrome, late
pregnancy; also steroid-induced and idiopathic edema, and
edema resistant to other diuretic therapy. 'Dyazide' is also
indicated in the treatment of mild to moderate hypertension.

Contraindications: Pre-existing elevated serum potassium.

Hypersensitivity to either component. Continued use in pro-
gressive renal or hepatic dysfunction or developing hyper-
kalemia.

Warnings: Do not use dietary potassium supplements or
potassium salts unless hypokalemia develops or dietary
potassium intake is markedly impaired. Enteric-coated po-
tassium salts may cause small bowel stenosis with or with-
out ulceration. Hyperkalemia (>5.4 mEq/L) has been re-
ported in 4% of patients under 60 years, in 12% of patients
over 60 years, and in less than 8% of patients overall. Rarely,
cases have been associated with cardiac irregularities.

Accordingly, check serum potassium during therapy, partic-
ularly in patients with suspected or confirmed renal insuf-
ficiency (e.g., certain elderly or diabetics). If hyperkalemia
develops, substitute a thiazide alone. If spironolactone is
used concomitantly with ‘Dyazide’, check serum potassium
frequently — they can both cause potassium retention and
sometimes hyperkalemia. Two deaths have been reported in
patients on such combined therapy (in one, recommended
dosage was exceeded; in the other, serum electrolytes were
not properly monitored). Observe regularly for possible
biood dyscrasias, liver damage or other idiosyncratic reac-
lions. Blood dyscrasias have been reported in patients
receiving Dyrenium (triamterene, SK&F). Rarely, leukopenia,
thrombocytopenia, agranulocytosis, and aplastic anemia

have been reported with the thiazides. Watch for signs of
impending coma in acutely ill cirrhotics. Thiazides are
reported to cross the placental barrier and appear in breast
milk. This may result in fetal or neonatal hyperbilirubinemia,
thrombocytopenia, altered carbohydrate metabolism and
possibly other adverse reactions that have occurred in the
adult. When used during pregnancy or in women who might
bear children, weigh potential benefits against possible
hazards to fetus.

Precautions: Do periodic serum electrolyte and BUN deter-
minations. Do periodic hematologic studies in cirrhotics with
splenomegaly. Antihypertensive effects may be enhanced in
postsympathectomy patients. The following may occur:
hyperuricemia and gout, reversible nitrogen retention, de-
creasing alkali reserve with possible metabolic acidosis,
hyperglycemia and glycosuria (diabetic insulin requirements
may be altered), digitalis intoxication (in hypokalemia). Use
cautiously in surgical patients. Concomitant use with antihy-
pertensive agents may result in an additive hypotensive
effect.

Adverse Reactions: Muscle cramps, weakness, dizziness,
headache, dry mouth; anaphylaxis; rash, urticaria, photo-
sensitivity, purpura, other dermatological conditions; nausea
and vomiting (may indicate electrolyte imbalance), diarrhea,
constipation, other gastrointestinal disturbances. Rarely,
necrotizing vasculitis, paresthesias, icterus, pancreatitis, and
xanthopsia have occurred with thiazides alone.

Supplied: Bottles of 100 capsules.

SK&F CO.

Carolina, P.R. 00630

a subsidiary of Smith Kline & French Laboratories

DZ-106

Friday, April 21, 1972

Towsley Center

The University of Michigan

Ann Arbor

1972 Conference
On Medical Aspects
Of High School Sports

Here is the complete program:

9-9:30 a.m. Registration

9:45-10:15 a.m. “Athletic Injuries of the Hand’’
Dean Lewis, MD, orthopaedic surgeon, U-M Med-
ical Center

10:15-10:45 a.m. “Triage and Evaluation of the In-
jured Athlete"

Joseph S. Torg, MD, orthopaedic surgeon, Tem-
ple University Medical School, Philadelphia

10:45-11:15 a.m. “Follow-up Study on Injury as a
Result of Blocking at the Knee”

Thomas Peterson, MD, orthopaedic surgeon, Ann
Arbor

Sponsored by the Michigan State Medical So-
ciety; Michigan chapter, American College of Emer-
gency Physicians, and the University of Michigan
Towsley Center.

High school team physicians, coaches and train-
ers will hear experts in the medical care of the
athlete at the Seventh Annual Conference on the
Medical Aspects of High School Sports April 21
at Towsley Center for Continuing Medical Educa-
tion, The University of Michigan.

This year’s conference is planned in conjunction
with the annual U-M Conference for High School
football coaches and trainers April 21-22, which
will be followed by the annual U-M Spring Foot-
ball Game Saturday afternoon, April 22.

Interested persons must pre-register for the
luncheon, at a total cost of $4.50 for program and
meal. (See coupon below) The fee is $2 for pro-
gram only.

11:45-1 p.m. Luncheon — Towsley Center

1- 1:30 p.m. “Effects of Shoe Type and Cleat
Length on Incidence and Severity of Knee In-
juries Among High School Football Players"
Joseph S. Torg, MD

1:30-2 p.m. Demonstrations of techniques in diag-
nosing knee injuries

2- 2:30 p.m. Rehabilitation techniques in acute and
chronic knee injuries

Lindsey McLean, RPT, head trainer, U-M

2:30-3:30 p.m. Panel discussion — “Treatment of
Knee Injuries”

Moderator: William Redmon, MD, Midland
Participants:

Conservation treatment — James Feurig, MD, team
physician, Michigan State University
High school team physician’s viewpoint — Robert
Evans, MD, Sturgis

Operative treatment — Joseph Torg, MD
Coaches’ viewpoint — Paul Cummings, line coach
and defensive coordinator, Plymouth High School
Trainer’s viewpoint — Lindsey McLean, RPT

REGISTRATION FORM

Return to; MEDICAL ASPECTS OF HIGH SCHOOL SPORTS
Department of Postgraduate Medicine
The University of Michigan Medical Center
Towsley Center for Continuing Medical Education
Ann Arbor, Michigan 48104

NAME

ADDRESS

CITY STATE ZIP

I would like tickets for the luncheon and program on April 21. (Total cost $4.50)

SEND CHECK PAYABLE TO THE UNIVERSITY OF MICHIGAN

1

MICHIGAN MEDICINE APRIL 1972 307

V-CillinK”Pediatric

potassium

phenoxymethyl Additional information

, , available to the

profession on request.

UUlllUIIIII Eli Lilly and Company

” Indianapolis, Indiana 46206

*Based on Lilly selling price to wholesalers.

308 MICHIGAN MEDICINE APRIL 1972

Scieqtffic papers

Lupus erythematosus

By Leon Herschfus, DDS
Detroit

Lupus Erythematosus, a disease of probable auto-
immune pathogenesis, is a chronic, dystrophic, de-
generative connective tissue illness with protean
clinical manifestations.

All collagen disorders have one feature in com-
mon; i.e., the clinical signs and symptoms are the
result of connective tissue injury.1 Since skin and
mucous membrane consist primarily of this sub-
stance, there are dermal and oral manifestations
of collagen diseases. Some cutaneous signs are spe-
cific for these entities, and other findings merely
suggest the presence of a connective tissue abnor-
mality.

The above collagen disease concept, dating back
to Klemperer, is not supported by present data,
but it serves a useful purpose in the presentation
of the cutaneous and oral manifestations. In ac-
tuality, lupus erythematosus is a classic prototype
of auto-immune diseases characterized by a con-
stellation of autoantibodies against numerous com-
ponents of the body.

The disease is usually described as occurring in
two forms:

1) Chronic or discoid lupus erythematosus (cu-
taneous) .

2) Systemic or disseminated erythematosus (vis-
ceral) with its acute, subacute and chronic
varieties.

Although the cutaneous and visceral forms ap-
pear related, the clinical course, pathology and
prognosis differ markedly.

CHRONIC DISCOID LUPUS is essentially a
cutaneous disorder which usually affects the face
involving cheeks and bridge of the nose, resulting

Doctor Herschfus is chief, Department of Den-
tal Surgery, Mount Carmel Mercy Hospital and
Medical Center in Detroit.

in a “butterfly” distribution (Fig. 1). However, the
process is not limited to this area and may in-
volve other zones of the face, oral mucous mem-
branes, lips, scalp, ears, neck, chest and extrem-
ities. The lesions usually occur as erythematous,
greasy, scaling plaques with focal atrophy, follicu-
lar plugging and telangiectasia. These processes
are sharply defined, i.e., discoid.

If the cutaneous involvement is widespread, the
term “chronic disseminated discoid lupus” is com-
monly used. Except for the cutaneous lesions, this
form of lupus erythematosus is usually asympto-
matic. Exacerbations and extensions of the lesions
may occur, especially in the spring and summer,
because of exposure to sunlight.

Fig. 1. Typical "butterfly” pattern of
Lupus Erythematosus with lower lip
involvement. Through courtesy of Alice
Palmer, MD.

MICHIGAN MEDICINE APRIL 1972 309

LUPUS ERYTHEMATOSUS/Continued

Fig. 2. Moderately enlarged hyperemic kidneys
with petechial hemorrhages on subcapsular sur-
faces.

• i

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V .• \,

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■ . x J>%

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**/

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Fig. 3. Kidney revealing proliferative glomeruli-
tis and wire loop capillaries.

Fig. 4. Skin showing liquefaction degeneration
of basal cells and lymphocytic infiltration of
dermis compatible with diagnosis of Lupus
Erythematosus.

Fig. 5. Smear revealing multiple L.E. cells.

310 MICHIGAN MEDICINE APRIL 1972

About 25% of the patients with chronic lupus
erythematosus have oral lesions,2-3-4’5 which usually
coexist with the cutaneous manifestations. Occa-
sionally the oral mucosal lesions may precede the
dermal eruption. The buccal mucosa and ver-
milion border are the areas most often involved.6-7
The lips, particularly the lower lip (Fig. 1), are
frequently affected.8

DISSEMINATED LUPUS ERYTHEMATOSUS
is characterized by severe systemic symptoms since
the involvement is more widespread. It is a dis-
ease of connective tissue and small blood vessels,
and may involve any organ, but in particular, the
kidney and heart (Figs. 2 and 3). Formerly it was
considered as a cutaneous disease, but now the con-
dition is recognized and diagnosed without cu-
taneous manifestations. The clinical pattern is usu-
ally quite variable since one organ may be in-
volved at a time, or different organs may be in-
volved at different times, or simultaneously.

The picture is dominated by severe symptoms
of fever, weight loss, pain in muscles and joints as
well as blood changes such as anemia, leukopenia
and hypergammaglobulinemia.9 In addition, muco-
cutaneous lesions, subcutaneous nodules, photo-
sensitivity,10-11 generalized lymphadenopathy and
cardiac, pulmonary, pleural, hepatic, gastrointest-
inal, ocular and renal involvement may occur. The
above manifestations may be symptoms and signs
seen at various times in multiple combinations.

Systemic lupus erythematosus in its acute form
may be a fulminating disease with death occurring
within a few weeks. Patients with subacute or
chronic systemic lupus may live a few years or
longer. Death is usually due to renal insufficiency,
intercurrent pulmonary infection in a weakened
patient, or cardiac involvement and heart failure.

Oral lesions in disseminated lupus erythematosus
are more pronounced with a greater tendency to
bleeding and ulceration, particularly in the acute
phase of the disease.12

This disorder has a predilection for females be-
tween puberty and menopause, but the dissem-
inated form may affect children, newborns13 -14-15
and postmenopausal women, as shown in our case
report. In children, the peak incidence is between
10-13 years of age.16 In adults, the peak incidence
is during the child-bearing age.

Pathology

The characteristic histologic findings in lupus
erythematosus are fibrinoid degeneration, mucoid
degeneration, acute vasculitis and collagenous fi-
brosis and hyalinization. Any organ in the body
can be affected, causing an array of clinical and
laboratory signs, symptoms and findings.17-18-19

The concept that discoid and systemic lupus

erythematosus are different entities has been pro-
moted in textbooks for decades, but recent evi-
dence indicates that the two processes are merely
different manifestations of the same basic disorder.
An array of antinuclear antibodies are found in
both varieties.20 One cannot determine from the
clinical or histologic examination of a discoid-
appearing lesion whether or not there is systemic
involvement. Only the history, physical examina-
tion and laboratory findings will settle that point
of diagnosis.

In the discoid variety, the epidermis undergoes
alternating achnthosis and atrophy associated with
local liquefaction necrosis of the basal cell layer.
Conical keratotic plugs and sebaceous atrophy may
occur. The latter is one of the earliest follicular
changes in the pilosebaceous follicles (Fig. 4). The
dermis reveals hyperemic changes of the papillary
and subpa pillary layers with dense collections of
lymphocytes and melanophores in the upper and
midportions. This lymphocytic infiltrate is the
most prominent dermal sign and may be diffusely
scattered through all layers of the dermis.21 In the
latter stage, there is focal destruction of elastic
fibers resulting in a merging of collagenous and
elastic fibers, a feature of considerable diagnostic
value in chronic lupus erythematosus.

It must be emphasized that the histopathologic
changes observed in the skin and mouth are non-
specific and lack of specificity of cutaneous lesions
may well be a reflection of the limited number of
ways in which the skin and connective tissues can
react to injury.

Pinkus states: “Lupus erythematosus of the oral
mucosa cannot be differentiated from lichen pla-
nus with any degree of assurance.”22 Actually, the
epidermal changes are similar to those of lichen
planus. However, keratotic plugging is usually ab-
sent from lesions of the buccal mucosa and tongue.

As with the discoid variety, we find the above
alterations in the systemic lupus erythematosus as
changes occur in the connective tissue at multiple
sites and origins. The heart, kidneys, vessels, skin,
pericardial and pleural surfaces, lungs and lym-
phoid tissues are chiefly affected.

The finding of L.E. cells in a patient suspected
of having systemic lupus is strong supportive evi-
dence of such a diagnosis. The L.E. cells were
first described in bone marrow by Hargraves, Rich-
mond and Morton.23 Ultimately, as technics im-
proved, the peripheral blood was found suitable
for such testing (Fig. 5). Hargraves’ initial work
and subsequent modification of the L.E. test by
Haserick, Lewis and Bortz24 and Zinkham and
Conley,25 gave us a procedure which is a landmark
in the diagnosis and treatment of lupus erythema-
tosus disseminatus, since this test is routinely nega-
tive in patients with discoid lupus erythematosus.

MICHIGAN MEDICINE APRIL 1972 311

LUPUS ERYTHEMATOSUS/Continued

Fig. 6. Deep ulceration on left lateral margin
of the tongue.

Fig. 8. Elbow with ulceration and slightly under-
mined edges.

Fig. 7. Fingertips with evidence of arthritic de-
formities and erythema. Note ulcerations on
knuckles.

Fig. 10. Eroded bluish-red lesion on the buccal
mucosa of left cheek near the commissure.

Fig. 9. Crusted areas on lips.

312 MICHIGAN MEDICINE APRIL 1972

However, L.E. cells may be observed in patients
with pernicious anemia, hemolytic anemia, peri-
arteritis nodosa, dennatomyositis, scleroderma,
drug hypersensitivity, rheumatoid arthritis, hepa-
titis and hydralazine syndrome. L.E. phenomenon
is usually diagnostic of disseminated lupus erythe-
matosus. Repeated L.E. tests are positive in ap-
proximately 75-100% of patients who have clin-
ically typical cases. A single random test will only
be positive in 25-40% of systemic lupus cases. The
formation of the L.E. cell in patients with systemic
lupus is dependent upon the presence of the L.E.
plasma factor, which is known to be a 7S gamma
globulin. It has the characteristics of antibody
globulin and the antigen with which it reacts is
closely associated with nuclear deoxyribonucleo-
protein (histone + deoxyribonucleic acid) . The
manner in which the formation of the L.E. cell
factor is stimulated is not fully understood. With
multiple abnormal antibodies, a disturbance of the
antibody-forming tissue has been substantiated
with genetic and acquired factors playing a role.

As a result of systemic involvement, approxi-
mately 75% of cases will show a normocytic, nor-
mochromic anemia secondary to mild-moderate
bone marrow depression. In addition, a hemor-
rhagic diathesis may develop producing an ac-
quired hemolytic anemia. Leukopenia is present
in over half of the patients, apparently associated
with leuko-agglutinins. “Idiopathic” thrombocyto-
penic purpura is not uncommonly found in lupus
erythematosus and splenectomy may cause an
exacerbation of the disease. The evidence of false
serologic tests for syphilis has been reported in
nearly 50%, depending on the source of the pop-
ulation under examination. This finding is correct
prior to the introduction of the Treponema im-
mobilization and Treponema pallidum Comple-
ment tests, which are not widely used in the de-
tection of syphilis.

Case Report

A.C., white female, widow

Chief Complaint:

Painful sore tongue with a burning sensation
making chewing difficult and painful for four
months. Ease of fatigue and generalized malaise of
six months duration.

Present Illness:

Patient developed a painful lesion on the tongue
(Fig. 6) and a sore throat several months ago and
consulted a physician who treated her with anes-
thetic troches and penicillin for about three
months. She was referred to her dentist for pos-
sible irritation to the tongue. Since patient did not

respond to prescribed therapy, she was referred to
my office. At this time, she was slightly hoarse.

Past History:

Medical: a) Hypertension for the past 12 years.

b) Skin rash on face for the past six-
eight months was treated with a
cortisone ointment.

c) Arthritis without deformities for
the past three years.

Surgical: Hemorrhoidectomy and appendectomy.

Family History:

Patient has three children in good health. Hus-
band is a severe cardiac and alcoholic.

Habits:

Noncontributory.

Physical Examination:

Examination revealed a well developed, acutely
ill, feverish, elderly white female who appeared
very apprehensive. Temperature was 99.2; pulse
86; blood pressure 130/80.

Skin: Erythematous lesions on face, back of neck
and arms. Scaly non-pruritic patches were noted
on the ears. The typical “butterfly” pattern across
the bridge of the nose and malar eminences was
absent. Fingertips showed erythema with some
arthritic deformities. The hands disclosed some
ulceration on the knuckles (Fig. 7). Erythematous
lesions on elbows (Fig. 8) and knees are more prom-
inent associated with ulcerations having under-
mined edges.

Mouth: Normally shaped lips but both, especial-
ly the lower, showed crusted areas (Fig. 9). Sev-
eral upper and lower teeth were missing and not
replaced by prosthesis. Normal amount of calculus
was present.

Tongue was red and showed a deep ulceration
on the left side which was rather painful to pres-
sure (Fig. 6). The left cheek near the commissure
revealed an eroded bluish-red lesion (Fig. 10).

Clinical Impression:

It was obvious that the oral manifestations were
only one facet of a complex systemic condition.
The debilitated condition, arthritis, cutaneous and
mucous membrane erythematous lesions, fever and
the scaly rash on the ears, suggested the diagnosis
of Erythema Multiforme, Moniliasis, Lupus Ery-
thematosus (Disseminatus) or Pemphigus.

MICHIGAN MEDICINE APRIL 1972 313

LUPUS ERYTHEMATOSUS/Continued

Fig. 11-B. Cutaneous biopsy showing central
focal area of liquefaction degeneration of col-
lagen and abundant chronic inflammatory ele-
ments in adjacent connective tissues. Note
pseudomembrane formation of the basal cell
layer of epithelium.

Treatment:

a) Capsules B Complex with Vitamin C, one
t.i.d

b) Alkaline mouthwash.

c) Regular diet, free of spicy foods, served at
moderate temperatures.

Laboratory Data:

Smear and culture from tongue revealed mo-
nilia albicans.

Treatment

After Bacteriologic Studies
Were Obtained:

a) Capsules B Complex with Vitamin C, one
t.i.d

b) Alkaline mouthwash.

c) Regular diet, free of spicy foods, served at
moderate temperatures.

d) Oral Mycostatin, two tablets q.i.d.

Patient continued to complain of pain in
tongue, chest, and neck muscles. Also, there was
no improvement in the cutaneous erythema and
oral lesions, and hoarseness became persistent. It
was, therefore, decided to admit patient to the
hospital for further observation and laboratory
tests with recommendation to rule out lupus ery-
thematosus and pemphigus.

Course in Hospital (First Admission):

Patient was examined in consultation by an in-
ternist, dermatologist and allergist. No agreement
could be reached as to diagnosis. Blood pressure
was between 130/80 and 110/80. Temperature
ranged between 99-100° F. Pulse was 68-96/minute.

Laboratory Data:

CBC: Hg. 13.7 grams or 91%; RBC 4.50 mil-
lion; WBC 5,200 with stabs 0, polys 66, lymphs
24 and monos 10.

Skin Biopsy: Chronic nonspecific dermatitis.
Blood Serology: Negative.

Urinalysis: Color: yellow; character: clear; re-
action: acid; albumin, sugar and acetone: nega-
tive; few epithelial cells and crystals.

Sedimentation Rate: 60 minutes: 56 mm.

Course in Hospital (Second Admission):

Patient was sent home after spending 13 days
in the hospital. Twenty-four hours after discharge,
she was readmitted since malaise, weakness and
dyspnea became worse. The patient was immedi-
ately put on I.V. cortisone.

Fig. 11-A. Cutaneous biopsy showing subepider-
mal edema with distortion of basal cell layer and
marked infiltration of inflammatory cells in un-
derlying connective tissues.

314 MICHIGAN MEDICINE APRIL 1972

Laboratory Data:

Bone Marrow Biopsy: Revealed typical lupus
erythematosus cell formation (Fig. 5).

Skin Biopsy: Compatible with lupus erythema-
tosus (disseminatus) .

CBC: Hg. 16.0 grams or 10 7%; RBC 5.0 mil-
lion; WBC 6,850 with stabs 1, polys 8S, lymphs
13 and monos 3.

Blood Serology: Negative.

Urinalysis: Same as on first admission.

Sedimentation Rate: Same as on first admission.

Surgical Pathology Report:

Gross Pathology: The specimen consisted of an
elliptical segment of skin measuring 2.2 x 1.6 x
1.0 cms. One surface was covered by well de-
fined erythematous patch with superficial minute
scales. No zones of ulceration were seen. Serial
sections of the entire tissue were submitted for
microscopic examination.

Microscopic Pathology: Sections consisted of skin
showing pronounced histopathological changes
(Fig. 11, A and B). The squamous epithelium
was intact. The basal cells were undergoing
liquefaction necrosis with disorder of arrange-
ment. The rete Malpighii were atrophic in some
areas whereas other zones disclosed acanthosis.
Hyperkeratosis was a conspicuous finding asso-
ciated with kerototic plugs in the follicular
openings. Parakeratosis was usually absent. The
corium revealed marked edema. The capillaries
and larger vessels were distended by red blood
cells and their walls were edematous. A patchy
inflammatory reaction was seen chiefly in the
vicinity of hair follicles and sebaceous glands.
These cells consisted mainly of lymphocytes; a
smaller number of plasma cells and histiocytes
were observed. In addition, minute zones of
basophilic degeneration of collagen and elastic
tissue was apparent in the upper corium.

Final diagnosis:

compatible with lupus erythematosus

Course in Hospital:

Although the prognosis for patients with S.L.E.
has greatly improved since the advent of steroid
therapy, unfortunately this patient did not re-
spond well. She developed severe hypertension with
renal involvement followed by acute bronchitis.
Severe leukopenia with a white count below
2500/cm ensued, accompanied by Cushing’s syn-
drome and central nervous system involvement.
The hospital stay was stormy. The patient suffered
a severe abscess of the buttock requiring drainage,

and a cellulitis of the right elbow. Neither re-
sponded to antibiotics. Patient expired 11 days
after last admittance.

Summary and conclusion

1) The case of Systemic Lupus Erythematosus
in a female over 60 years of age is reported, al-
though the disease affects chiefly females between
the ages of 10-40 years.

2) Discoid and Systemic forms are only differ-
ent manifestations of the same basic disorder.

3) Both conditions may have oral manifesta-
tions except that in the systemic variety, the oral
lesions are more pronounced with a greater tend-
ency to bleeding and ulceration.

4) One cannot determine from the clinical or
microscopic examination of a discoid-appearing
lesion whether or not there is systemic involve-
ment.

5) Finally, the correlation of clinical and lab-
oratory findings are essential in the correct diag-
nosis of this disease.

References

1. Klemperer, P.: Concept of Collagen Diseases, Amer
J Path 26:505-519 (July) 1950.

2. Bernier, J. L.: The Management of Oral Disease :
A Treatise on the Recognition, Identification, and
Treatment of Diseases of the Oral Regions, St.
Louis: Mosby, 1955.

3. Burket, L. W.: Oral Medicine, Diagnosis and

Treatment, ed 3, Philadelphia: Lippincott, 1957.

4. Orban, B. J.: Atlas of Clinical Pathology of the
Oral Mucous Membrane, ed 5, St. Louis: C. V.
Mosby Co., 1960.

5. Gardner, A. F.: Pathology in Dentistry , Spring-
field, 111.: A. C. Thomas, 1968.

6. Curtis, A. C.; Folio, M. L.; and Ruttan, H. R.:
Clinical Diagnosis of Dermatological Lesions of
Face and Oral Cavity, Oral Surg 3:750-783 (June)
1950.

7. Wise, F.: Severe Lupus Erythematosus of the Scalp
and Buccal Mucosa, Arch Derm 40:514, 1939.

8. Bechet, P. E.: Lupus Erythematosus of the Lower
Lip, J Cutan Dis 3:119, 1918.

9. Kunkel, H. G. et al: Extreme Hypergammaglobu-
linemia in Young Women with Liver Disease, J
Clin Invest 30:654, 1951.

10. Knox, J. M.: Photosensitivity Reactions in Various
Diseases, Postgrad Med 33:564-570 (June) 1963.

11. Feldman, H. A.: Disseminated Lupus Erythema-
tosus, JAMA 183:714-715 (Feb 23) 1963.

12. Andreasen, J. O.: Oral Manifestations in Discoid
and Systemic Lupus Erythematosus, I. Clinical In-
vestigation, Acta Odont Scand 22:295-310 (Aug)
1964.

13. Cook, C. D. et al: Systemic Lupus Erythematosus:
Description of 37 Cases in Children and a Discus-

MICHIGAN MEDICINE APRIL 1972 315

LUPUS ERYTHEMATOSUS/Continued

sion of Endocrine Therapy in 32 of the Cases,
Pediatrics 26:570-585 (Oct) I960.

14. Jacobs, J. C.: Systemic Lupus Erythematosus in
Childhood: B.eport of Thirty-five Cases With Dis-
cussion of Seven Apparently Induced by Anti-
convulsant Medication and of Prognosis and Treat-
ment, Pediatrics 32:257-264 (Aug) 1963.

15. Jackson, R.: Discoid Lupus in a Newborn Infant
of a Mother With Lupus Erythematosus, Pediatrics
33:425-430 (March) 1964.

16. Peterson, R. D.; Vernier, R. L.; and Good, R. A.:
Lupus Erythematosus, Pediat Clin N Amer 10:941-
978 (Nov) 1963.

17. Jessar, R. A.; Lamont-Havers, R. W.; and Ragan,
C.: Natural History of Lupus Erythematosus Dis-
seminatus, Ann Int Med 38:717-731 (April) 1953.

18. Dubois, E. L.: Effect of L. E. Cell Test on Clinical
Picture of Systemic Lupus Erythematosus, Ann Int
Med 38:1265-1294 (June) 1953.

19. Shearn, M. A., and Pirofsky, B.: Disseminated Lu-
pus Erythematosus: Analysis of 34 Cases, Arch Int
Med 90:790-807 (Dec) 1952.

20. Peterson, W. C. Jr., and Gokeen, M.: Antinuclear
Factors in Chronic Discoid Lupus Erythematosus,

Arch Derm 86:783-787 (Dec) 1962.

21. Pinkus, H., and Meheegan, A. H.: A Guide to
Dermatohistopathology, New York: Appleton-Cen-
tury-Crofts, 1969.

22. Idem p 177.

23. Hargraves, M. M.; Richmond, H.; and Morton, R.:
Presentation of 2 Bone Marrow Elements: “Tart”
Cell and “L. E.” Cell, Mayo Clin Proc 23:25-28
(Jan 21) 1948.

24. Haserick, J.; Lewis, L. A.; and Bortz, D. W.:
Blood Factor in Acute Disseminated Lupus Erythe-
matosus: Determination of Gamma Globulin as
Specific Plasma Fraction, Amer J Med Sci 219:660
(June) 1955.

25. Zinkham, W. H., and Conley, C. L.: Some Factors
Influencing Formation of L. E. Cells: Methods for
Enhancing L. E. Cell Production, Bull Johns Hop-
kins Hosp 98:102-119 (Feb) 1956.

This article is reprinted with permission from

the Journal of Oral Medicine.

For reprints: Please write to Doctor Herschfus
at 761 Fisher Bldg., Detroit, Mich. 48202.

316 MICHIGAN MEDICINE APRIL 1972

The need for

burn care facilities in Michigan

By Irving Feller, MD
Keith H. Crane, MSE
K. E. Richards, MD
George Koepke, MD
Ann Arbor

Documented methods for treating burn injuries
date back to the pyramids, but only during the
last 25 years has the care of the burned patient
been recognized as requiring special medical skills
and often special care facilities. The level of
interest and activity has increased rapidly in the
past two decades, but the number and distribution
of specialized care facilities remains woefully in-
adequate. What follows here is a discussion of the
demand for such facilities, the numbers and lo-
cations of current facilities, and the type, number,
and location of new facilities needed to provide
adequate care for severely burned patients
throughout the State of Michigan.

Table 1 presents some measurements of the
magnitude of the present burn problem in the
United States. Table 2 presents similar statistics
for the State of Michigan. Over 100,000 burn
accidents occur in Michigan each year, approxi-
mately 3,200 patients are hospitalized, and about
400 die from these injuries. The 385,000 days of
disability and the $13 million in medical costs
show the scope of the problem in Michigan.

In spite of increased recognition of the lack
of sufficient facilities, progress toward improve-
ment is painfully slow. At present, less than 100
of the 6,000 general hospitals in the United States
provide specialized burn care,* 1 2 3 and only five of
the 200 hospitals in Michigan provide such care.
Figure 1 shows existing facilities and programs
located in Michigan.

The slow rate of progress cannot be blamed

Doctor Feller is clinical associate professor
of surgery, and director of the University of
Michigan Burn Center, where Mr. Crane is a
research assistant.

Doctor Richards is a clinical instructor and
Doctor Koepke is professor of physical medicine
and rehabilitation at the U-M Medical Center.

Table 1

The Burn Problem in the United States1

Data of Burn
Injuries Per Year

A. Incidence 2,200,000

B. Mortality 9,000

C. Hospital Admissions 74,0002

D. Disability Days 8,900,000

1. In Hospital 1,300,000

2. In Bed (not hospital) 2,000,000

3. In Restricted Activity 5,600,000

E. Hospital and/or Medical Costs ....$300,000,000

1. Compiled using data from the U.S. Public Health
Service, the Commission on Professional and
Hospital Activities-Ann Arbor, and the National
Burn Information Exchange-Ann Arbor.

2. 70,000 burns of the skin; 4,000 eye and internal
burns.

Table 2

The Burn Problem in Michigan*

Number of Burn
Injuries Per Year

A. Incidence 100,000

B. Mortality 400

C. Hospital Admissions 3,200

D. Disability Days 385,000

1. In Hospital 56,000

2. In Bed (not hospital) 87,000

3. In Restricted Activity 242,000

E. Hospital and/or Medical Costs .... $13,000,000

*Approximately 4.3% of the United States totals.

entirely on the hospitals and their administrations.
A special hospital facility is of little value without
the adequately skilled medical personnel to use
it, and the medical schools are ultimately respon-
sible for supplying these skilled personnel. Only
41 of the 92 medical schools in the U.S. A. are
presently affiliated with hospitals offering any
specialized burn care, and only nine of these have
burn centers for teaching and research as well as
for patient care. The net effect of today’s shortage
of medical skills and facilities for burn treatment
is that approximately 90% of all burn patients
do not receive the quality of care they need.
The problem is a lack of appreciation for the
specialized care required by the burned patient.

All patients with burns serious enough to re-
quire hospitalization require some level of special-

MICHIGAN MEDICINE APRIL 1972 317

BURN CARE FACILITIES/Continued

ized treatment. All bum victims have lost some
of the protective and regulatory functions of their
skin and are thereby susceptible to infections,
fluid loss, metabolic disorders, and other compli-
cations. A considerable amount of time and at-
tention is required to prevent or contain these
complications. The average length of hospitaliza-
tion for patients with skin burns is about 18
days, which is 80% higher than the average length
of hospitalization for patients with all types of
injuries.

The primary purpose of the burn treatment
facility is to provide the resources required for
care of the burn accident victims. However, all
burns are not alike and therefore the facilities
required for their treatment are not alike. Cur-
rent specialized bum care facilities are now classi-
fied as follows: (1) bum centers; (2) burn units;
and (3) burn programs. These are defined as
follows:

Burn Program: At this level, the hospital has
no specialized facilities or areas for bum care.
However, a consistent plan for management of
bum patients is implemented by an interested
and experienced physician (or jointly by several
physicians) . As a measure of experience, it is as-
sumed that the physician is treating at least 25
bums per year.

Burn Unit: This denotes a bum program being

conducted in a specialized facility which is used
only for burns. It is assumed that this facility has
at least four beds and that at least 35 bum pa-
tients per year are treated there. A limited amount
of research and teaching may be present on an
intermittent basis.

Burn Center: This denotes a larger bum unit,
with a special emphasis on research and teaching
as well as patient care. The facility provides very
intensive burn-patient care which requires the
support of the research and teaching staffs. In
turn, the intensive care environment provides
the ideal “classroom” for teaching the complexities
of burn care, and also serves as a “laboratory”
for research into the many uncertainties of pres-
ent-day burn treatment. It is assumed that the
facility has at least six beds, and that at least 50
patients with bums are treated there per year.

The major factors considered in judging the
relative severity of a burn injury, and hence the
level of bum care required, are as follows:

1) The age of the patient.

2) The total size (area) of the burn (including
full-thickness and partial-thickness skin loss)
measured as a percent of total body surface.

318 MICHIGAN MEDICINE APRIL 1972

National Burn Information Exchange
MORTALITY ANALYSIS:

% Survival vs. Age and Total Area Burned

% AGE

Burn

0-1

2-4

5-34

35-49

50-59

60-74

75-100

Total

0-9

100

100

100

99

97

95

80

99

10-19

99

99

100

98

96

78

61

97

20-29

91

95

98

94

84

54

44

92

30-39

75

82

91

77

58

23

0

79

40-49

54

67

83

60

38

13

0

68

50-59

20

44

66

47

27

11

0

50

60-69

6

22

49

32

19

8

0

35

70-79

20

25

23

8

25

0

0

18

80-89

0

5

14

8

6

0

0

9

90-100

0

9

3

0

0

0

0

2

Total

91

89

88

79

71

54

38

83

August, 1971

3) The depth of the burn, i.e., the area of full-
thickness skin loss (third-degree burn) mea-
sured as a percent of total body surface.

4) The location (s) of the burn on the body.

5) The past medical history of the patient.

6) The presence of other injuries in addition
to the burn.

Of these factors, the first three are the most im-
portant. Also, since the size of burn and depth
of burn are often correlated, the knowledge of
just the patient’s age and total area burned can
often yield an accurate prognosis. Table 3 demon-
strates the relationship of survival to age and

total area burned for a sample of over 10,000
patients (as reported by participants of the Na-
tional Burn Information Exchange2) . Considera-
tions of this and other severity-factor data led to
the establishment of general criteria for determin-
ing the kind of facility that would be adequate for
a burned patient. These criteria are summarized
in Table 4. Note that the factor of full-thickness
burn is not included, because it cannot be deter-
mined accurately until later in the treatment
process.

Approximately 3,200 patients with bum injuries
are admitted, to Michigan hospitals each year.
Using the criteria from Table 4, admissions can
be divided into three categories: (1) “Severe”

skin-burn patients— i.e., those who require treat-
ment in a burn unit or burn center; (2) “Mod-
erate” skin-burn patients— i.e., those who require
treatment in a hospital with a bum program;
and (3) Eye or internal burn injuries.

It is estimated that there are 600 severe and
2,400 moderate burn patients treated in Michigan
each year. Bum centers and burn units are not
expected to refuse admission to moderate burns
from their local community. However, it is as-
sumed that non-specialized-care institutions will
refer moderate burns to the nearest burn program,
and also that burn programs (as well as non-
specialized-care institutions) will refer severe burns
to the nearest burn unit or burn center. An ideal
referral plan may never be completely imple-
mented. However, the experience of the Univer-

Table 4

Recommendations for Burn Care Facility Triage
Determined by Severity of Burn

Area Burned and Other Severity Factors

Age

0-59 yrs.

60+ yrs.

1-19%

20-100%

With Severity Factors
A, B, or C

1-19%

20-100%

= BURN PROGRAM

il = BURN CENTER OR BURN UNIT
| = BURN CENTER

A. Part of Body Burned: A burn of the perineal area or a combination
burn of the face, neck, and chest.

B. Past Medical History: A past medical history affecting present health
(e.g., diabetes, heart disease, etc.)

C. Concurrent Injury: An injury in addition to the burn (e.g., skull, fracture,
severe abdominal injury, etc.)

MICHIGAN MEDICINE APRIL 1972 319

BURN CARE FACILITIES/Continued

Table 5

Proposed Distribution of Burn Centers and/or
Burn Units in Michigan

Burn Center Number of Total

or Burn Unit Beds Needed Burn Centers
Metropolitan Average Daily at 90% and Burn Units

Area Census* Occupancy Proposed**

Centers Units

Detroit and Pontiac 34 38 1 2

Ann Arbor 17 19 1 1

Grand Rapids 8 9 0 1

Kalamazoo 6 7 0 1

Saginaw 6 7 0 1

Flint 5 6 0 1

Lansing 5 6 1 0

Sault Ste. Marie 4 5 0 1

Total 85 97 3 8

♦Distributed proportionately to areas based upon 1970 population, except
for Ann Arbor where true patient census figures were used.

**Based upon a minimum size of 4 beds and a maximum size of 15 beds.

sity of Michigan Burn Center is that such a re-
ferral pattern can develop over a period of about
five years, even without official encouragement,
once the proper facility is established and avail-
able.

The data indicates that there is a need for
beds in the Michigan hospitals to accommodate
the 3,000 patients. If the “burn unit or bum
center” census was distributed proportionately to
the metropolitan areas in the state which could
reasonably support such facilities (based upon
1970 census figures) , Michigan would require a
mix of 11 bum units and centers, with a total
capacity of 97 beds to accommodate the 1,200
who require this type of facility each year. This
is based on an estimated occupancy rate of 90%,
a minimum practical facility size of four beds,
and a maximum facility size of 15 beds. These
figures are presented in Table 5.

In a similar fashion, the 1,800 patients who
would make up the “burn program” census were
distributed to the 18 largest population areas. If
each burn program had an average daily census
of one to three patients, this would mean that
25-75 patients per year would be treated at each
of these hospitals. On the basis of this estimate,
Michigan would require 31 bum programs to
meet present needs. These figures are presented in
Table 6.

Figure 2 shows a proposed geographic distribu-
tion of three bum centers, eight burn units, and

31 bum programs consistent with the information
presented in Tables 5 and 6. No precise basis was
established for delineation and location of bum

Table 6

Proposed Distribution of Burn Programs
in Michigan

Metropolitan

Area

Burn Program
Average Daily
Census*

Total

Burn Programs
Proposed**

Detroit and Pontiac . .

35

12

Grand Rapids

6

2

Flint

5

2

Lansing

4

2

Kalamazoo

3

1

Saginaw

3

1

Ann Arbor

3

0

Marquette

2

1

Muskegon

2

1

Jackson

2

1

Benton Harbor

2

1

Battle Creek

2

1

Bay City

1

1

Midland

1

1

Petoskey

1

1

Traverse City

1

1

Port Huron

1

1

Monroe

1

1

Total

75

31

♦Distributed proportionately to areas based upon 1970
population exceot for Ann Arbor where true census figures
were used.

♦♦Based upon an average daily census of 1-3 patients.

320 MICHIGAN MEDICINE APRIL 1972

(b

Figure 2

Proposed Burn Care Facilities in Michigan

centers, other than the presence of a medical
school in the area.

Hence, the general location of burn centers
(and many burn programs as well) would best
be determined after careful consideration of the
availability of qualified doctors, paramedical per-
sonnel, and supportive facilities in each area. The
specific location (i.e., “parent” hospital) of every
bum center, unit, and program must take into
account these same factors at the specific hospital.

Comparing Figure 1 (present burn care facili-
ties) with Figure 2 (proposed bum care facilities)
leaves little doubt that Michigan does not yet
have the facilities to provide adequate treatment
to burned patients. Where 11 burn centers and
bum units are needed, only three exist; and
where 31 burn programs are needed, only two
exist. Furthermore, the distribution of these
limited facilities is not ideal.

Bum patients who should be treated in local

burn care facilities are, in many cases, being re-
ferred hundreds of miles from their family and
friends for treatment that often turns out to be
for a long time. This situation must ultimately
be rectified through regional and state-wide plan-
ning of burn care facilities. In addition to facility
planning, a reporting system should also be in-
stituted to monitor the performance of new fa-
cilities. The National Burn Information Exchange2
represents a system that could be very useful on
a state-wide basis to ensure that new facilities
are operating effectively.

References

1. Feller, I.: “Classification of Burn-Care Facilities
in the United States”; Journal of the American
Medical Association; Vol. 215, No. 3; January 18,
1971.

2. Feller, I.: "National Burn Information Exchange”;
Surgical Clinics of North America; Vol. 5, No. 6,
December, 1970.

MICHIGAN MEDICINE APRIL 1972 321

cPeriqatal 7 ips

By Paul M. Zavell, MD
Detroit

The following case from the files of the Wayne
County Medical Society Perinatal Mortality Com-
mittee is presented as an aid in continuing educa-
tion.

Maternal

This was the seventh pregnancy of this 40-year-
old 0+ white mother.

Her first three pregnancies were uneventful with
three living children. Her fourth pregnancy ended
in a spontaneous abortion at about five months.
Following this she developed hypertension that
persisted. Her blood pressure ranged systolic 140-
160 and diastolic 80-100.

Her fifth pregnancy resulted in twin premature
infants, both of which survived and are alive and
apparently normal. Her sixth pregnancy was
stormy with pre-eclampsia and resulting in a still-
birth at 39 weeks.

During this pregnancy, her seventh, she had
blood pressure ranges recorded at prenatal visits
of systolic 180-200 and diastolic 90-110. She is five
feet six inches and gained thirty pounds during the
pregnancy (140—170#). She had been on Hy-
grotin 100 mgm daily, a low salt diet and limited
activity.

Because of her elevated blood pressure and de-
velopment of +1 pedal edema she was hospitalized
at 38 weeks gestation. After careful observation
and several consultations, it was decided to do a
C-Section and this was done (Transverse Low) by
the 39th week. Her blood pressure while in the
hospital ranged 166-182 systolic with 88-98 dias-
tolic.

Fetal

A seven pound, two ounce white, male infant
was delivered with apgar of seven at one minute
and nine at five minutes. (He exhibited lethargy,
was dusky with respiratory retractions almost clear-
ing completely; he was given oxygen and mist in
incubator.) Cord blood was 0. Soon after arrival
in the nursery, the infant again seemed to get pro-
gressively worse with return of duskiness and res-

Doctor Zavell is chairman, Neo-Natal and Hos-
pital Care Committee, Michigan Chapter, A.A.P.,
and chairman, Perinatal Mortality Study Com-
mittee, Wayne County Medical Society.

piratory distress. Blood studies were quickly drawn
and reported as

1) PC02 = 66 mm Hg (34-45)

P02“ = 15 mm Hg (75-100)

PH = 7.0 (7.35-7.45)

2) CBC with Hgb of 10.4 gm, Hct = 38, Rbc =
3.48x106, WBC - 10,970, PMN = 26, Bd =
15, Lymph = 58, Eos = 01 with 21/100
WBC of Normoblasts.

No treatment was initiated except oxygen and
mist.

Six hours after birth repeat blood studies were
drawn and reported back one hour later as Ph =
7.2, PC02 = 78, P02 = 30. The hemoglobin was
reported as 10.6 gm. A chest X-ray showed cardiac
enlargement, cause undetermined. At this time,
the infant was started on I.V. Fluid of 10% G/W
with added Sodium Bicarbonate.

By 10 hours of life, it was deemed wise to give
the infant blood and 60 cc of packed cells were
given. Also, at this time, antibiotics were started
with 150,000 U of aq Penicillin I.V. and 15 mgm

I.M. of Kanamycin both q 1 2 hours.

Despite all this, the infant progressively dete-
riorated and expired at 18 hours of age. The final
clinical impression was “probable sepsis and pos-
sible congenital heart disease with secondary res-
piratory distress.”

An autopsy was done showing massive aspiration
of amniotic fluid, hyaline membrane disease and
anoxic subdural and subarachnoid hemorrhage.

Perinatal committee comments

1. Although it may be argued that with a hemo-
globulin of 10 to 10.6 gm a transfusion was not
really necessary, it is recognized that the buffering
effect and oxygen transportation capabilities of
this blood can be very important to an infant in
such a hazardous condition.

2. If packed cells are given it is recommended
that these be limited to 5 cc/# rather than 8-9
cc/# as given here.

3. Any infant with CNS, respiratory or unusual
signs and symptoms (poor feeding, lethargy, vom-
iting) should be considered as a possible hypo-
glyemic candidate. Blood glucose should be done
at least once.

4. Where respiratory distress symptoms are pres-
ent, early use of I.V. fluids with sodium bicarbo-
nate following the Usher method should be con-
sidered.

5. Where anemia is present and unexplained,
examination of the maternal blood for fetal hemo-
globin to rule out fetal to maternal hemorrhage
is a worthwhile procedure.

322 MICHIGAN MEDICINE APRIL 1972

#

The Stokes -Adams syndrome

Mechanisms and treatment

By Robert A. O’Rourke, MD
San Diego

During the past few years markedly improved
cardiac monitoring has more precisely elucidated
the underlying electrocardiographic mechanisms
producing Stokes-Adams syncope. Moreover, the
rapid advances in electrical pacemakers have con-
tributed significantly to the prevention and treat-
ment of arrhythmia-induced syncope.

Electrocardiographic mechanisms

At one time ventricular standstill was thought
to be the sole mechanism responsible for Stokes-

( Second in a two-part series)

Adams syncope and it is still considered the most
frequent underlying rhythm disturbance. How-
ever, it is now established that Stokes-Adams at-
tacks may also be clue to extreme bradycardia or
to a variety of tachyarrhythmias, particularly ven-
tricular tachycardia and ventricular fibrillation.
Continuous monitoring has demonstrated that sev-
eral electrocardiographic mechanisms may produce
syncope in the same patient.

The arrhythmias responsible for Stokes-Adams
syncope may be divided into seven groups:

1. Sudden interruption of atrioventricular im-
pulse transmission causing transient asys-
tole. When the cardiac rhythm changes from
a sinus mechanism or incomplete A-V block

Doctor O’Rourke is with the Department of
Medicine of the University of California at San
Diego. His paper is one in a series on clinical
cardiology prepared by the American Heart Asso-
ciation and made available to Michigan Med-
icine by the Michigan Heart Association.

to complete heart block, a period of asystole
often occurs before the junctional or ventric-
ular pacemaker assumes rhythmicity at its
inherent rate. This “warm-up period” varies
from ten to ninety seconds and is termed the
“preautomatic pause.”

2. Atrial standstill with failure of the junction-
al pacemaker resulting in ventricular asys-
tole. When sinoatrial node impulse forma-
tion ceases and the A-V junctional tissue fails
to assume rhythmicity, ventricular asystole
results. This mechanism for Stokes-Adams
syncope may occur in patients with inferior
wall myocardial ischemia and may be influ-
enced by vagal hyperactivity. This is an un-
common mechanism of arrhythmia-induced
syncope.

3. Asystole in the presence of established
heart block. This arrhythmia may result
from a shift in the pacemaker below the area
of non-conduction to still a lower focus re-
sulting in a period of asystole resembling the
“preautomatic pause.”

4. Paroxysmal ventricular tachycardia or fibril-
lation in the presence of complete heart
block. A slow heart rate during complete
heart block predisposes to rapid impulse
formation from ectopic foci. Either ventric-
ular tachycardia or fibrillation may then en-
sue with syncope resulting.

5. Paroxysmal ventricular tachycardia or fibril-
lation during normal A-V conduction. These
arrhythmias are most frequently observed in
patients with acute myocardial infarction but
have also caused syncopal episodes in pa-
tients with apparently normal hearts.

6. Supraventricular arrhythmias. Supraventric-
ular tachycardias and bradycardias associated
with syncopal episodes have been demon-
strated by continuous electrocardiographic
monitoring in many patients with the Stokes-
Adams syndrome. Frequently the sinus brady-
cardia predisposes to episodic supraventric-
ular tachycardia (“bradycardia-tachycardia

MICHIGAN MEDICINE APRIL 1972 323

STOKES-ADAMS/Continued

syndrome”) . In patients with coronary artery
disease tachycardia increases myocardial ox-
ygen demands and decreases left coronary
artery diastolic blood flow, often decreasing
cardiac output despite the increase in heart
rate. Syncopal episodes may result.

Sinus bradycardia, sinoatrial and sinoatrial
arrest may cause syncope in patients with
heart disease who are unable to increase
stroke volume sufficiently to maintain ade-
quate cerebral blood flow.

7. Combined forms. Uncommonly, paroxysmal
tachyarrhythmias may be followed by a pe-
riod of asystole due to a delay in automatic-
ity of pacemakers which have been sup-
pressed during the tachycardia.

The recognition that different electro-
cardiographic mechanisms may produce syn-
cope in the same patient on different occa-
sions is important in therapy.

Treatment

The aim of therapy for arrhythmia-induced syn-
cope is threefold: (1) prompt restoration of the
circulation during cardiac arrest, (2) restoration
of an intrinsic cardiac rhythm adequate to main-
tain cerebral blood flow and (3) prevention of
recurrent episodes.

Medical Treatment. The medical therapy of com-
plete heart block includes the correction of poten-
tial contributing factors such as acidosis and hy-
perkalemia. The sympathomimetic drugs, which
include parenteral epinephrine, oral ephedrine
and isoproterenol by either route of administra-
tion, are primarily indicated when ventricular asys-
tole or bradycardia occurs in complete heart block
and intracardiac pacing is unavailable. These
agents act by increasing A-V conduction, increas-
ing the rate of the ventricular pacemaker, and
shifting the lower pacemaker to a higher focus in
the common bundle or A-V junctional tissue. Dur-
ing an attack of arrhythmia-induced syncope due
to bradycardia, isoproterenol should be given by
intravenous infusion during ECG monitoring so
that its administration can be rapidly terminated
if ventricular irritability results.

The vagalytic agent atropine may increase the
ventricular rate in complete heart block complicat-
ing a recent inferior wall myocardial infarction.
Atropine is often successful in the treatment and
prevention of Stokes-Adams syncope due to sinus

bradycardia, sinoatrial block and bradycardia-
tachycardia syndrome.

Steroids through their anti-inflammatory and
hypokalemic effects have been occasionally success-
ful in improving A-V conduction in patients with
complete heart block due to myocarditis or acute
myocardial infarction.

The trisodium salt of EDTA (ethylenediamine
tetra-acetic acid) , a calcium chelating agent, has
been used in the treatment of complete heart
block due to digitalis intoxication when electrical
pacing is unavailable.

Pacemaker therapy. Because of the unpredictable,
potentially fatal nature of Stokes-Adams attacks
and the inconsistent results and frequent complica-
tions with drug therapy, electrical pacing has be-
come the treatment of choice when syncope occurs
in patients with complete heart block.

The general indications for pacemaker insertion
include (1) complete heart block associated with
congestive heart failure (2) complete heart block
with Stokes-Adams syncope (3) complete heart
block following acute anterior or interior wall
myocardial infarction (4) partial A-V block (sec-
ond degree block) complicating anterior wall myo-
cardial infarction and (5) post surgical complete
heart block.

Recent reports have demonstrated the feasibility
of suppressing episodes of ventricular tachycardia
and fibrillation in patients with normal A-V con-
duction by pacing the atrium or the ventricle at a
rate faster than that present between episodes of
ventricular tachyarrhythmia. Electrical pacing has
been employed successfully in combination with
propranolol and cardiac sympathectomy in the
treatment of otherwise unresponsive ventricular
arrhythmias. Rapid atrial pacing has been used
successfully in the treatment of supraventricular
tachycardias including atrial flutter and parox-
ysmal atrial tachycardia.

In patients with syncopal attacks due to ventric-
ular tachycardia or ventricular fibrillation compli-
cating complete heart block, the emergency inser-
tion of a ventricular pacemaker is strongly indi-
cated. A ventricular pacemaker is the only means
available for the long-term prevention of ventric-
ular tachyarrhythmias in patients with heart block.
If transient ventricular asystole complicates com-
plete heart block a ventricular pacemaker is also
indicated. A single Stokes-Adams attack in a pa-
tient with complete heart block is sufficient reason
for pacemaker insertion.

324 MICHIGAN MEDICINE APRIL 1972

Suicides : Does our society care?

By John Halick, MD
Greenville

Suicide is a pervasive problem in our country.
A bulletin issued by the National Institutes of
Mental Health predicts that during the decade of
the seventies, at least 26,000 Americans annually
will be certified as suicides; at least half again as
many will die unrecognized self-destructive deaths,
and more than three million . . . will make se-
rious enough suicide attempts to require some
medical intervention.”1

Despite the vast hidden reservoir of suicide in
current statistics of death by such means as alco-
hol, drugs, and highway accident, several factors
dull the public consciousness toward this cause of
death.

First is the reluctance to face the unique circum-
stances of this form of death, either personally or
collectively.

Secondly— and most important to physicians— a
body of comprehensive and documented statistics
simply does not exist. No single organization, at
either county or state level, maintains a compre-
hensive bank of information on suicide and suicide
attempts.

1969 statistics for the state reveal 978 actual su-
icides. Wayne County, the most populous in Mich-
igan, reported 304. However, Bruce Danto, MD,
director of the Suicide Prevention Center in De-
troit, indicated in private correspondence that a
truer estimate would be three to five times greater!

Major need —

to centralize prevention efforts

How can we begin to cope with this massive
hidden problem? The major need is through state
legislative action and effort. Because of the com-
plex factors involved, all health services— public
health, mental health, and aspects of public educa-

Doctor Halick is in private practice in Green-
ville and is a founding member of the Montcalm
County Mental Health Board.

tion— should be united in a Department of Com-
prehensive Health Services. Action at the county
level, because of financial and personnel limita-
tions, is not feasible. State and federal help is
needed.

At the present stage, the legislature should ap-
point a suicide study committee from all disci-
plines and geographic areas, including all races
and creeds. The objective would be to establish
an inter-disciplinary program, under a well-coordi-
nated statewide agency that can attack the prob-
lem of suicide.

Help can be given
in various fields

Suicide, more than any other phenomenon, re-
quires a truly “gestalt” approach. But the current
primitive psycho-social and medical criteria for
evaluating, and preventing, death by suicide re-
quires urgent re-evaluation.

Assistance could be given in several areas:

Medical. Currently, taxonomic classification is
based on anatomic, physiologic, psychological, and
pathological terminology. Fundamental changes in
the keeping of medical records must occur. Socio-
logical and economic terminology must be intro-
duced in a sophisticated manner, for progress in
recognizing and controlling the suicide rate.

It would seem appropriate if the Mental Health
Department of the State of Michigan would en-
force a comprehensive taxonomic nomenclature.
Data could then be retrieved on all issues involv-
ing mental health.

Suicide hospitalization centers should also be
established throughout the state. Such hospitals,
designated as suicide therapeutic centers, should
include all necessary medical disciplines and inten-
sive care facilities.

Public Education. The Department of Public
Instruction should make provision for immediate
referral of any student who manifests suicidal
ideation (masked, latent or overt) .

MICHIGAN MEDICINE APRIL 1972 325

SUICIDES/Continued

Since suicide is the fourth or fifth leading cause
of death for 15- to 35-year olds, teachers should be
educated to detect suicidal tendencies. Most threat-
ened suicides are ambivalent toward death, and
wish to be rescued.

Public education programs should also be set up
to detail suicide prevention services, such as a
telephone answering center. It has been estimated
than 50 to 70 percent of those who eventually kill
themselves communicate their intent in advance.2
Thus, the need for a statewide network of answer-
ing services is obvious as part of an effective pre-
vention program.

Religion. Active organized participation of the
clergy is a cornerstone of an overall program. Each
church should set aside periods of time for indi-
vidual counsel for parishioners who face emotional
crises with suicidal possibilities.

Society must face
the suicide problem

As a practicing physician I emphatically believe
that the current recognized incidence of suicide
can be multiplied by a factor of at least seven.
The State of Michigan spends large sums of tax
money in the control of diseases which are now
rare. The incidence of death by smallpox, diph-

theria, polio, lockjaw, and syphilis is virtually non-
existent. In marked contrast, the incidence of mor-
tality by suicide is enormous. It is especially note-
worthy that the second cause of death among col-
lege students is suicide.

A critical need is new legislation which will re-
quire the reporting of actual, attempted and
threatened suicide to a central agency, such as the
department of mental health. Michigan has al-
ways been in the vanguard of public health de-
velopments, and hopefully the legislature will rise
to the challenge for new laws in this area.

The existential writer Albert Camus stated that
“There is but one truly serious philosophical prob-
lem, and that is suicide. Judging whether life is or
is not worth living amounts to answering the
fundamental question of philosophy. All the rest
. . . comes afterwards.”3

References

1. Center Comments, Bulletin of Suicidology, National
Institute of Mental Health No. 7, Fall 1970.

2. Fawcett, Jan; Leff, M.; Bunney, W.E.; ‘‘Suicide’’
from Archives of General Psychiatry. Volume 21.
August 1969.

3. Camus, Albert. From “An Absurd Reasoning” in
THE MYTH OF SISYPHUS.

£Q

Monthly Surveillance Report

Cases of Certain Diseases Reported
To the Michigan Department of Public Health

For The Four-Week Period Ending February 25, 1972

1972

1971

1972

1971

Total

This

Same

Total

Total

Cases

4-Week

4-Week

To Above

Same

for

MICHIGAN

Period

Period

Date

Date

1971

DEPARTMENT

Rubella

132

276

236

432

2,955

OF PUBLIC

Congenital Rubella Syndrome

0

0

0

0

1

HEALTH

Measles

164

76

328

129

2,659

Whooping Cough

8

11

21

16*

140*

Diphtheria

0

0

0

0

1

Mumps

349

1,309

693

2,399

10,748

Scarlet Fever &

Strep Sore Throat

1,447

1,440

2,539

2,689

11,244

Tetanus

0

0

0

0

7

Poliomyelitis (paralytic)

0

0

0

0

0

Hepatitis

348

419

770

811

4,828

Salmonellosis

(other than S. typhi)

43

47

107

102

691

Typhoid Fever (S. typhi)

1

1

1

1

10

Shigellosis

46

11

94

39

295

Aseptic Meningitis

3

10

9

20

239

Encephalitis

8

14

16

24

108

Meningococcic Meningitis

4

7

9

11

64

H. Influenza Meningitis

4

5

9

14

82

Tuberculosis

132

141

244

244

1,824

Syphilis

447

285

812

633

4,689

Gonorrhea

1,728

1,359

3,242

2,991

22,115

Information can be supplied by the local

health department on the

local incidence of

disease.

Maurice Reizen, M.D., Director
Michigan Department of Public Health

‘corrected totals

326 MICHIGAN MEDICINE APRIL 1972

Attitudes toward abortion law reform

at The University of Michigan Medical Center

By Durlin Hickok, AB
Colin Campbell, MD
Ann Arbor

Abortion law reform has been a matter of con-
cern in the United States for several years, and a
number of states have enacted new laws which
generally permit abortion to be obtained more
readily than it had been previously.

In the spring of 1970 no less than eight different
abortion bills were under consideration by the
Senate of the State of Michigan. Because members
of the health professions will have a major role in
the actual carrying out of the provisions of any
new law or laws, we undertook to determine the
attitudes at that time towards abortion law re-
form of students in the Schools of Nursing, Med-
icine and Public Health, and of the faculty and
house staff of the clinical departments of the Uni-
versity of Michigan Medical Center.

Materials and methods:

A questionnaire was sent to all of the students
registered in the second term of the 1969-70 school
year in the Schools of Nursing, Medicine and Pub-
lic Health. Another questionnaire differing from
the first only in that it was color-coded by specialty
and that faculty members were not asked to give
their ages, was sent to house staff and factdty of
the clinical departments of the University of Mich-
igan Medical Center. The questionnaire is repro-
duced below. (FIG. I)

The intra-university mail service was used to
deliver the questionnaires which were sent in large
brown envelopes. A preaddressed return envelope
was enclosed in the original mailing. In order not
to prejudice responses, the return address given for
questionnaires sent to students and faculty was,
Medical Student Council Committee on Abortion,
Medical Science Building. In hopes of obtaining a

Mr. Hickok is a medical student, and Doctor
Campbell is with the Department of Obstetrics
and Gynecology at the University of Michigan.

better response from house staff the junior author’s
name and office address were on the return enve-
lope.

The first two options given were intended to
elicit the polar views on abortion laws. Option
number three, while placing no specific restrictions
on who might have an abortion, puts the subject
in the medical realm and provides for confidential-
ity.

Option number four refers to the present Mich-
igan abortion law which provides that abortion
may be performed only when it is necessary to
save the life of the mother. The wording is such
that the burden of proof that abortion is necessary
rests on the physician.

Option number five is intended to provide for
the opinion that the present Michigan law is a
good one, except for the burden placed on the
physician to prove that what he did was necessary.

Options six, seven, eight and nine are all pro-
posals for abortion laws which have been con-
sidered in Michigan.

The two “conscience clauses” have been added
as amendments to some of the proposed bills.

The returns were tabulated on punch cards and
analyzed by computer. The results were categorized
according to the intent of the responses. A positive
response to item one indicates a wish to prohibit
abortions altogether. Positive responses of items
four and five indicate a conservative position on
abortion law. Positive responses to any combina-
tion of items six, seven and eight are indicative of
some wish for change, but short of removing all
restrictions. Positive responses to items two, three
and nine in effect would approve abortion with
virtually no restrictions.

Results

1030 of 2630 questionnaires were returned en-
tirely completed and without any incompatibility
between choices.

A few more were returned either incompletely

MICHIGAN MEDICINE APRIL 1972 327

ABORTION LAW REFORM/Continued

Figure I

The Michigan Criminal Code on abortion now forbids abortion except to preserve a preg-
nant woman’s life, with burden of that proof being placed on the physician. A number of pro-
posals for changing Michigan’s current Criminal Code are now under consideration by the legis-
lature.

Please make X’s in the boxes next to any of the statements below which represent how
you feel about the regulation of abortion in medical practice in Michigan. Treat each item sep-
arately and answer as many as you wish.

1. □ Abortion should be considered illegal under all circumstances.

2. □ There should be no laws at all governing who may perform an abortion or where it

may be performed.

3. □ The question of whether or not to perform an abortion shall be a matter of concern

solely between the physician and his patient and shall be subject to all the privileges
of confidentiality as are other patters between a physician and his patient.

4. □ I favor no change in the current laws.

5. □ I favor the current laws, without burden of proof being placed on the physician.

6. □ An abortion may be performed if there is significant risk that the continuation of the

pregnancy would seriously impair the physical health of the mother.

7. □ An abortion may be performed if there is significant risk that the continuation of the

pregnancy would seriously impair the mental health of the mother.

8. □ An abortion may be performed where a pregnancy results from rape or incest.

9. □ An illegal abortion shall be defined by law as any abortion not performed at an ap-

proved location by a licensed physician.

The following two “conscience clauses” have been a topic of discussion in the state hear-
ings this year. Place an X in the box(es) that you favor.

□ No physician or hospital or member of a hospital staff shall be compelled by any pro-
vision of law to participate in the termination of a pregnancy if they do not wish to
do so.

□ No abortion shall be performed without written consent of the woman.

Please complete the following: Age Sex M F

Please place this in the enclosed envelope and return by university mail.

Medical School Council
Committee on Abortion

filled out or with incompatible choices. The total
return was 39%. The lowest return was from the
medical students, 142 of 824 (17%) . The low re-
sponse rate from medical students does not repre-
sent lack of interest in the issues involved, because
similar responses are obtained from other such
mailings. At least 2/3 of all 3rd and 4th year stu-
dents are on clerkships out of Ann Arbor and do
not visit their medical school mail boxes regularly.
The greatest return was from the Public Health
students, 127 of 200 (63%) .

The over-all responses were as follows:

862 (83.6%) favored abortion virtually without
restriction, 121 (11.7%) favored some degree of
liberalization, 37 (3.6%) were content with the
present Michigan law and 10 (1%) preferred that
abortion be prohibited completely. (TABLE I)

Chi square analysis of these data does not indi-
cate any significent difference between the groups.
The same sort of analysis was conducted by sex
and once again no significant difference occurred.

Because of the color-cocling of the questionnaire
it was possible to look at the responses from the
physicians by area of specialization. Responses
were analyzed in four sub-groups, medicine and
medical specialties, surgery and surgical specialties,
obstetrics-gynecology, and psychiatry. (TABLE II)

No significant differences were found among
house staff regardless of field, although it is inter-

esting that 17 of 19 obstetric-gynecology residents
were in favor of abandoning virtually all restric-
tions on abortion, and the other two wanted some
liberalization of the present law.

The differences between faculty members was
greater, and did reach significant levels. All 12
members of the obstetric-gynecology faculty pre-
ferred removing restrictions on performing abor-
tion. Psychiatrists joined the obstetricians in being
more likely to favor abandonment of restrictions
than surgeons or physicians.

Both conscience clauses were favored by a large
margin, the first 952 to 115 and the second 883 to
184. The first conscience clause is designed to pro-
tect physicians, hospital staff and hospitals from
being required to participate in abortion. There
were significant differences between the groups in
regard to this clause. Faculty members and Public
Health students were less inclined to favor the
clause than were house staff and other students.
The second conscience clause provides protection
for women from being compelled to have an abor-
tion. Differences here were not significant, but
nurses were a little more likely to favor and public
health students a little less likely to favor this
clause.

Summary and conclusions

(1) Results of a questionnaire survey on abor-
tion law reform at the University of Michigan

328 MICHIGAN MEDICINE APRIL 1972

Table I

Over-All Responses to Questionnaire

REMOVE

LESS

NO

MORE

RESPONDENTS

RESTRICTIONS

RESTRICTIVE

CHANGE

RESTRICTIVE

Medical Students

129

9

3

1

Nursing Students

238

32

12

0

Faculty

147

27

5

4

House Staff

239

41

13

3

Public Health Students

109

12

4

2

TOTAL 1030

862

121

37

10

Table II

Responses of Physicians by Specialty

REMOVE

LESS

NO

MORE

RESTRICTIONS

RESTRICTIVE

CHANGE

RESTRICTIVE

HOUSE STAFF

Obstetrics-gynecology

17

2

0

0

Psychiatrists

28

3

1

0

Medical

124

23

7

1

Surgical

70

13

5

1

TOTAL 295

239

41

13

2

FACULTY

Obstetrics-gynecology

12

0

0

0

Psychiatrists

28

2

0

0

Medical

66

14

7

3

Surgical

41

11

1

1

TOTAL 186

147

27

8

4

Medical Center indicate that 83.6% of nursing,
medical and public health students, house staff
and faculty of clinical departments responding
favored removal of virtually all restrictions on the
performing of abortion. Less than 5% of those
responding favored retaining the present Michigan
law or adopting a more conservative approach.
The remaining 12% opted for some liberalization
short of nearly unrestricted availability of abor-
tion.

(2) No significant differences in attitude to-
wards abortion law were detected by age, sex or
level of training.

(3) Psychiatrists and obstetrician-gynecologists
were more likely than surgeons and internists to
favor elimination of nearly all restrictions on the
performance of abortion (p<.05) .

(4) The two “conscience clauses” which are de-
signed to protect physicians and hospitals on the
one hand, and women on the other, were heavily
endorsed, 89% for the first, and 83% for the
second.

Abortion law
reform committee
files 218,000 signatures

The Michigan Coordinating Committee for Abor-
tion Law Reform has virtually assured that the mat-
ter will be on the November ballot.

On March 1 the committee submitted 218,000
signatures to the secretary of state’s office, making
Michigan only the second state to go the petition
route to consider abortion law reform.

The committee, headed by Jack Stack, MD, Alma,
hoped the initiatory legislation, which would permit
abortions for any reason within the first 20 weeks
of pregnancy, would be submitted to the legislature
by the first of April.

The legislature would then have 40 session days
to consider the bill. If they have not then passed
the bill (which its backers anticipate), it will go on
the November ballot.

MICHIGAN MEDICINE APRIL 1972 329

GYour> opiqioii please

MSMS asked the question:

“In the spring of 1971, the Michigan legis-
lature passed a resolution encouraging all
Michigan medical schools to establish depart-
ments of family medicine. So far, none of the
medical schools has such a department. Do you
believe there is a need to establish family prac-
tice departments ? What more can be done to
foster their creation ?”

These doctors replied :

Joseph V. Fisher, MD
Chelsea

The Constitution of the State of Michigan pro-
hibits mandatory legislation to direct the activities
of the state’s medical schools. Consequently the
current resolution passed by the 1971 Michigan
legislature was permissive in its direction.

“So far none of the medical schools has such a
department.” This statement is true. However, in
each of our three medical schools granting M.D.
degrees, departments of family medicine are in
some stage of development.

At Michigan State University’s College of Human
Medicine, an ad hoc committee has recommended
to the dean and faculty that an autonomous de-
partment of family medicine, research and develop-
ment be initiated. This department would be di-
rected by a qualified practitioner of family med-
icine and would train family MD’s. This recom-
mendation should soon receive a decision at Mich-
igan State University.

At Wayne State a Department of Community and
Family Medicine is in operation. All junior medical
students take a five weeks rotation in this depart-
ment and in the senior year elective preceptor-
ships with selected family physicians are available.

At the University of Michigan Medical School a
family practice residency training program is ready
for approval by the dean and faculty. This would
involve the affiliation and the collaborative re-
sponsibility for training of family practice residents
at the University of Michigan Medical Center, St.
Joseph Mercy Hospital (Ann Arbor), and the Chel-
sea Community Hospital. This is looked upon as
the initial step towards the establishment of a de-
partment of family medicine.

“Do you believe there is a need to establish
Family Practice departments?” This need is self
evident. A great deal of the present discontent
about medical care is directed at the need for
qualified and concerned primary care physicians.
This is the type of doctor that the public wants,
and may soon demand!

“What more can be done to foster their crea-
tion?” The medical schools need to be reminded,
as tax-supported institutions, that they have an ob-
ligation to direct a major share of their activities
and training endeavors to supply the type of physi-
cians the people of Michigan require.

Specifically this responsibility can be realized
by: (1) Student requests for curriculum changes to
allow them to have exposure to and experience in
family medicine training. Statistics from the Uni-
versity of Michigan Medical School show a definite
trend toward interest in primary care and partic-
ularly family practice for senior year elective time
(up 16.7% from 1971). (2) Legislative Action. Rep-
resentative Marvin Stempien’s committee was di-
rected by the state legislature to study the train-
ing of doctors for family practice and the retrain-
ing of such doctors for practice in Michigan. (3)
Consumer demand for family practice training. The
Michigan Health Council, UAW-CIO, Farm Bureau
and League of Women Voters are potent and vocal
sources of potential support and should be en-
listed.

The Michigan Academy of Family Physicians has
as one of its goals the establishment of departments
of family practice at each of the three medical
schools. It is our desire to assist and work collab-
oratively with the medical schools to this end, and
we intend to persistently and persuasively labor in
this endeavor. We feel that the people of Michigan
are entitled to have available competent and com-
passionate primary medical care, which can only
be accomplished through training of family physi-
cians in all Michigan medical schools by a De-
partment of Family Practice.

(Doctor Fisher is president of the Michigan Acad-
emy of Family Physicians.)

Roy J. Gerard, MD
Saginaw

Throughout our country there is increasing evi-
dence that we have a crisis in the delivery of
health care. This crisis has developed because
of several reasons, some of them related to spe-
cific regional differences, others related to more
universal causes. Among them are:

1. The doctor-patient ratio which has not been

330 MICHIGAN MEDICINE APRIL 1972

maintained or improved by the output of our
nation’s medical schools.

2. Increased utilization of medical manpower.

3. Distribution of physicians.

There are wide discrepancies in physician dis-
tribution; for instance, rural vs. urban areas with
many shortages in rural areas, and in urban ghetto
areas there has been a real decrease in the
number of available physicians.

4. Increase in specialization without relation to
the needs of communities. Some communities
have upwards of 20 boarded general sur-
geons, no E.N.T. physicians and very small
numbers of primary physicians.

5. Decrease in numbers of family physicians.

6. Increase in costs.

If in this country we develop a problem in
transportation we would be foolish if we did not
turn to the automobile industry for aid in solving
this problem; likewise, when we in Michigan have
a problem in health care delivery we would be
foolish if we did not turn to our medical schools
for aid in solving this problem.

While this presentation is to give reasons why
Michigan State University should have a Depart-
ment of Family Medicine, the reasons should be
valid and also should apply to the University of
Michigan and to Wayne as well as to the new
school of osteopathic medicine. If you would allow
me, I would like to treat the crisis of health care
as I would a patient, using the Problem Oriented
Record.

Family Medicine Problem List

Name: Crisis of Health Care Delivery

Number:

Date

Onset: 1930

ACTIVE

1. Population Explosion.

2. Increased Utilization.

3. Distribution of Physicians — Doctor Patient Ratio
Michigan — 1 physician to 900 people
Nationwide — 1 physician to 600 people.

4. Increase in specialization.

5. Decrease in number of Family Physicians.

6. Increasing Costs.

7. There are no real programs sponsored by
medical schools to develop Health Care
Assistants, Para Medical Personnel and
Health Care Teams.

INACTIVE

8. The threat of National Programs
with increasing utilization.

Date

Resolved:.

Doctor Fisher

Doctor Gerard

Problem 1

Population Explosion

Subjective Data: Many patients showing up in the emer-

gency room unable to contact or even
break into the health care system.

Objective Data: Ratio of patients to physicians.

1 to 900 Michigan
1 to 600 Nationwide

Plan: 1. Increase in size of medical schools

classes.

2. State supported schools should insist
on at least 5 years of state practice
after graduation.

Problem 2

Increased Utilization

Subjective Data: Emergency room patient population is

ever increasing, all episodic care.

Objective Data: No real evidence that we have reduced

the incidence of the major disabling dis-
eases, such as the degenerative diseases,
cancer and strokes.

Plan: Programs of health maintenance should

be part of the medical schools’ curricula.
The medical schools should have or be
part of a model of practice.

Today many of the systems of health care de-
livery are patterned after the university model. The
old model of university medicine was specially
oriented and fragmented with all the problems
of today’s medicine.

If university center models are oriented for
health care delivery, then so would be the fac-
similes. If the university center models are family
medicine oriented so would be the facsimiles.

Problem 3

The Distribution of Physicians

Subjective Data: There are many communities in the State

of Michigan without physicians. There
are parts of large communities without
physicians.

Objective Data: Saginaw, Michigan, for instance, with

the population of 125,000 has a pre-
ponderance of physicians segregating
themselves on the westside of the com-
munity, leaving a large segment of pop-

MICHIGAN MEDICINE APRIL 1972 331

YOUR OPINION /Continued

ulation on the eastside without primary
care physicians or leaving their care on
a catch as catch can basis, either in
indigent clinic or in emergency room.

Plan: Develop models of practice, which could

be developed for both urban and rural
areas, for both affluent and ghetto areas,
supervised and oriented towards primary
care with proper integration of paramed-
ical and specialist care.

Problem 4

Increase in Specialization

Subjective Data:

Objective Data:

Plan:

There are many reports that patients
have difficulty finding primary physicians.
Many communities have no or very few
primary physicians. The result is frag-
mentation of care with patients running
from doctor to doctor on a referral basis,
but no one taking primary responsibility
for supervision.

More than 80% of the graduating classes
in the last 10 years have gone into spe-
cialties.

1. To expose students to the primary
care model at the university level and
in satellite models of practice through-
out the state.

2. Exposure to teachers of family med-
icine in medical schools.

3. Reduce the trend towards over spe-
cialization.

Problem 5

The Decrease in Numbers of
Family Physicians

Subjective Data:

Objective Data:

Plan:

Many complaints of the shortage of fam-
ily physicians, (people yearn for the good
old days when the family doctor came
on horse and buggy).

The numbers of graduating physicians
who indicate that they want to go into
family practice have been decreasing for
approximately the last 30 years. Students
emulate their teachers. There are no
teachers of family medicine in medical
schools.

A family medicine department of Mich-
igan State University with the model of
practice. (A center around which the spe-
cialist function would be integrated,
would expose the medical student to the
family physician in his proper environ-
ment with the proper relationship to the
other specialties.) Problems 2, 3, 4 and 5
would all be on the way to solution with
this model.

Problem 6
Increase Costs

Subjective Data:

Objective Data:

Plan:

High premiums for health insurance.
Increased cost of health care.

National concern.

Most of this being consumed with epi-
sodic care.

Pressure in National Legislation.

Request for system overall.

Prepayment and other related ways of
stretching the health dollar should be
part of the university model. This would
go a long way to helping solve problem
2, utilization.

Problem 7

No real programs sponsored by
medical schools to develop health
care assistants and paramedical

Many programs at community levels
struggling toward development with many
problems such as standards and licen-
sures.

Over utilization of physician, where other
personnel could perform as well or better.

Use the model at the university to de-
velop a health manpower in order to
insure a better health care delivery.
Health care assistants and paramedical
personnel could be developed at the uni-
versity level within the model of prac-
tice.

One could develop teams of physicians,
paramedical personnel and other health
assistants that could be integrated into
rural and ghetto areas where the phy-
sician shortage is particularly acute.
This may be one way of keeping at least
temporarily some of the graduating medi-
cal students in our state.

In summary — many of the problems related to
the crisis in the delivery of health care are in-
volved in deficiencies in the delivery system. De-
livery system development should be a continuing
responsibility of the medical schools of the state.

The delivery system developed at the university
level should be or can be the prototype model
for those facsimiles in the communities.

If Michigan State University develops a model
of practice on its campus and has as its core a
functioning Department of Family Medicine, many
of the above mentioned problems would be re-
solved.

Doctor Gerard is director of the Family Practice
Residency program of the Saginaw Cooperative
Hospitals.

personnel

Subjective Data:

Objective Data:
Plan:

Jack R. Postle, MD
Petoskey

My crystal ball is sometimes cloudy, but on this
issue fairly clear. What I see in the future on the
medical scene is a continued centralization of med-
ical care into regional centers staffed by highly
trained specialists. I see some type of screening
and referring satellites in outlying areas, with a
definite working relationship with the regional cen-
ter. This function will be served for a while still by
general practitioners, but eventually it will be taken
over by medical assistants trained for this purpose.

General or family practice, as we have known it,
will continue to fade rapidly from the scene in spite
of many efforts to revive it. The technology of mod-
ern medical practice demands specialization for
mastery of any given portion thereof and it also re-
quires sophisticated medical facilities for its appli-
cation.

In spite of the legislature’s good intentions to
train more family doctors, I think they might as

332 MICHIGAN MEDICINE APRIL 1972

well try to bring back that bygone era of hand-
packed ice cream and Sunday rides in the coun-
try. Let us cherish the memory, but spend our ef-
forts trying to keep the medical delivery system
abreast of a rapidly changing technological society.

(Doctor Postle is an obstetrician-gynecologist in
private practice.)

William N. Hubbard, Jr., MD
Kalamazoo

Requiring medical schools to have departments
of family medicine really involves two questions.
The first of these is whether there should be for-
mal programs established for the special educa-
tional needs of future family physicians; and the
second question is whether these programs are
best supported by a departmental organization.

The first issue that a medical school faces in
any new effort is the source of funding. In addition
to income related to the educational effort, there
must also be income available from the patient
care offered in the new program and for the
research undertaken in it. It is not reasonable to
expect that a viable new program can be created
and maintained by parasitizing already inadequate
medical school budgets.

In order to teach family medicine it is necessary
for the medical school to have access to a clinical
setting where FAMILIES are given both primary
and continuing care. Since almost all hospital out-
patients are now either referred to specialty clinics
or are referred as individuals for episodic care,
hospitals rarely offer whole family units both pri-
mary and continuing care. It is in my judgment
useful to attempt an educational program in family
medicine only in a clinical resource that offers
primary and continuing care to entire families.

Of all forms of medical practice, the family phy-
sician is most responsive to the medical care
pattern of the particular community. Where special-
ists are readily available and health care institu-
tions highly developed, the role of the family phy-
sician will be very different indeed from the com-
munities that do not have ready access to special-
ists and may not have highly developed health
care institutions. It is therefore unlikely that a
given curriculum plan can prepare the student
appropriately for these two extremes, it would be
very difficult also to construct a single department
with enough manpower to provide the full range
of educational opportunities needed by the many
varieties of family physicians. In my opinion this
suggests that an interdepartmental program rather
than a segregated departmental structure would
be most supportive of family medicine.

It is unlikely that enough specialists in family
medicine will be trained to meet the need. As a
result, I would urge that the broad specialties —
internal medicine, pediatrics, obstetrics and gyne-
cology, and general surgery — have (at least as
electives) in their residency program a participa-
tion in the family practice environment so that

Doctor Hubbard

these broad specialists can also support the pur-
poses of family medicine.

To summarize, I would propose that educational
programs in family medicine should be developed
in the medical schools and should be fully funded
when they are presented as new program proposals
to the Legislature. Assured of this funding, a time
limit could be placed during which the medical
schools would be required to submit programs.

I would urge that htese programs do not need
to be departmentalized, but rather should be able
to draw on the full resources of the medical
school faculty in an interdepartmental effort that
would be based in a new clinical resource de-
signed to give primary and continuing medical care
to whole family units. These families should be rep-
resentative of the entire community and should not
be a stratified patient population; rather providing
a cross-section of the family problems that will be
met in general community practice.

A basic residency should be offered in family
medicine. This same family medicine program
should be available to supplement the broad
specialty residencies.

In the most general terms, family medicine
should be each physician’s concern and its form
should be responsive to the needs of the com-
munity in which it is practiced.

(Doctor Hubbard is vice president of Upiohn
Co. and general manager of its pharamaceutical
division. He was dean of the University of Michigan
Medical School 1959-1970.)

Leland E. Holly II, MD
Muskegon

Philosophically and biologically it has been noted
that man has survived so well because he is un-
specialized. Since his feet have not been hooves
nor his hands claws, he has met many environ-
mental challenges successfully. Many other exam-
ples of the great potential of man’s non-specialty
can be derived.

Is there a message here?

Is it not true that the greatest impact of med-
icine on people has been through the physician
who practices the non-specialty of family med-
icine? His great adaptability to the face-to-face

MICHIGAN MEDICINE APRIL 1972 333

YOUR OPINION/Continued

Doctor Holly

needs of people has been the shield of strength
behind which the shortcomings of the practice of
medicine have seemed less detrimental to the well-
being of the patient.

In the last 20 years, however, there have not
been enough of those fellows around and of those
remaining, some have slipped into poor habits. Per-
haps the decline in numbers and quality was in
part due to their seeming relegation to the position
of low man on the totem pole. Another factor may
have been the obscuring of the real values of med-
ical practice by the glories of specialization and
the emphasis by medical training on false or im-
complete goals of excellence. All of medicine has
suffered.

Countering the trend, two factors have begun to
operate. The new graduate physician appears to be
oriented differently than his predecessors. People-
care and face-to-face encounters where medical
need and action are appear to signal a renaissance
of the family practice philosophy even if not its
mode of practice. At the same time a thoughtful,
forward-looking breed of old-young family prac-
titioners have sought improved skills and knowl-
edge, as well as stature, with the formation of the
“specialty" of family practice.

This is a program to efficiently deliver at the
family level excellent medical care to a broad base
of people suffering from a tremendous range of ills,
real and imagined. This is the level where medicine
has the most meaning and works the greatest good.
This is a proud path for new graduates to follow.

Specialism as we see it in the surgeon, the radi-
ologist, the cardiologist or what-have-you is but an
extension, a sharpening if you will, of the skills of
the family practitioner. The science of medicine is
enhanced but the humanity is diluted. Indeed, the
role of the family practitioner is not for every phy-
sician since it demands skills and understanding
of scope and potential found only in those capable
of “unspecialization.”

The family practitioner must also be highly moti-
vated and trained. Medical schools need not have
fancy “departments of family practice” as long as
they recognize the need to identify, motivate and
train good young men qualified for this tough,
front-line work in the delivery of health care. After
all, family practice is the noblest of the specialties
because it is characterized by a broad instead of
a narrow range of excellence, because it stands at

the front of the rest of us, and because it comes
closest to fulfilling the ideal of the practice of med-
icine. That should be what medical schools are all
about.

(Doctor Holly is a radiologist.)

Don Marshall , MD
Kalamazoo

A department of family or community medicine
in a medical school could serve an important func-
tion, by coordinating the training of general prac-
titioners, and by championing the importance of
treating the whole man against the fractionizing
effect of specialists. But whether the need for
such a department is great could well be ques-
tioned. The same goal could be attained by a
change in the attitude of the existing departments,
in favor of the family doctor and his approach to
medical care.

We must agree, I hope, on certain facts. 1) We
always have had and always will need specialists.

2) The patient needs a point of entrance into the
health care system, and there should be a broadly
trained individual at or near that point to screen
and supervise his medical needs, in a continuing
manner. That person could well be a general or
family doctor.

Such a physician should be expert in triage
for referring to specialists, and must recognize
his own few incapabilities, but he could give
definitive care to the patient much of the time.

3) Every patient should have a personal health team
leader, who will correlate all reports and decide
management; this could be any specialist, but is
preferably one with a broad training, as an in-
ternist or pediatrician, or better yet a family phy-
sician. 4) Specialists as a group know every medi-
cal item that the GP knows; but the GP should
know more about the whole individual, his family
and environment, than the specialist. 5) Just cre-
ating a department of family medicine would not
automatically attain the above goals, any more
than more dollars alone are solving the health
needs of our people; the new department would
have to succeed in gaining stated goals, or it
would be useless.

Across this country and in Michigan there is a
broad belief that we need more GPs, and that
medical school faculties are prejudiced against
GPs. Consequently the conviction has long been
held by GPs and some others that their goal of
training more GPs and of elevating the status of
GPs is doomed to failure unless they can gain
family medicine departments in medical schools.
Such a department would presumably counter-
balance and hopefully abolish the alleged prejudice
against GPs. The truth of that assumption remains
to be proven.

(Continued on page 346)

334 MICHIGAN MEDICINE APRIL 1972

In planning high or low calorie diets, Campbell’s more than
50 different soups offer you a wide choice. And, most of
Campbell's Soups contain a wide variety of ingredients that
can serve as supplementary sources of many essential

CALORIES/ 1 Cup Prepared Soup

Vegetable

Tomato

Cream of Asparagus
Cream of Chicken
Beef

Cream of Potato
Cream of Mushroom
Green Pea

Beef Broth
Consomme
Chicken with Rice
Chicken Gumbo
Chicken Noodle
Chicken Vegetable
Turkey Noodle
Vegetable Beef

nutrients.

* From “Nutritive Composition of Campbell’s Products” which
gives values of important nutritive constituents of all Campbell’s
Products. For your copy, write to Campbell Soup Company,
Dept. 536, Camden, New Jersey 08101.

rhere’s a soup

for almost every patient and diet
..for every meal
and, it's made by

All women are not equal in their endogenous
hormonal output. And, while all oral contracepti
are fundamentally effective, they exhibit differences
in their activity levels and estrogen-progestogen
ratios that affect different women differently— in
both short and long-term use. Some brands
may be insufficient for the woman’s needs or else
may exceed them.

Searle offers a family of O.C. products that covers
the range of women’s needs to help you provide
the right pill for the right woman at the right time.

References. 1. Editorial Oral Contraceptives Which Pill for Which Patient7 Patient Care 390-115
(Feb ) 1969 and 4:135-145 (June 15) 1970 2. Greenblatt. R 8 Progestational Agents in Clinical
Practice, Med. Sci 18 37-49 (May) 1967. 3. Kistner. R W Gynecology Principles and Practice, ed. 2.
Chicago, Year Book Medical Publishers, 1971 4. Kistner, R W The Pill Facts and Fallacies About
Today's Oral Contraceptives, New York, Delacorte Press, 1968 5. Nelson, J. H Clinical Evaluation of
Side Effects of Current Oral Contraceptives, J Reprod Med. 6:5055 (Feb) 1971 6. Orr.G W Oral
Progestational Agents- Therapy and Complications, S Dakota J Med 22*11-17 (Jan.) 1969

the Ovulen phase

Most women* with a balanced hormone profile and
normal menses do best on a middle-of-the-road pill
that is neither estrogen dominant nor strongly
progestogen dominant.

("‘Typical clues — normal body build and breasts,
feminine appearance, healthy skin and hair. Vaginal
cytology slide— balanced "pink and blue’.’)

Some women having problems on other O.C.s
might do well on Ovulen.

Ovulen has a distinctive hormonal balance that
combines moderate estrogenic activity with a slight]
progestogen dominance. It has an excellent record

of patient acceptance.

Ovulen

Each white tablet contains: ethynodiol diacetate 1 mg / mestranol 0.1 mg.

SEARLE

For brief summary of prescribing information,
see following page.

the Enovid-E phase

Some women* who secrete less estrogen than most
do best on a pill with a moderate estrogen
overbalance.

("Typical clues— oily complexion, acne, hirsutism,
masculinity, flat chest. Vaginal cytology slide—
“blue’.’)

Patients with estrogen deficiency may show:
premenopausal syndrome intermittent depression
early-cycle bleeding increased appetite

scanty menses steady weight gain

vaginal candidiasis

Enovid-E not only provides increased estrogenic
activity with low progestogen activity, but also
contains the only progestogen that is not
antiestrogenic. Therefore it offers less risk of high-
dose progestogen side effects.

Enovid-E

the Demulen phase

Many women* who secrete more estrogen than most
do well on a pill with lower estrogen activity and an
increased progestogen overbalance.

("Typical clues— shorter, plumper, full-breasted,
with glowing skin and no wrinkles. Vaginal cytology
slide “pink!’)

Some women with special conditions that may
be aggravated by higher estrogen-activity products
may do better on this ratio.

Demulen combines minimal estrogenic activity
with a moderate ratio of progestogen overbalance.

It is particularly well suited to the young when
low-dose (activity) is preferred. Demulen offers
little risk of the most potent progestogen side
• early breakthrough bleeding is often

emulen

Each white tablet contains: ethynodiol diacetate 1 mg./ethinyl estradiol 50 meg Each tablet contains: norethynodrel 2.5 mg./mestranol 0.1 mg.

Each pink tablet in 0vulen-28*and Demulen“-28isa placebo, Oral contraceptives are complex medications and, after

containing no active ingredients. reference to the prescribing information, should be prescribed

Both Ovulen and Demulen are available in 21- and 28-pill schedules with discriminating care.

for the 3 phases of Eve:

a family of O.C. products

Ovulen* Demulen

Each white tablet contains: Each white tablet contains:

ethynodiol diacetate 1 mg./mestranol 0.1 mg. ethynodiol diacetate 1 mg./ethinyl estradiol 50 meg.

Each pink tablet in Ovulen-28®and Demulerf-28 is a placebo, containing no active ingredients.

Actions -Ovulen and Demulen act to prevent ovulation by inhibitingthe out-
put of gonadotropins from the pituitary gland. Ovulen and Demulen depress
the output of both the follicle-stimulating hormone (FSH) and the luteinizing
hormone (LH).

Special note-Oral contraceptives have been marketed in the United
States since 1960. Reported pregnancy rates vary from product to product.
The effectiveness of the sequential products appears to be somewhat lower
than that of the combination products. Both types provide almost completely
effective contraception.

An increased risk of thromboembolic disease associated with the use of
hormonal contraceptives has now been shown in studies conducted in both
Great Britain and the United States. Other risks, such as those of elevated blood
pressure, liver disease and reduced tolerance to carbohydrates, have not been
quantitated with precision.

Long-term administration of both natural and synthetic estrogens in sub-
primate animal species in multiples of the human dose increases the frequency
of some animal carcinomas. These data cannot be transposed directly to man.
The possible carcinogenicity due to the estrogens can be neither affirmed nor
refuted at this time. Close clinical surveillance of all women taking oral contra-
ceptives must be continued.

Indication -Ovulen and Demulen are indicated for oral contraception.

Contraindications- Patients with thrombophlebitis, thromboembolic
disorders, cerebral apoplexy or a past history of these conditions, markedly im-
paired liver function, known or suspected carcinoma of the breast, known or
suspected estrogen-dependent neoplasia and undiagnosed abnormal genital
bleeding.

Warnings-The physician should be alert to the earliest manifestations of
thrombotic disorders (thrombophlebitis, cerebrovascular disorders, pulmonary
embolism and retinal thrombosis). Should any of these occur or be suspected
the drug should be discontinued immediately.

Retrospective studies of morbidity and mortality conducted in Great Britain
and studiesof morbidity intheUmtedStates have shown a statistically significant
association between thrombophlebitis, pulmonary embolism, and cerebral
thrombosis and embolism and the use of oral contraceptives. There have been
three principal studies in Britain13 leading to this conclusion, and one4 in this
country. The estimate of the relative risk of thromboembolism in the study by
Vessey and Doll3 was about sevenfold, while Sartwell and associates4 in the
United States found a relative risk of 4.4, meaning that the users are several
times as likely to undergo thromboembolic disease without evident cause as
nonusers. The American study also indicated that the risk did not persist after
discontinuation of administration and that it was not enhanced by long-
continued administration. The American study was not designed to evaluate
a difference between products. However, the study suggested that there might
be an increased risk of thromboembolic disease in users of sequential prod-
ucts. This risk cannot be quantitated, and further studies to confirm this finding
are desirable.

Discontinue medication pending examination if there is sudden partial or
complete loss of vision, or if there is a sudden onset of proptosis, diplopia or
migraine. If examination reveals papilledema or retinal vascular lesions medica-
tion should be withdrawn.

Since the safety of Ovulen and Demulen in pregnancy has not been demon-
strated, it is recommended that for any patient who has missed two consecutive
periods pregnancy should be ruled out before continuing the contraceptive
regimen. If the patient has not adhered to the prescribed schedule the possi-
bility of pregnancy should be considered at the time of the first missed period.

A small fraction of the hormonal agents in oral contraceptives has been
identified in the milk of mothers receiving these drugs. The long-range effect to
the nursing infant cannot be determined at this time.

Precautions-The pretreatment and periodic physical examinations
should include special reference to the breasts and pelvic organs, including a
Papanicolaou smear since estrogens have been known to produce tumors,
some of them malignant, in five species of subprimate animals. Endocrine and
possibly liver function tests may be affected by treatment with Ovulen or Demu-
len. Therefore, if such tests are abnormal in a patient taking Ovulen or Demulen,
it is recommended that they be repeated after the drug has been withdrawn for
two months. Under the influence of progestogen-estrogen preparations pre-
existing uterine fibromyomas may increase in size. Because these agents may
cause some degree of fluid retention, conditions which might be influenced by
this factor, such as epilepsy, migraine, asthma, cardiac or renal dysfunction,
require careful observation. In breakthrough bleeding, and in all cases of irregular
bleeding per vaginam, nonfunctional causes should be borne in mind In un-
diagnosed bleeding per vaginam adequate diagnostic measures are indicated.
Patients with a history of psychic depression should be carefully observed and

thedrugdiscontinued if the depression recurs to a serious degree. Any possible
influence of prolonged Ovulen or Demulen therapy on pituitary, ovarian, adrenal,
hepatic or uterine function awaits further study. A decrease in glucose tolerance
has been observed in a significant percentage of patients on oral contracep-
tives. The mechanism of this decrease is obscure. For this reason, diabetic pa-
tients should be carefully observed while receiving Ovulen or Demulen therapy,
Theageofthe patient constitutes no absolute limitingfactor, although treatment
with Ovulen or Demulen may mask the onset of the climacteric. The pathologist
should be advised of Ovulen or Demulen therapy when relevant specimens are
submitted. Susceptible women may experience an increase in blood pressure
following administration of contraceptive steroids.

Adverse reactionsobserved in patients receivingoral contracep-
tives A statistically significant association has been demonstrated between
use of oral contraceptives and the following serious adverse reactions: thrombo-
phlebitis, pulmonary embolism and cerebral thrombosis.

Although available evidence is suggestive of an association, such a relation-
ship has been neither confirmed nor refuted for the following serious adverse
reactions: neuro-ocular lesions, e.g, retinal thrombosis and optic neuritis.

The following adverse reactions are known to occur in patients receiving oral
contraceptives: nausea, vomiting, gastrointestinal symptoms (such as abdom-
inal crampsand bloating), breakthrough bleeding, spotting, change in menstrual
flow, amenorrhea during and after treatment, edema, chloasma or melasma,
breast changes (tenderness, enlargement and secretion), change in weight
(increase or decrease), changes in cervical erosion and cervical secretions, sup-
pression of lactation when given immediately post partum, cholestatic jaundice,
migraine, rash (allergic), rise in blood pressure in susceptible individuals and
mental depression.

Although the following adverse reactions have been reported in users of
oral contraceptives, an association has been neither confirmed nor refuted:
anovulation post treatment, premenstrual-like syndrome, changes in libido,
changes in appetite, cystitis-like syndrome, headache, nervousness, dizzi-
ness, fatigue, backache, hirsutism, loss of scalp hair, erythema multiforme,
erythema nodosum, hemorrhagic eruption and itching.

The following laboratory results may be altered by the use of oral contra-
ceptives. hepatic function: increased sulfobromophthalein retention and other
tests; coagulation tests: increase in prothrombin, Factors VII, VIII, IX and X;
thyroid function: increase in PBI and butanol extractable protein bound iodine,
and decrease in T3 uptake values: metyrapone test and pregnanediol deter-
mination.

References: 1. Royal College of General Practitioners: Oral Contracep-
tion and Thrombo-Embolic Disease, J. Coll. Gen. Pract. 13: 267-279 (May) 1967.
2. Inman, W. H. W„ and Vessey, M. P : Investigation of Deaths from Pulmonary,
Coronary, and Cerebral Thrombosis and Embolism in Women of Child-Bearing
Age, Brit. Med. J. 2:193-199 (April 27) 1968. 3. Vessey, M. P, and Doll, R. Investi-
gation of Relation Between Use of Oral Contraceptives and Thromboembolic
Disease. A Further Report, Brit. Med. J. 2:651-657 (June 14) 1969 4. Sartwell,
P. E„ Masi, A T.; Arthes, F. G.; Greene, G R., and Smith, H. E.: Thromboem-
bolism and Oral Contraceptives: An Epidemiologic Case-Control Study, Amer.
J. Epidem. 90365-380(Nov.) 1969.

Products of SEARLE & CO.

San Juan, Puerto Rico 00936

Enovid-E'

norethynodrel 2.5 mg./mestranol 0.1 mg.

Actions -Enovid-E acts to prevent ovulation by inhibiting the output of
gonadotropins from the pituitary gland. Enovid-E depresses the output of both
the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH).

Indication -Enovid-E is indicated for oral contraception.

The Special Note, Contraindications, Warnings, Precautions and Adverse
Reactions listed above for Ovulen and Demulen are applicable to Enovid-E and
should be observed when prescribing Enovid-E.

Enovid-E

brand of norethynodrel with mestranol

Product of G. D. Searle & Co.

RO. Box 5110, Chicago, Illinois 60680

Where "The Pill" Began zn

SEARLE

SEARLE

Try Eutrorron a stubborn diastolic

pargyline hydrochloride 25 mg. and methyclothiazide 5 mg.

When you're not satisfied with your patient's diastolic
“end point " under present treatment , consider a trial of Eutron .
It will often bring further reduction of blood pressure ,
even in severe diastolic hypertension .

I Special Characteristics of Eutron :

—

Course of therapy usually is smooth, with
blood pressure reducing gradually over one to
three weeks.

Around-the-clock effect from a single daily dose.

Provides diuresis when edema accompanies
hypertension.

Free of central depressant action.

Lower doses of pargyline hydrochloride are
made possible because of the methyclothiazide
component.

TM— Trademark

Special Restrictions (see back of page) :

Tyramine-containing foods (e.g. aged cheese)
should be avoided. (For further listing of foods,
see back of page.)

If alcohol is used, it should be used cautiously
and in reduced amounts.

Patients should be warned against the concurrent
use of non-prescription medications (particularly
cold preparations and antihistamines), or
prescription drugs without physician’s consent.

Discontinue Eutron at least two weeks prior to
elective surgery.

Before prescribing Eutron, see prescribing
information in package insert. A brief
summary appears on next page. 201353

Brief Summary
EUTRON"

pargyline hydrochloride and methyclothiazide

Filmtab®

INDICATIONS. EUTRON (pargyline hydrochloride and methyclothiazide) is indicated in the
treatment of patients with moderate to severe hypertension, especially those with severe
diastolic hypertension. It is not recommended lor use in patients with mild or labile hypertension
amenable to therapy w th sedatives and/or thiazide diuretics alone.

Because of the potent diuretic properties of methyclothiazide, the combination is particularly
suited for use when congestive heart failure or other conditions requiring diuretic therapy
coexist with hypertension, or when edema attributable to antihypertensive therapy develops.

As discussed in regard to dosage and administration, it is desirable to establish the dosage
requirements for EUTRON by the administration of Eutonyl and Enduron separately.

CONTRAINDICATIONS. 1. Pargyline therapy is contraindicated in patients with pheo-
chromocytoma, paranoid schizophrenia, hyperthyroidism and advanced renal failure.

2. Pargyline should not be administered to those with malignant hypertension, or to children
under twelve years of age because significant clinical information concerning the use of the
drug in these conditions is not available.

3. I n general, the lol lowing drugs or agents are contraindicated in patients receiving pargyline
hydrochloride:

a. Centrally acting sympathomimetic amines such as amphetamine and its derivatives (also
found in anorectic preparations).

Peripherally acting sympathomimetic drugs such as ephedrine and its derivatives (also
found in nasal decongestants, hay fever preparations and cold remedies).

b. Aged and natural cheese (e g., Cheddar, Camembert, and Stilton), and other foods (e g ,
pickled herring, Chianti wine, pods of broad beans, chicken livers, chocolate and yeast
products), which require the action of bacteria or molds for their preparation or preserva-
tion, because of the presence of pressor substances such as tyramine. Banana peels are
also contraindicated. Cream cheese, processed cheese, and cottage cheese can be allowed
in the diet during EUTRON therapy, since their tyramine content is inconsequential.

In some patients receiving EUTRON, tyramine may precipitate an abrupt rise in blood
pressure accompanied by some or all of the following: severe headache, chest pain, profuse
sweating, palpitation, tachycardia or bradycardia, visual disturbances, stertorous breath-
ing, coma, and intracranial bleeding (which could be fatal). A phenothiazine derivative or
phentolamine may be administered parenterally for treatment of such an acute hyper-
tensive reaction.

c. Parenteral administration of reserpine or guanethidine may cause hypertensive reactions
from sudden release of catecholamines. Parenteral use of these drugs is contraindicated
during, and for at least one week following, treatment with EUTRON.

d. Imipramine, amitriptyline, desipramine, nortriptyline, or their analogues should not be
used with pargyline. The use of these drugs with monoamine oxidase inhibitors has been
reported to cause vascular collapse and hyperthermia which may be fatal. A drug-free
interval (about two weeks) should separate therapy with EUTRON and use of these agents.

e. Methyldopa or dopamine, which may cause hyperexcitability in patients receiving pargyline,
should not be given.

f. Other monoamine oxidase inhibitors should not be added to a EUTRON regimen since
they may augment the effects of pargyline.

4. Methyclothiazide is contraindicated in patients with a known sensitivity to methyclothiazide
and/or other thiazide diuretics. It should not be used in patients with severe renal disease
(except nephrosis) or complete renal shutdown. Thiazide diuretics should not be used in the
presence of severe liver disease and/or impending hepatic coma Hepatic coma has been
reported as a consequence of hypokalemia in patients receiving thiazide diuretics.

WARNINGS

A PATIENTS

1. PATIENTS SHOULD BE WARNED AGAINST THE USE OF ANY OVER-THE-COUNTER
PREPARATIONS, PARTICULARLY "COLD PREPARATIONS" AND ANTIHISTAMINES
OR PRESCRIPTION DRUGS WITHOUT THE KNOWLEDGE AND CONSENT OF THE
PHYSICIAN.

2. PATIENTS SHOULD BE CAUTIONED ON THE USE OF CHEESE (SEE CONTRAINDICA-
TIONS) AND ALCOHOLIC BEVERAGES IN ANY FORM.

3. PATIENTS SHOULD BE WARNED ABOUT THE LIKELIHOOD OF THE OCCURRENCE OF
ORTHOSTATIC HYPOTENSION.

4. PATIENTS SHOULD BE INSTRUCTED TO REPORT PROMPTLY THE OCCURRENCE OF
SEVERE HEADACHE OR OTHER UNUSUAL SYMPTOMS.

5. PATIENTS WITH ANGINA PECTORIS OR CORONARY ARTERY DISEASE SHOULD
BE ESPECIALLY WARNED NOT TO INCREASE THEIR PHYSICAL ACTIVITIES IN
RESPONSE TO A DIMINUTION IN ANGINAL SYMPTOMS OR AN INCREASE IN WELL-
BEING OCCURRING DURING TREATMENT WITH EUTRON.

B. PHYSICIANS

1. WHEN INDICATED THE FOLLOWING SHOULD BE CAUTIOUSLY PRESCRIBED IN
REDUCED DOSAGES:

a ANTIHISTAMINES

b. HYPNOTICS, SEDATIVES OR TRANQUILIZERS
c NARCOTICS (MEPERIDINE SHOULD NOT BE USED)

2. DISCONTINUE EUTRON AT LEAST TWO WEEKS PRIOR TO ELECTIVE SURGERY.

3. IN EMERGENCY SURGERY THE DOSE OF NARCOTICS OR OTHER PREMEDICATIONS
SHOULD BE REDUCED TO 1/4 TO 1/5 THE USUAL AMOUNT. CLINICAL EXPERIENCE
HAS SHOWN THAT RESPONSE TO ALL ANESTHETIC AGENTS CAN BE EXAGGERATED
IN PATIENTS RECEIVING EUTRON. THEREFORE THE DOSE OF THE ANESTHETIC
SHOULD BE CAREFULLY ADJUSTED.

4. PARGYLINE HYDROCHLORIDE MAY INDUCE HYPOGLYCEMIA.

5. CARE SHOULD BE EXERCISED IN USING EUTRON IN PATIENTS WITH ADVANCED
RENAL FAILURE.

The possibility of sensitivity reactions to methyclothiazide or pargyline should be considered
in patients with a history of allergy or bronchial asthma.

There have been several reports published and unpublished, concerning nonspecific small
bowel lesions consisting of stenosis with or without ulceration, associated with the administra-
tion ot enteric-coated thiazides with potassium salts. These lesions may occur with enteric-
coated potassium tablets alone or when they are used with nonenteric-coated thiazides, or
certain other oral diuretics.

These small bowel lesions have caused obstruction, hemorrhage and perforation. Surgery
was frequently required and deaths have occurred.

Available information tends to implicate enteric-coated potassium salts although lesions
of this type also occur spontaneously. Therefore, coated potassium-containing formulations
should be administered only when adequate dietary supplementation is not practical, and
should be discontinued immediately if abdominal pain, distention, nausea, vomiting or gas-
trointestinal bleeding occurs.

The possibility of exacerbation or activation of systemic lupus erythematosus has been
reported for sulfonamide derivatives, including thiazides.

EUTRON does not contain added potassium.

USE IN PREGNANCY

Pargyline Hydrochloride. Safe use of pargyline during pregnancy or lactation has not yet
been established. Before prescribing pargyline in pregnancy, in lactation, or in women of
childbearing age, the potential benefits of the drug should be weighed against its possible
hazard to mother and child.

Methyclothiazide. Thiazides should be used with caution in pregnant women and nursing
mothers since they cross the placental barrier and appear in cord blood and in breast milk.
The use of thiazides may result in fetal or neonatal jaundice, bone marrow depression and
thrombocytopenia, altered carbohydrate metabolism in newborn infants of mothers showing
decreased glucose tolerance, and possible other adverse reactions which have occurred in
the adult. When the drug is used in women of childbearing age, the potential benefits of the
drug should be weighed against the possible hazards to the fetus.

PRECAUTIONS

Pargyline Hydrochloride. The therapeutic response to a variety of drugs may be changed,
or exaggerated, in patients receiving a monoamine oxidase inhibitor such as pargyline hydro-
chloride Caffeine, alcohol, antihistamines, barbiturates, chloral hydrate, and other hypnotics,
sedatives, tranquilizers and narcotics (meperidine should not be used), should be used
cautiously and at reduced dosage in patients who are taking pargyline.

Pargyline has not been shown to damage the kidney or liver. However, laboratory studies
including complete blood counts, urinalyses, and liver function tests should be performed
periodically. The drug should be used with caution in the presence of liver disease. All patients
with impaired circulation to vital organs from any cause including those with angina pectoris,
coronary artery disease, and cerebral arteriosclerosis should be closely observed for symptoms
of orthostatic hypotension. If hypotension develops in these patients, EUTRON dosage should
be reduced or therapy discontinued since severe and/or prolonged hypotension may precipitate
cerebral or coronary vessel thromboses.

The hypotensive effect of pargyline may be augmented by febrile illnesses. It may be advisa-
ble to withdraw the drug during such diseases.

Since pargyline is excreted primarily in the urine, patients with impaired renal function
may experience cumulative drug effects. Such patients should also be watched for elevations
of blood urea nitrogen and other evidence of progressive renal failure. If such alterations
should persist and progress, the drug should be discontinued.

An increased response to central depressants may be manifested by acute hypotension
and increased sedative effect. Pargyline also may augment the hypotensive effects of anesthetic
agents and surgery. For this reason, the drug should be discontinued from at least two weeks
prior to surgery.

In the event of emergency surgery smaller than usual doses (1/4 to 1/5) of narcotics,
analgesics, sedatives, and other premedications should be used. If severe hypotension should
occur, this can be controlled by small doses of a vasopressor agent such as levarterenol.

Pargyline therapy should not be used in individuals with hyperactive or hyperexcitable
personalities, as some of these patients show an undesirable increase in motor activity with
restlessness, confusion, agitation and disorientation. Clinical studies have shown that par-
gyline may unmask severe psychotic symptoms such as hallucinations or paranoid delusions
in some patients with pre-existing serious emotional problems. This can usually be controlled
by judicious administration of chlorpromazine intramuscularly, or other phenothiazines, the
patient remaining supine for one hour after administration.

Pargyline should be used with caution in patients with Parkinsonism, as it may increase
symptoms. In addition, great care is required if pargyline is administered in conjunction with
anti-parkinsonian agents.

In experience to date, pargyline has not been associated with eye changes or optic atrophy
as reported with the use of some hydrazine monoamine oxidase inhibitors. However, patients
receiving this drug for prolonged periods should be examined for any changes in color per-
ception, visual fields, fundi, and visual acuity.

Clinical reports state that certain individuals receiving pargyline for a prolonged period of
time are refractory to the nerve-blocking effects of local anesthetics, e g . lidocaine.
Methyclothiazide. Thiazide therapy should be used with caution in patients with severely
impaired renal function because of the possibility of cumulative effects. Caution is also nec-
essary m patients with severely impaired hepatic function or progressive liver disease.

Thiazide drugs may reduce response to levarterenol. Accordingly, the dosage of vasopressor
agents may need to be modified in surgical patients who have been receiving thiazide therapy.

Thiazide drugs may increase the responsiveness to tubocurarine.

The antihypertensive effect of the drug may be enhanced in the svmpathectomized patient.

All patients should be observed tor clinical signs of fluid or electrolyte imbalance, including
hyponatremia ("low-salt” syndrome). These include thirst, dryness of the mouth, lethargy
and drowsiness.

Hypokalemia may occur during therapy with methyclothiazide. In such cases supplemental
potassium may be indicated Potassium depletion can be hazardous in patients taking digitalis.
Myocardial sensitivity to digitalis is increased in the presence of reduced serum potassium
and signs of digitalis intoxication may be produced by formerly tolerated doses of digitalis.
Hypochloremic alkalosis may occur following intensive or prolonged thiazide therapy. Re-
placement of chloride may be indicated in such cases.

Thiazides may decrease serum P B I . levels without signs of thyroid disturbance.
ADVERSE REACTIONS. Generally side effects should not be severe or serious when the
recommended dosages are used, and necessary precautions are observed. If side effects
are severe or persist in spite of symptomatic treatment, the dosage should be reduced or the
drug withdrawn. See also Warnings and Precautions.

Pargyline Hydrochloride. The most frequently occurring side effects are those associated
with orthostatic hypotension (dizziness, weakness, palpitation, or fainting). These usually
respond to a reduction of dosage. Patients should be warned against rising to a standing
position too quickly, especially when getting out of bed. Severe and persistent orthostatic
hypotension should be avoided by reduction in dosage and/or discontinuation of therapy.

Mild constipation, fluid retention with or without edema, dry mouth, sweating, increased
appetite, arthralgia, nausea and vomiting, headache, insomnia, difficulty in micturition night-
mares, impotence and delayed ejaculation, rash and purpura, have also been encountered.
Hyperexcitability, increased neuromuscular activity (muscle twitching) and other extra-pyra-
midal symptoms have been reported. Gain in weight may be due either to edema or increased
appetite. Drug fever is extremely rare. In some patients reduction of blood sugar has been
noted. Although the significance of this has not been elucidated, the possibility of hypo-
glycemic effects should be borne in mind. Congestive heart failure has been reported in patients
with reduced cardiac reserve.

Methyclothiazide. Side effects that may accompany thiazide therapy include anorexia,
nausea, vomiting, diarrhea, headache, dizziness, paresthesias, weakness, skin rash, photo-
sensitivity. Jaundice and pancreatitis also have been reported.

Blood dyscrasias, including thrombocytopenia with purpura, agranulocytosis and aplastic
anemia, have been reported with thiazide drugs.

Thiazides have been reported, on rare occasions, to have elevated serum calcium to hyper-
calc e m i c levels. The serum calcium levels have returned to normal when the medication has
been stopped. This phenomenon may be related to the ability ol the thiazide diuretics to
lower the amount of calcium excreted in the urine.

Elevations of blood urea nitrogen, serum uric acid, and blood sugar have occurred with the
use of thiazide drugs. Symptomatic gout may be induced.

Although not established as an adverseeffect of methyclothiazide, it has been reported that
thiazide diuretics may produce a cutaneous vasculitis in elderly patients.

®FILMTAB— Film-sealed tablets, Abbott. TM— Trademark

204364

MOVE-OUT STICKY MUCUS .

"Many physicians use iodides intravenously when they suspect that the main
reason for airway obstruction is sticky mucus but oral iodides are more
likely to exert an expectorant action.”1

"For the viscid sputum, potassium iodide (. . . preferable as enteric coated
tablets) may be best.”2

Provide tastefree, well-tolerated KI in convenient SLOSOL coated tablets —

IODO- NIACIN*

In asthma, bronchitis

Each SLOSOL coated tablet contains potassium
iodide 135 mg. and niacinamide hydroiodide 25 mg.

COLE

please see next page for prescribing information —

Promote Productive Cough-

"The productive cough
serves the necessary
purpose of removing
excess mucus from
the bronchial tree.”3

. . there is clear evidence
that the loosening of the bronchial mucus
blanket must begin from within the under-
lying mucus glands where it is anchored
and not from the surface. Complications
of iodides are too occasional to avoid the
use of this valuable medication.”3

Rx Information:

INDICATIONS: The primary indication for lodo-Niacin is in any clinical
condition where iodide therapy is desired. All of the usual indications for the
iodides apply to lodo-Niacin and include:

RESPIRATORY DISEASE: The use of lodo-Niacin is indicated whenever an
expectorant action is desired to increase the flow of bronchial secretion and
thin out tenacious mucus as seen in bronchial asthma, and other chronic
pulmonary disease. lodo-Niacin has also proven of value in sinusitis, bron-
chitis, bronchiectasis, and other chronic and acute respiratory diseases
where the expectorant action of iodide is desired.

THYROID DISEASE: lodo-Niacin is indicated in any thyroid disorder due to
iodine deficiency, such as endemic goiter or hypoplastic goiter, and where
hypothyroidism is secondary to iodine deficiency. lodo-Niacin will suppress
mild hyperthyroidism completely, and partially suppress more severe hyper-
thyroid states. lodo-Niacin is also of value in suppressing the symptoms of
hyperthyroidism and decreasing the size and vascularity of the thyroid gland
prior to thyroidectomy.

ARTERIOSCLEROSIS: Iodides have been reported as relieving some of the
symptoms associated with arteriosclerosis. The mechanism of action is un-
known, but the effects are documented.

OPHTHALMOLOGY: lodo Niacin has been reported to be of value in retinal and
vitreous hemorrhages. The mechanism of action is unknown, but absorption

of the hemorrhagic areas has been observed following use of this drug. It is
also reported to be of value in reducing or removing vitreous floaters.

SIDE EFFECTS: Serious adverse side effects from the use of lodo-Niacin are
rare. Mild symptoms of iodism such as metallic taste, skin rash, mucous
memprane ulceration, salivary gland swelling, ana gastric distress have
occurred occasionally. These generally subside promptly when the drug is
discontinued. Pulmonary tuberculosis is considered a contraindication to
the use of iodides by some authorities, and the drug should be used with cau-
tion in such cases. Rare cases of goiter with hypothyroidism have been
reported in adults who had taken iodides over a prolonged period of time,
and in newborn infants whose mothers had taken iodides for prolonged
periods. The signs and symptoms regressed spontaneously after iodides were
discontinued. The causal relationship and exact mechanism of action of
iodides in this phenomenon are unknown. Appropriate precautions should be
followed in pregnancy and in individuals receiving lodo-Niacin for prolonged
periods.

DOSAGE: The oral dose for adults is two tablets after meals taken with a
glass of water. For children over eight years, one tablet after meals with
water. The dosage should be individualized according to the needs of the
patient on long-term therapy.

HOW SUPPLIED: Cole's lodo-Niacin tablets are available in bottles of 100,
500 and 1,000 Slosol coated pink. NDC 55-6458

IODO-NIACIN*

Each SLOSOL tablet contains potassium iodide 135 mg. and
niacinamide hydroiodide 25 mg. Sig. jj tabs, t.i.d. p.c.

References: 1. Itkin, I. H., Am. Fam. Phys. 4:83, 1971. 2. Feinberg, S. M., Consultant
Sept., 1971, pg. 32. 3. Bookman, R., Ann. Allerg. 29:367, 1971.

COLE

PHARMACAL CO. INC.

St. Louis, Mo. 63108

or open to infection •••

choose the topicals
that give your patient-

p broad antibacterial activity against
susceptible skin invaders
low allergenic risk— prompt clinical response

Special Petrolatum Base

Neosporin* Ointment

(polymyxin B-bacitracin-neomycin)

Each gram contains: Aerosporin® brand polymyxin B sulfate, 5000 units;
zinc bacitracin, 400 units; neomycin sulfate 5 mg. (equivalent to 3.5 mg.
neomycin base); special white petrolatum q. s.

In tubes of 1 oz. and V2 oz. for topical use only.

\anishing ((ream Base

Neosporin-G Oeam

(polymyxin B-neomycin-gramicidin) -

Each gram contains: Aerosporin® brand polymyxin B sulfate, 10,000 1

units; neomycin sulfate, 5 mg. (equivalent to 3.5 mg. neomycin base);

' gramicidin, 0.25 mg., in a smooth, white, water-washable vanishing

cream base with a pH of approximately 5.0. Inactive ingredients: liquid ;
petrolatum, white petrolatum, propylene glycol, polyoxyethylene
polyoxypropylene compound, emulsifying wax, purified water, and 0,25%
methylparaben as preservative.

In tubes of 15 g.

NEOSPORIN for topical infections due to susceptible organisms, as in
impetigo, surgical after -care, and pyogenic dermatoses.

Precaution: As with other antibiotic preparations, prolonged use may
result in overgrowth of nonsusceptibie organisms and/or fungi. Appro
measures should be taken if this occurs. Articles in the current medi1
literature indicate an increase in the prevalence of persons allergic to
neomycin. The possibility of such a reaction should be borne in mind.
Contraindications: Not for use in the external ear canal if the eardrum is
perforated. These products are contraindicated in those individuals who
have shown hypersensitivity to any of the components.

Complete literature available on request from Professional Services
Dept. PML.

iate

I

‘a.

ft

Wellcome

Burroughs Wellcome Co.

Research Triangle Park
North Carolina 27709

■Ml

When irritable colon feels like this

... in the presence of spasm or hypermotility,
gas distension and discomfort, KINESEET
provides more complete relief :

D belladonna alkaloids— for the hyperactive bowel
[U simethicone— for accompanying distension and pain due to gas
n phenobarbital— for associated anxiety and tension

Composition: Each chewable, fruit-flavored, scored tab-
let contains: 16 mg. phenobarbital (warning: may be
habit-forming); 0.1 mg. hyoscyamine sulfate; 0.02 mg.
atropine sulfate; 0.007 mg. scopolamine hydrobromide;
40 mg. simethicone.

Contraindications: Hypersensitivity to barbiturates or
belladonna alkaloids, glaucoma, advanced renal or he-
patic disease.

Precautions: Administer with caution to patients with
incipient glaucoma, bladder neck obstruction or uri-

nary bladder atony. Prolonged use of barbiturates may
be habit-forming.

Side effects: Blurred vision, dry mouth, dysuria, and
other atropine-like side effects may occur at high doses,
but are only rarely noted at recommended dosages.
Dosage: Adults: One or two tablets three or four times
daily. Dosage can be adjusted depending on diagnosis
and severity of symptoms. Children 2 to 12 years: One
half or one tablet three or four times daily. Tablets may
be chewed or swallowed with liquids.

STUART PHARMACEUTICALS I Pasadena, California 91109 | Division of ATLAS CHEMICAL INDUSTRIES, INC.

(from the Greek kinetikos,
to move,

and the Latin sedatus,
to calm)

KINESED®

antispasmodic/sedative/antiflatulent

Spring peeper (tree frog, Hyla crucifer)-.
this small amphibian can expand
its throat membrane with air until it is
twice the size of its head.

MICHIGAN MEDICINE APRIL 1972 345

YOUR OPINION /Continued

Doctor Marshall Mr. Wieman

What is unique about the GP? Despite a depart-
ment of family medicine, students would be taught
medical diagnosis and treatment by specialists
as they are today. Psychiatry and obstetrics and
heart disease are the same whether the patient
faces a GP or is inside the Mayo Clinic. I have
heard a Michigan dean reply, when urged to
have a department of family medicine, “What would
we teach differently than is being taught today?’’
When GPs have a scientific meeting, they invite
specialists in to lecture.

I believe there is a feeling today that a depart-
ment of family medicine could and should re-
arrange existing knowledge, and change the em-
phasis, in the teaching of GPs. It would not teach
different facts, but would coordinate what is now
being taught into a different approach, that of
studying and caring for the whole man, instead of
his separate systems. A department of family medi-
cine could alter the curriculum to give more train-
ing to the GP in psychosomatic and behavioral
problems, the sociology and economics and pre-
ventive aspects of family medical care, and a
more sophisticated familiarity with the referral re-
sources of a community.

A new department of family medicine in our
medical schools could do much, if established and
given full cooperation. The same result could prob-
ably be obtained without such a new department,
if the existing faculty would acknowledge the same
goals, and act to'attain them.

(Doctor Marshall is an ophthalmologist. He is a
former MSMS councilor and past president of the
Michigan Association for Regional Medical Pro-
grams.)

James L. Weatherhead
East Lansing

It occurs to me that the first question one must
ask is, “How best may we meet the ever increasing
primary family needs of the Michigan medical con-
sumer?” A great portion of this answer must be
the turning out, via our state institutions, of more
primary family practitioners.

Logically, the next question needing an answer
is, “How may we increase the percentage of grad-
uating physicians committed to a life time of prac-
tice in this needed field?” I believe this answer
lies in the minds and wills of medical students

somewhere in the midst of their first and second
years of training.

Yes, it is my opinion that only if medical stu-
dents, during their training, are favorably exposed
to family medicine, will our existing medical col-
leges indeed graduate sorely needed workers in
the primary care field.

If the key word above is “exposure,” then per-
haps the actual mandate to our state’s medical
schools is to discover the best mode or vehicle to
meaningfully picture in every student’s “mind’s
eye,” the best conceptual image of family med-
icine during a formative stage of undergraduate
training.

In short, we must “sell” or make appealing the
family medicine concept to students!

Having read of the experiences of the 20 now
existent departments of family medicine in the
U.S., my own opinion is that the establishment of
structured departments may not be the only nor the
best way of accomplishing the heretofore dis-
cussed objective. This is by no means to say, that
said departments are not warranted. I believe there
is a basis for their formation. Department forma-
tion, however, is likely not the proverbial “cure-all”
as envisioned by others in this state.

Clearly, family medicine is not the same as in-
ternal medicine, nor pediatrics, nor even the same
as a university health service physician or emer-
gency room physician. It is, in fact, a very spe-
cialized brand of medical practice requiring special
skills, training and personality types. It seems to
follow then, that as any other medical specialty,
family medicine should develop its objectives, nom-
enclature, its own literature and, of course, re-
search. So for these reasons, family medicine is
truly a “specialty” deserving of all the burdens,
academic responsibilities and prestige accorded to
its fellow specialty fields.

Based on my own experiences and interaction
with student colleagues at all three state institu-
tions, I believe that the presence alone, of even the
most prestigious department of family medicine,
would probably not result in a sharp percentage in-
crease of graduating family practitioners.

What then, can be done to augment student de-
cisions for family medicine in the presence or ab-
sence of a formal department of family medicine?
A great factor could be early, adequate exposure
to the practicing family physician in his own office
setting, in his community hospital setting and most
importantly in the university setting. Given that a
student’s only exposure is the mention of “the
L.M.D.” in the case presentation at medical grand
rounds or a “last ditch,” third or fourth year expe-
rience in “boondock” or “ghetto” medicine, what
chance for appeal as “Good Quality Clinical Med-
icine” has family practice? On the other hand, if
from day one, a student sees a family physician as
one of his physical diagnosis instructors or sees a
positive consultation relationship with university
clinical staff or even is encouraged to participate
with the family physician in community health care,

346 MICHIGAN MEDICINE APRIL 1972

it is then more likely that family practice will be
authentically viewed as a “peer” in the array of
medical specialties.

Finally, it is of note that the manner in which
departments of family medicine are organized,
largely determines their effectiveness, indeed, their
viability in the university setting. According to a
communication from the A.A.G.P. on September 24,
1971, there exist 20 departments of family medicine
and 20 “divisions or offices” of family medicine in
the nation’s medical schools. Those programs ini-
tiated by med-school faculty and family practice
residencies with administrative approval have done
markedly better in terms of smooth implementation
and annual increases of family practitioners than
have organizations initiated by deans without the
hearty support of faculty and existent community
personnel.

To summarize, I believe the onus to meet Mich-
igan’s growing primary physician deficit is not sole-
ly on the shoulders of medical school administra-
tors, but must jointly be shared by medical school
faculty, curriculum planners, family practice resi-
dencies, community hospitals and most importantly
the Michigan Academy of Family Practice. Mich-
igan-trained family practitioners for Michigan will
not increase in numbers without student introduc-
tion and interest during their formative undergrad-
uate years.

(Mr. Weatherhead is chairman of the Family
Practice Club at Michigan State University.)

Henry M. Wieman
Detroit

I believe it is imperative that Departments of
Family Medicine be established in Michigan medi-
cal schools. Such a move is overdue. I am happy
to see that the state legislature has acted in
this direction, but I feel that if the “encourage-
ment” fails, stronger steps should be taken.

I openly admit that I am biased, because I plan
on becoming a family practitioner. I feel the need
for a family medicine department in order that the
medical school can train me in my future specialty.

At one time, a majority of medical school grad-
uates became general practitioners and presum-
ably the faculty of medical schools saw themselves
training general practitioners.

Needless to say, times have changed, both in the
fate of medical school graduates and the attitudes
of the teaching faculty. Probably partly in reaction
to this state of affairs, and due to the logarithmic
growth of medical knowledge and technology, fam-
ily medicine has carved out a specialty of its own.
I feel that my need to be exposed to my future
specialty in medical school is a real need for many
medical students.

Besides teaching those of us who may choose
family practice, a department of family medicine
could benefit students who choose another spe-
cialty as well. Neurologic problems are seen in

family practice, for instance, and vice versa. Prob-
lems of real people rarely fall entirely within the
boundaries of a given specialty’s purview. I may
have occasion to trust the care of a patient to a
neurologist, and the more I know about how the neu-
rologist is likely to handle the situation, the more
helpful I can be in providing long-term care and
guidance for the patient and his family. Likewise,
the neurologist may have occasion to trust the care
of a patient to a family practitioner and the same
considerations apply.

The medical school as a whole needs a depart-
ment of family medicine. The perspective and ex-
perience of family medicine specialists would be
useful in the academic community of the medical
school. Medical schools need, and family practi-
tioners deserve, their involvement in the shaping
of priorities and curricula of the schools.

Most students pick their specialty or change
their minds about their specialty while in medical
school. In view of the widely held belief, which I
share, that there is a great undersupply of family
practitioners and a relative oversupply of many of
the other specialties, means must be found to en-
courage medical students to become family prac-
titioners. I don’t think that departments of family
medicine will guarantee more family practitioners
and I certainly don’t think it should be the only
effort in this direction; however, it seems obvious
that a medical student floundering around in his
junior year is influenced by the men around him
and the interesting subjects presented. It would
certainly seem that some family practitioners around
a medical school would land a few floundering
juniors.

Well, besides this golden-penned rhetoric, what
methods should be used to bring departments of
family medicine about? It should be recognized
that departments, especially good ones, aren’t built
in a day.

I think the legislature should use financial incen-
tives to demand the creation of these departments.
I think the legislature has the right to influence the
institutions it finances, particularly if it thinks the
institution is not performing its civic duty properly.
Meanwhile, family practitioners interested in teach-
ing in the state should continue to forcefully offer
their services as teachers to the medical schools.
I know that at Wayne, efforts of this kind have been
fruitful and we have a Department of Community
and Family Medicine which meets some of the
needs discussed above, and in time, I am sure,
will meet more of them.

Hopefully, family medicine departments will
evolve without recourse to coercion by the legis-
lature.

(Mr. Wieman is a member of the junior class at
Wayne State University’s School of Medicine.)

MICHIGAN MEDICINE APRIL 1972 347

nV, •

1 1
*

In the glaucoma patient v
on cerebral or peripheral ®
vasodilator therapy V

no treatment i
conflict E9
reported m

VASODiLAN

(ISOXSUPRINE HO)

the compatible vasodilator

• no reported increase of intraocular pressure.

• conflicts have not been reported with diuretics,
corticosteroids, antihypertensives or miotics.

• complications in the treatment of coronary
insufficiency, hypertension, diabetes, peptic
ulcer or liver disease have not been reported.

In fact, there are no known contraindications
in recommended oral doses other than it
should not be given in the presence of frank
arterial bleeding or immediately postpartum.

Although not all clinicians agree on the value of vasodilators in vascular disease, several
investigators' '* have reported favorably on the effects of isoxsuprine. Effects have been dem-
onstrated both by objective measurement !,i and observation of clinical improvement.1,5
Indications: Cerebrovascular insufficiency, arteriosclerosis obliterans, diabetic vascular
diseases, thromboangiitis obliterans (Buerger’s disease), Raynaud’s disease, postphlebitic
conditions, acroparesthesia, frostbite syndrome and ulcers of the extremities (arterio-
sclerotic, diabetic, thrombotic). Composition: VasodIlan tablets, isoxsuprine HC1 10 mg.
and 20 mg. Dosage: Oral — 10 to 20 mg. t.i.d. or q.i.d. Contraindications and Cautions:
There are no known contraindications to recommended oral dosage. Do not give imme-
diately postpartum or in the presence of arterial bleeding. Side Effects: Occasional pal-
pitation and dizziness can usually be controlled by dosage reduction. Complete details
available in product brochure from Mead Johnson Laboratories. References: 1. Clark-
son, I. S., and LePere, D. M.: Angioiogy 77:190-192 (June) 1960. 2. Horton, G. E.,
and Johnson, P, C., Jr.: Angioiogy 75:70-74 (Feb.) 1964. 3.

Dhrymiotis, A. D., and Whittier, J. R. : Curr. Ther. Res.

■*0124-128 (April) 1962. 4. Whittier, J. R.: Angioiogy 75:82-87
(Feb.) 1964. laboratories

© 1971 MEAD JOHNSON a COMPANY • EVANSVILLE, INDIANA 47721 U.S.A.

184571

<gV[SMS ill actiori

MSMS represents
many opinions,
types of physicians

(Editor’s Note: The following is excerpted from
testimony by Doctor Masters before the National
Democratic Policy Council' Subcommittee on
Health.)

By Brooker L. Masters, MD
Chairman, MSMS Council

“The Michigan State Medical Society has an of-
ficial position recognizing that there are currently
many acceptable methods of practicing medicine.
Michigan physicians feel that multiple options for
the delivery of medical care should remain open to
physicians.

“Our nation is great because we do have plura-
listic systems of education, agriculture and others.
It is appropriate because no single approach will
work across our large nation where population
densities vary, where cultural values differ, and so
many conditions are unique.

“In Michigan today we have solo medical prac-
tices, group practices, professional corporations,
clinics, hospitals with salaried staffs, hospitals with
fee-for-service staffs, and other forms of practice.

We believe that each in its own way is contributing
to the effective practice of medicine in Michigan.
These variations permit the doctor to select the
best structure to provide care for his patients.

'“Any insistence that medicine be practiced the
same in the inner city of Detroit as in my rural
community in Western Michigan would be unwise.

“Our Michigan State Medical Society member-
ship spans the whole spectrum of medical doctors
— from the medical school professor to the medical
researcher to the salaried physician to the fee-for-
service solo practitioner. But it is only through the
Michigan State Medical Society that the private
practitioner has a voice in Michigan.

“As the prime providers of medical care in Mich-
igan, doctors are deeply concerned about the
health and medical needs of the people in Mich-
igan. We have 40 active committees which study
various medical concerns and we are activists in
attacking these problems.

“The medical profession accepts its vital role in
this fast-moving evolution toward further improve-
ments. We are dedicated to making available med-
ical care for everybody. We are deeply concerned
about the costs of medical care. We are insistent
through our many review committees that high pro-
fessional standards of quality be maintained.

“No country has developed, in the opinion of
physicians, a better combination of these three fac-
tors— general access, reasonable cost, and high
quality.”

Judicial Commission
has new leaders:
Doctors Payne, Mason

The MSMS Judicial Commission, as of its annual
election Feb. 16, has new leaders.

They are C. Allen Payne, MD, Grand Rapids,
chairman, and Robert J. Mason, MD, Birmingham,
vice chairman. Doctor Payne and Doctor Mason are
both past presidents of MSMS, with Doctor Mason
serving most recently in 1969-70. Doctor Payne is
also president of the State Board of Registration in
Medicine.

New members of the Judicial Commission are
Doctor Mason, George Mogill, MD, Huntington
Woods, and Justin L. Sleight, MD, Lansing.

350 MICHIGAN MEDICINE APRIL 1972

At the first meeting in February of the MSMS Plan-
ning and Priorities Committee, Stuart Gould, MD,
Ann Arbor, center, took over the chairmanship from
Brooker L. Masters, MD, Fremont, right, who is now
chairman of The MSMS Council. John J. Ylvisaker,
MD, Detroit, left, MSMS treasurer, interpreted Phase
II of the Alexander Grant study for the committee
members, and several task forces were appointed.
Reports on the task forces’ activities will appear in
future issues of Michigan Medicine.

(iMicliigaq medisceqe

April 12 — Child Abuse Conference, sponsored by
Michigan chapter, American Academy of Pedi-
atrics and Headstart program of Lansing, at MSU
Life Sciences Building, contact: Theresa Haddy,
MD, conference chairman, B246A Life Sciences
I, MSU, East Lansing, 48823

April 12-13 — Annual spring conference, Institute for
Study of Mental Retardation and Related Disabil-
ities, Rackham Building, U-M, contact: ISMRRD,
the U-M, 611 Church Street, Ann Arbor, 48104

April 13-15 — Michigan Heart Association Heart
Days, Cobo Hall, Detroit, contact: Harold Arnow,
publicity director, MHA, 13100 Puritan, Detroit,
48227

April 19 — Woman’s Auxiliary to MSMS, Legislative
Day, Olds Plaza, Lansing, contact: Mrs. R. J.
Westerhoff, 2458 Maplewood, SE, Grand Rapids,
49506

April 19-20 — Woman’s Auxiliary to MSMS, spring
conference, Hospitality Inn, Lansing, contact:
Mrs. Charles Schoff, 5209 Sunset Drive, Midland,
48640

April 19-20 — Conference on Supportive Therapy for
Family Practice, Kellogg Center, East Lansing,
sponsored by Michigan Academy of Family Phy-
sicians, contact: Joseph V. Fisher, MD, presi-
dent, MAFP, 116 Park St., Chelsea, 48118

April 23-26 — MSU College of Human Medicine
Workshop, “The Community: A Base for Under-
graduate Medical Education,” Park Place Motor
Inn, Traverse City, contact: Andrew D. Hunt, Jr.,
MD, Dean, College of Human Medicine, MSU,
East Lansing, 48823

April 26 — The Council, MSMS Headquarters, con-
tact: Warren F. Tryloff, director

April 26th — Twelfth annual Clinical Conference,
Bronson Methodist Hospital, “Liver Disease for
the Clinician,” contact: Keith S. Henley, MD,
University of Michigan Medical School, University
Medical Center, Ann Arbor, 48104

April 27-30 — Annual Convention, American Asso-
ciation of Medical Assistants, Srate of Michigan,
Holiday Inn, Crosstown Parkway, Kalamazoo,
contact: Mrs. Betty Boers, president, 1116 Sher-
idan, Kalamazoo, 49001

April 30-May 5 — American Nurses Association Bi-
ennial Convention, Cobo Hall, Detroit, contact:
Miss Virginia Stone, executive director, Detroit
district, Michigan Nurses Association, 396 Fisher
Bldg., Detroit, 48202

April 28-29 — Cancer symposium, Michigan Division,
American Cancer Society, and Wayne State Uni-
versity, "Early Carcinoma of the Breast,” at the
university, contact: Bob Hillcoat, University Rela-
tions, WSU, Detroit, 48202

May 7-9 — Spring conference, “The Addicted Wom-
an,” Michigan Alcohol and Addiction Association,
Pantlind Hotel, Grand Rapids, contact: Russell S.
McMillan, DrPh, chairman, Conference Planning
Committee, MAAA, Box 61, Lansing

May 10-12 — Annual meeting, Michigan Public
Health Association, Park Place Motor Inn, Trav-

erse City, contact: Ralph Lewis, Department of
Postgraduate Medicine, Towsley Center, The
University of Michigan, Ann Arbor, 48104

May 13 — Annual May Seminar, “Comparative Pa-
thology,” Michigan Society of Pathologists, Hur-
ley Hospital, Flint, contact: Jacob E. Briski, MD,
Saint John Hospital, 22101 Moross Road, Detroit,
48236

May 13 — 17th annual all-day scientific meeting,
Michigan Society of Anesthesiologists, Sheraton-
Cadillac Hotel, Detroit, contact: Ralph E. Bauer,
MD, MSA secretary-treasurer, Henry Ford Hos-
pital, Detroit, 48202

May 18-19 — Annual Gull Lake meeting, MSMS
Committee on Maternal and Perinatal Health,
Kellogg Biological Station, Gull Lake, contact:
Helen Schulte, MSMS Headquarters

May 18-19 — 15th Annual Clinnic Days, emphasis
“Team Medicine,” Children’s Hospitals of Mich-
igan and Wayne State University School of Med-
icine, at the hospital, contact: Larry E. Fleisch-
mann, MD, chairman, 3901 Beaubien, Detroit,
48201

May 19-20 — 11th annual Kidney Disease Sympo-
sium, sponsored by Kidney Foundation of Mich-
igan, at Mercy College Conference Center, De-
troit, contact: Sidney Baskin, MD, chairman, 3378
Washtenaw Ave., Ann Arbor, 48104

May 20-27 — Michigan Week

May 22-23 — National chapter meeting and scientific
session, American College of Emergency Physi-
cians, Shanty Creek, Bellaire, contact: Gaius
Clark, MD, 865 Pebblebrook Lane, East Lansing,
48823

May 22-23 — National Conference on Instrumenta-
tion and Hazards in Cardiac Care, Towsley Cen-
ter, University Medical Center, Ann Arbor, spon-
sored by Council on Clinical Cardiology of the
American Heart Association and the Michigan
Heart Association, contact: Harold Arnow, public
information director, MHA, P.O. Box L-V 160,
Southfield, 48076

May 24-26 — Annual Medical Staff-Trustee-Admin-
istrator Forum, sponsored by Michigan Hos-
pital Association, Boyne Mountain Lodge, Boyne
Falls, contact: Frank A. Drazkowski, Administra-
tor, Grand View Hospital, US 2, Ironwood, 49938

May 31-June 3 — Continuing Medical Education
course on “Treatment of the Seriously Injured
or III in the Emergency Department,” American
College of Surgeons Committee on Trauma, in
Detroit, contact: Oscar P. Hampton, Jr., MD, Di-
rector of Trauma Division, ACS, 55 E. Erie St.,
Chicago, 60611

June 2-3 — Gaylord Trauma Day, Hidden Valley Ot-
sego Ski Club, Gaylord, contact: Benjamin He-
nig, MD, Keyport Clinic, 308 Michigan Ave.,
Grayling, 59738

June 5-6 — Annual Spring Mental Health Meeting,
Kellogg Center, MSU, contact: Bruce Alderman,
conference consultant for medical continuing ed-
ucation, Continuing Education Service, MSU,
East Lansing, 48823

June 5-7 — Initial Management of the Acutely III and
Injured Patient, Ann Arbor, contact: Charles F.
Frey, MD, Department of Surgery, University of
Michigan Medical Center, Ann Arbor, 48104

MICHIGAN MEDICINE APRIL 1972 351

M EDI SCENE/ Continued

June 7 — The Council, MSMS Headquarters, con-
tact: Warren F. Tryloff, Director
June 18-22 — Many Michigan physicians will attend
AMA Annual Convention in San Francisco
June 23-24 — Annual Meeting, Upper Peninsula
Medical Society, Holiday Inn, Marquette, contact:
Thomas B. Bolitho, MD, UPMS president, 1414
W. Fair Ave., Marquette, 49855
June 26-29 — International Symposium on Clinical
Aspects of Metabolic Bone Disease, Henry Ford
Hospital, contact: Boy Frame, MD, Henry Ford
Hospital, Detroit, 48202

June 26-30 — American College of Physicians, Con-
ference on Medical Interviewing, Kellogg Center,
MSU, contact: Allen Enelow, MD, chairman, De-
partment of Psychiatry, MSU, East Lansing 48823
July 9-14 — Continuing Education Course, “Consul-
tation Skills,” — U-M School of Public Health,
Weber’s Inn, Ann Arbor, contact: Anna B. Brown,
PhD, M4234 School of Public Health II, the U-M,
Ann Arbor, 48104

July 15-19 — 26th Annual Postgraduate Scientific
Assembly of Michigan Academy of Family Phy-
sicians, Boyne Highlands, Harbor Springs, con-
tact: George Hoekstra, MD, chairman, 100 Maple
St. Parchment, 49004

July 23-28 — Continuing Education Course, “Com-
munity and Professional Relations,” sponsored
by U-M School of Public Health, Weber’s Inn,
Ann Arbor, contact: Anna B. Brown, PhD, M4234
School of Public Health II, the U-M, Ann Arbor,
48104

July 27-28 — Coller - Penberthy - Thirlby Conference,
Park Place Motor Inn, Traverse City, contact: L.
P. Skendzel, MD, Traverse City, chairman
Oct. 1 and 4 — The Council, Sheraton-Cadillac Ho-
tel, Detroit, contact: Warren F. Tryloff, Director
Oct. 1-5 — 107th Annual Session of the Michigan
State Medical Society, Sheraton-Cadillac Hotel,
Detroit, contact: Richard Campau, MSMS Head-
quarters, Box 950, East Lansing, 48823
Nov. 8 — The Council, special meeting, noon, MSMS
Headquarters, contact: Warren F. Tryloff, Direc-
tor

Dec. 6 — The Council, MSMS Headquarters, contact:
Warren F. Tryloff, Director

MSMS

will soon survey
your priorities, Doctor

Work is underway by the MSMS staff, under the
direction of the Bureau of Economic Information,
to design a survey of MSMS members’ attitudes
toward key medical issues in Michigan, such as
abortion law reform, chiropractic, malpractice in-
surance, care of Medicaid recipients and manda-
tory recertification.

First review of proposed questions for the survey
will be made by The MSMS Council this spring.

Pre-Sate ®

(chlorphentermine HCI)

CAUTION: Federal law prohibits dispensing without
prescription.

Indications: Pre-Sate (chlorphentermine hydrochlo-
ride) is indicated in exogenous obesity, as a short
term ( i.e ., several weeks) adjunct in a regimen of
weight reduction based upon caloric restriction.
Contraindications: Glaucoma, hyperthyroidism, phe-
ochromocytoma, hypersensitivity to sympathomi-
metic amines, and agitated states. Pre-Sate
(chlorphentermine hydrochloride) is also contrain-
dicated in patients with a history of drug abuse or
symptomatic cardiovascular disease of the following
types: advanced arteriosclerosis, severe coronary
artery disease, moderate to severe hypertension, or
cardiac conduction abnormalities with danger of ar-
rhythmias. The drug is also contraindicated during
or within 14 days following administration of mona-
mine oxidase inhibitors, since hypertensive crises
may result.

Warnings: When weight loss is unsatisfactory the
recommended dosage should not be increased in
an attempt to obtain increased anorexigenic effect;
discontinue the drug. Tolerance to the anorectic
effect may develop. Drowsiness or stimulation may
occur and may impair ability to engage in potenti-
ally hazardous activities such as operating ma-
chinery, driving a motor vehicle, or performing
tasks requiring precision work or critical judgment.
Therefore, such patients should be cautioned ac-
cordingly. Caution must be exercised if Pre-Sate
(chlorphentermine hydrochloride) is used concom-
itantly with other central nervous system stimu-
lants. There have been reports of pulmonary hyper-
tension in patients who received related drugs.
Drug Dependence: Drugs of this type have a poten-
tial for abuse. Patients have been known to increase
the intake of drugs of this type to many times the
dosages recommended. In long-term controlled
studies with high dosages of Pre-Sate, abrupt ces-
sation did not result in symptoms of withdrawal.
Usage In Pregnancy: The safety of Pre-Sate (chlor-
phentermine hydrochloride) in human pregnancy has
not yet been clearly established. The use of ano-
rectic agents by women who are or who may be-
come pregnant, and especially those in the first
trimester of pregnancy, requires that the potential
benefit be weighed against the possible hazard to
mother and child. Use of the drug during lactation
is not recommended. Mammalian reproductive and
teratogenic studies with high multiples of the human
dose have been negative.

Usage In Children: Not recommended for use in
children under 12 years of age.

Precautions: In patients with diabetes mellitus there
may be alteration of insulin requirements due to
dietary restrictions and weight loss. Pre-Sate (chlor-
phentermine hydrochloride) should be used with
caution when obesity complicates the management
of patients with mild to moderate cardiovascular
disease or diabetes mellitus, and only when dietary
restriction alone has been unsuccessful in achieving
desired weight reduction. In prescribing this drug
for obese patients in whom it is undesirable to in-
troduce CNS stimulation or pressor effect, the phy-
sician should be alert to the individual who may be
overly sensitive to this drug. Psychologic disturb-
ances have been reported in patients who concomi-
tantly receive an anorexic agent and a restrictive
dietary regimen.

Adverse Reactions: Central Nervous System: When
CNS side effects occur, they are most often mani-
fested as drowsiness or sedation or overstimulation
and restlessness. Insomnia, dizziness, headache,
euphoria, dysphoria, and tremor may also occur.
Psychotic episodes, although rare, have been noted
even at recommended doses. Cardiovascular: tachy-
cardia, palpitation, elevation of blood pressure.
Gastrointestinal: nausea and vomiting, diarrhea, un-
pleasant taste, constipation. Endocrine: changes
in libido, impotence. Autonomic: dryness of mouth,
sweating, mydriasis. Allergic: urticaria. Genitouri-
nary: diuresis and, rarely, difficulty in initiating
micturition Others: Paresthesias, sural spasms.
Dosage and Administration: The recommended adult
daily dose of Pre-Sate (chlorphentermine hydrochlo-
ride) is one tablet (equivalent to 65 mg chlorphen-
termine base) taken after the first meal of the day.
Use in children under 12 not recommended.
Overdosage: Manifestations: Restlessness, confu-
sion, assaultiveness, hallucinations, panic states,
and hyperpyrexia may be manifestations of acute in-
toxication with anorectic agents. Fatigue and de-
pression usually follow the central stimulation.
Cardiovascular effects include arrhythmias, hyper-
tension, or hypotension and circulatory collapse.
Gastrointestinal symptoms include nausea, vomiting,
diarrhea, and abdominal cramps. Fatal poisoning
usually terminates in convulsions and coma.
Management: Management of acute intoxication with
sympathomimetic amines is largely symptomatic and
supportive and often includes sedation with a bar-
biturate. If hypertension is marked, the use of a
nitrate or rapidly acting alpha-receptor blocking
agent should be considered. Experience with he-
modialysis or peritoneal dialysis is inadequate to
permit recommendations in this regard.

How Supplied: Each Pre-Sate (chlorphentermine
hydrochloride) tablet contains the equivalent of
$5 mg chlorphentermine base; bottles of 100 and
1000 tablets.

Full information available on request.

The action is being taken at the direction of a
1971 MSMS House of Delegates resolution.

WARNER-CHILCOTT

Division, Warner-Lambert Company
Morris Plains, New Jersey 07950

352 MICHIGAN MEDICINE APRIL 1972

lor the ,

practical

generation

F re -Sate

(ehlorphentermine
HC1)

the trend is

toward our kind
of anorectic

Not a controlled drug under the Comprehensive
Drug Abuse Prevention and Control Act

• low potential for abuse

• less CNS stimulation than with d-amphetamine
or phenmetrazine

Effective anorectic adjunct to your program
of caloric restriction and diet re-education

\ « weight loss comparable to d-amphetamine »an&

\ \ phenmetrazine, superior to placebo

• convenient one-a-day dosage

Pre-Sate® (ehlorphentermine HCl)...the increasingly practical appetite suppressant

When you select this familiar antibiotic for
IV infusion you have available a broad dosage range
that hospitalized patients may need.

Intravenous Lincocin (lincomycin
hydrochloride, Upjohn), with its 1.2 to
8 grams/ day dosage range, covers many
serious and even life-threatening
infections. Lincocin is effective in
infections due to susceptible strains of
streptococci, pneumococci, and
staphylococci. Lincocin IV therefore
can be as useful in your hospitalized
patients as its IM use has proved to be in
your office patients. As with all
antibiotics, in vitro susceptibility studies
should be performed.

1.2 to 8 grams/ day IV dosage range:. :

Most hospitalized patients with
uncomplicated pneumonias respond
satisfactorily to 1 .2 to 1.8 grams/ day of
Lincocin IV. These doses may have to
be increased for more serious infections.

In life-threatening situations as much
as 8 grams/ day has been administered
intravenously to adults.

In usual IV doses, Lincocin (lincomycin
hydrochloride, Upjohn) should be
diluted in 250 ml or more of normal
saline solution or 5% glucose in water.
But when 4 grams or more per day is
given, Lincocin should be diluted in not
less than 500 ml of either solution,
and the rate of administration should
not exceed 1 00 ml/hour. Too rapid
intravenous administration of doses
exceeding 4 grams may result in
^■hypotension or, in rare instances,
cardiopulmonary arrest.

Effective gram-positive antibiotic:

Lincocin IV is effective in respiratory
tract, skin and soft-tissue, and bone

infections caused by susceptible strains
of pneumococci, streptococci, and
staphylococci, including penicillin-
resistant strains. Staphylococcal strains
resistant to Lincocin (lincomycin
hydrochloride, Upjohn) have been
recovered. Before initiating therapy,
culture and susceptibility studies should
be performed. Lincocin has proved
valuable in treating patients hyper-
sensitive to penicillin or cephalosporins,
since Lincocin does not share
antigenicity with these compounds.
However, hypersensitivity reactions
have been reported, some of these in
patients known to be sensitive to
penicillin.

administered concomitantly with other
antimicrobial agents when indicated.
However, Lincocin should not be used
with erythromycin, as in vitro antagonism
has been reported.

Lincocin-

Sterile Solution (300 mg per ml)

(lincomycin hydrochloride,Upjohn)

For further prescribing information, please see following page.

Well tolerated at infusion site: Lincocin
intravenous infusions have not
produced local irritation or phlebitis,
when given as recommended. Lincocin
is usually well tolerated in patients who
are hypersensitive to other drugs.
Nevertheless, Lincocin should be used
cautiously in patients with asthma or
significant allergies.

In patients with impaired renal function,
the recommended dose of Lincocin
should be reduced to 25—30% of
the dose for patients with normal
kidney function. Its safety in
pregnant patients and in infants
less than one month of age has
not been established.

Lincocin may be used with other
antimicrobial agents: Since Lincocin
is stable over a wide pH range, it is
suitable for incorporation in
intravenous infusions; it also may be

1972 The Upjohn Compan

(lincomycin hydrochloride, Upjohn)

Up to 8 grams per day by IV infusion for
hospitalized patients with life-threatening infections.
Lincocin is effective in infections due to
susceptible strains of streptococci, pneumococci,
and staphylococci. As with all antibiotics,
in vitro susceptibility studies should be performed.

act

ity

art

•E

sy;

pn

lift

Ot

wi

th;

fin

Each Lincomycin

preparation hydrochloride

contains: monohydrate

equivalent to
lincomycin base

250 mg Pediatric Capsule 250 mg

500 mg Capsule 500 mg

*Sterile Solution per 1 ml 300 mg

Syrup per 5 ml 250 mg

"Contains also: Benzyl Alcohol 9 mg; and,
Water for Injection — q.s.

Lincocin (lincomycin hydrochloride) is in-
dicated in infections due to susceptible strains
of staphylococci, pneumococci, and strepto-
cocci. In vitro susceptibility studies should
be performed. Cross resistance has not been
demonstrated with penicillin, ampicillin,
cephalosporins, chloramphenicol or the tet-
racyclines. Some cross resistance with eryth-
romycin has been reported. Studies indicate
that Lincocin does not share antigenicity
with penicillin compounds.

CONTRAINDICATIONS: History of prior
hypersensitivity to lincomycin or clindamy-
cin. Not indicated in the treatment of viral
or minor bacterial infections.

WARNINGS: CASES OF SEVERE AND
PERSISTENT DIARRHEA HAVE BEEN
REPORTED AND HAVE AT TIMES
NECESSITATED DISCONTINUANCE
OF THE DRUG. THIS DIARRHEA HAS
BEEN OCCASIONALLY ASSOCIATED
WITH BLOOD AND MUCUS IN THE
STOOLS AND HAS AT TIMES RE-
SULTED IN AN ACUTE COLITIS. THIS
SIDE EFFECT USUALLY HAS BEEN
ASSOCIATED WITH THE ORAL DOS-
AGE FORM BUT OCCASIONALLY HAS

BEEN REPORTED FOLLOWING PA-
RENTERAL THERAPY. A careful inquiry
should be made concerning previous sensi-
tivities to drugs or other allergens. Safety
for use in pregnancy has not been estab-
lished and Lincocin (lincomycin hydrochlo-
ride) is not indicated in the newborn. Reduce
dose 25 to 30% in patients with severe im-
pairment of renal function.

PRECAUTIONS: Like any drug, Lincocin
should be used with caution in patients
having a history of asthma or significant
allergies. Overgrowth of nonsusceptible or-
ganisms, particularly yeasts, may occur and
require appropriate measures. Patients with
pre-existing monilial infections requiring
Lincocin therapy should be given concomi-
tant antimoniHal treatment. During pro-
longed Lincocin therapy, periodic liver
function studies and blood counts should be
performed. Not recommended (inadequate
data) in patients with pre-existing liver dis-
ease unless special clinical circumstances in-
dicate. Continue treatment of /3-hemolytic
streptococci infections for 10 days to
diminish likelihood of rheumatic fever or
glomerulonephritis.

ADVERSE REACTIONS: Gastrointestinal
—Glossitis, stomatitis, nausea, vomiting. Per-
sistent diarrhea, enterocolitis, and pruritus
ani. Hemopoietic— Neutropenia, leukopenia,
agranulocytosis, and thrombocytopenic pur-
pura have been reported. Hypersensitivity
reactions— Hypersensitivity reactions such
as angioneurotic edema, serum sickness, and
anaphylaxis have been reported, sometimes
in patients sensitive to penicillin. If allergic
reaction occurs, discontinue drug. Have
epinephrine, corticosteroids, and antihista-

mines available for emergency treatment
Skin and mucous membranes— Skin rashes
urticaria, vaginitis, and rare instances of ex
foliative and vesiculobullous dermatitis have
been reported. Liver— Although no direct re
lationship to liver dysfunction is established
jaundice and abnormal liver function test:
(particularly serum transaminase) have beer;
observed in a few instances. Cardiovasculai
—Instances of hypotension following paren-
teral administration have been reported
particularly after too rapid IV administra-
tion. Rare instances of cardiopulmonary ar-
rest have been reported after too rapid IV
administration. If 4.0 grams or more admin-
istered IV, dilute in 500 ml of fluid and
administer no faster than 100 ml per hour
Special senses— Tinnitus and vertigo have
been reported occasionally. Local reaction i
—Excellent local tolerance demonstrated tc
intramuscularly administered Lincocin
(lincomycin hydrochloride). Reports of pain
following injection have been infrequent.
Intravenous administration of Lincocin in
250 to 500 ml of 5% glucose in distilled
water or normal saline has produced nc
local irritation or phlebitis.

19;

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Mi

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ur

mi

i>)

P»

su

HOW SUPPLIED: 250 mg and 500 mg\
Capsules— bottles of 24 and 100. Sterile
Solution, 300 mg per ml— 2 and 10 ml viahi
and 2 ml syringe. Syrup, 250 mg per 5 rm
—60 ml and pint bottles.

For additional product information, consult
the package insert or see your Upjohn (
representative.

MED B-6-S (KZL-7) JA71-1631

The Upjohn Company
Kalamazoo, Michigan 49001

Upjohn

u

c

140/90 is normal blood pressure. . . or is it?

An extensive study based on nearly 4 million
life insurance policies suggests that a blood pressure
reading of 140/90 requires close medical supervision.

Study Findings. Twelve years ago
the Society of Actuaries reported on
an extensive study based on the lives
and deaths represented by almost
4 million life insurance policies.
From this vast survey —“The Build
and Blood Pressure Study"1—
insurance experts concluded that:

• Blood pressure above 140/90 is
accompanied by increased morbid-
ity and requires close medical
attention.

• Even small increments in either
systolic or diastolic blood pressure
progressively and steeply shorten
life expectancy.

Other Studies. Studies conducted
with large numbers of patients since
that time have echoed the above
findings. Two studies published in
1970 — the VA Cooperative Study
Group on "Effects of Treatment on
Morbidity in Hypertension"2 and
the "Framingham Study"3 — sug-
gest that treatment of even mild
hypertension may, over time, offer
significant benefits to the patient.

Another Point of View. Although a
growing body of studies suggests
that treatment of mild hypertension
is warranted, medical opinion is not
unanimous. Some clinicians recom-
mend that drug treatment for mild
hypertension be reserved for
patients with additional risk factors
such as smoking, high cholesterol

1 . Society of Actuaries, The Build mid Blood Pressure Study, 1959.

2. Veterans Administration Cooperative Study Group on Anti-
hypertensive Agents, "Effects of Treatment on Morbidity in
Hypertension," JAMA 213: 1143-1152, Aug. 17, 1970.

3. Kannei, William B., et nl. : "Epidemiologic Assessment of the
Role of Blood Pressure in Stroke — The Framingham Study,"
JAMA 224:301-310, Oct. 12, 1970.

4. Kirkendall, Walter M.: "What's With Hypertension These Days?"
Consultant, Jan. 1971.

levels, heart or kidney involve-
ment, or a family history of vas-
cular disease. Dr. Walter M.
Kirkendall stated this position
in his recent paper "VVTiat' s
With Hypertension These
Days?"4 Discussing the man-
agement of hypertension in
patients with a sustained dia-
stolic pressure up to 100 mm Hg,
he said: "Generally, I do not
recommend antihypertensive
therapy unless patient's blood
pressure approaches the upper
limit for the group and a number
of adverse factors exist, such as
male sex, family history of vascular
disease, youth, evidence of heart
or kidney involvement."

Drug Therapy for Hypertension.

Although opinion varies on when
to start drug therapy for mild hyper-
tension, many physicians agree
that treatment should start with
a thiazide diuretic such as
HydroDIURIL. For the adult patient,
the usual starting dosage is 50 mg
b.i.d. Dosage adjustments are recom-
mended as the patient responds to
treatment. The patient whose
therapy begins with HydroDIURIL
frequently can continue to benefit
from it, because HydroDIURIL
usually maintains its antihyperten-
sive effect even when
therapy is prolonged.

25- and 50-mg tablets

HydroDIURIL*

(Hydrochlorothiazide| MSD)
Therapy to Start With

For a brief summary of prescribing
information, please see next page.

MSD

MERCK

SHARa

DOHME

25- and 50-mg tablets

HydroDIURIC

(Hydrochlorothiazide|MSD)
Therapy to Start With

Drug Therapy for Hypertension. Although opinion varies on when to start drug
therapy for mild hypertension, many physicians agree that treatment should start
with a thiazide diuretic such as HydroDIURIL. For the adult patient, the usual start-
ing dosage is 50 mg b.i.d. Dosage adjustments are recommended as the patient
responds to treatment. The patient whose therapy begins with HydroDIURIL
frequently can continue to benefit from it, because HydroDIURIL usually maintains
its antihypertensive effect even when therapy is prolonged.

CONTRAINDICATIONS: An uria; increasing
azotemia and oliguria during treatment of severe pro-
gressive renal disease. Known sensitivity to this
compound. Nursing mothers; if use of drug is deemed
essential, patient should stop nursing.

WARNINGS: May precipitate or increase azotemia.
Use special caution in impaired renal function to avoid
cumulative or toxic effects. Minor alterations of fluid
and electrolyte balance may precipitate coma in hepatic
cirrhosis.

When used with other antihypertensive drugs, care-
ful observation for changes in blood pressure must be
made, especially during initial therapy. Dosage of
other antihypertensive agents, especially ganglion
blockers, must be reduced by at least 50% because
HydroDIURIL potentiates their action.

Stenosis and ulceration of the small bowel causing
obstruction, hemorrhage, and perforation have been
reported with the use of enteric-coated potassium tab-
lets, either alone or with nonenteric-coated thiazides.
Surgery was frequently required, and deaths have oc-
curred. Such formulations should be used only when
indicated and when dietary supplementation is im-
practical. Discontinue immediately if abdominal pain,
distention, nausea, vomiting, or gastrointestinal bleed-
ing occurs.

Thiazides cross placenta and appear in cord blood.
In women of childbearing age, potential benefits must
be weighed against possible hazards to fetus, such as
fetal or neonatal jaundice, thrombocytopenia, and pos-
sibly other adverse reactions which have occurred in
the adult.

The possibility of sensitivity reactions should be
considered in patients with a history of allergy or bron-
chial asthma. The possibility of exacerbation or activa-
tion of systemic lupus erythematosus has been
reported for sulfonamide derivatives, including
thiazides.

PRECAUTIONS: Check for signs of fluid and elec-
trolyte imbalance, particularly if vomiting is excessive
or patient is receiving parenteral fluids. Warning signs,
irrespective of cause, are dryness of mouth, thirst,
weakness, lethargy, drowsiness, restlessness, muscle
pains or cramps, muscular fatigue, hypotension,
oliguria, tachycardia, and gastrointestinal dis-
turbances. Hypokalemia may develop (especially with
brisk diuresis) in severe cirrhosis; with concomitant
steroid or ACTH therapy; or with inadequate electro-
lyte intake. Digitalis therapy may exaggerate metabolic
effects of hyp alemia, especially with reference to

myocardial activity. Hypokalemia may be avoided or
treated by use of potassium chloride or giving foods r
with a high potassium content. Similarly, any chloride
deficit may be corrected by use of ammonium chloride ^
(except in patients with hepatic disease) and largely jcs
prevented by a near normal salt intake. Hypochloremic f(l
alkalosis occurs infrequently and is rarely severe. In
severely edematous patients with congestive failure or
renal disease, a low salt syndrome may occur if dietary
salt is unduly restricted, especially during hot weather.

Thiazides may increase responsiveness to tubocu-
rarine. The antihypertensive effect of the drug may be
enhanced in the postsympathectomy patient. Arterial
responsiveness to norepinephrine is decreased, neces-
sitating care in surgical patients. Discontinue drug 48
hours before elective surgery. Orthostatic hypotension
may occur and may be potentiated by alcohol, barbit- de
urates, or narcotics. 1 ter

Pathological changes in the parathyroid glands with or
hypercalcemia and hypophosphatemia have been seen tic
in a few patients on prolonged thiazide therapy. The m£
effect of discontinuing thiazide therapy on serum cal-
cium and phosphorus levels may be helpful in assess-
ing the need for parathyroid surgery in such patients.
Parathyroidectomy has elicited subjective clinical im-
provement in most patients, but has no effect on
hypertension. Thiazide therapy may be resumed after
surgery.

Use cautiously in hyperuricemic or gouty patients;
gout may be precipitated. May affect insulin require-
ments in diabetics; may induce hyperglycemia and
glycosuria in latent diabetics.

ADVERSE REACTIONS: Rare reactions include
thrombocytopenia, leukopenia, agranulocytosis, aplas-
tic anemia, cholestasis, and pericholangiolitic hepatitis.
Nausea, vomiting, diarrhea, dizziness, vertigo, pares-
thesias, transient blurred vision, sialadenitis, purpura,
rash, urticaria, photosensitivity, or other hypersensi-
tivity reactions may occur. Cutaneous vasculitis pre-
cipitated by thiazide diuretics has been reported in
elderly patients on repeated and continuing exposure
to several drugs. Scattered reports have linked
thiazides to pancreatitis, xanthopsia, neonatal throm-
bocytopenia, and neonatal jaundice. When adverse
reactions are moderate or severe, the dosage of
thiazides should be reduced or therapy withdrawn.

For more detailed information, consult your MSD MSD
Representative or see the Direction Circular. Merck
Sharp & Dohme, Division of Merck & Co., Inc., West SHARA
Point, Pa. 19486 DOHME

o lUedical cate programs

An HMO in your future ?

How six special programs
deliver health care in Michigan

During the past several months, Herbert
Mehler, chief of research and analysis for the
MSMS Department of Government Relations,
has conducted a series of on-site visits to clin-
ics and centers in Michigan delivering dif-
ferent types of health care .

Here Mr. Mehler continues his reports.

(Third in a series.)

Visits were made to six centers which included
an HMO-type clinic under State contract, a fee-for-
service group practice in both suburban and the
inner city and a Government-subsidized clinic in a
rural setting.

Knowledge about these various organizations is
designed to enable physicians to individually de-
termine if they wish to remain in solo, partnership
or corporate practice or accept the option of par-
ticipating in a prepaid group practice/health
maintenance organization (HMO) program.

Here is a brief resume of these medical-provid-
ing structures.

1. Detroit Medical and Surgical Center

An incorporated fee-for-service clinic provid-
ing medical and health care to inner city resi-
dents including Medicare, Medicaid and BC/-
BS recipients. Federal and private foundation
funding permitted center to employ full-time
and part-time salaried physicians including
necessary paramedical personnel. Awarded
grant to investigate feasibility of structuring
an HMO.

2. Gratiot Family Health Center

This facility in Alma is under the auspices of
the East Central Michigan Health Service.
Federal funding was granted to provide year-
round services for treatment of non-acute
illnesses and injuries and to administer pre-
ventive immunizations. Migrant agricultural
workers and rural and urban residents are
eligible for services commensurate with a
sliding scale for financial contribution. Per-
sons with little or no funds either contribute
nothing or a nominal fee of fifty cents (50 if)
per visit. One full-time, a part-time and other
physicians (MD-DO) agreed to provide treat-

ment at the center at an hourly rate or re-
ceive fee-for-service when treating patients in
offices. Health, Education and Welfare select-
ed this project to be a community learning
laboratory to determine if providers, commu-
nity workers and lay citizens can success-
fully operate a program of this type.

3. Woodland Medical Group, Inc. P.C.

This professional corporation is a vested, pri-
vate practice without government funding. It
provides medical and health services to
Medicare, Medicaid, BC/BS, V.A. and
CHAMPUS eligibles. The group employs full-
time multi-specialty physicians on a yearly
salary with the opportunity to share in any
surpluses after a year’s service. Currently
negotiating with Social Services for contract-
ing services to a defined group of Medicaid
eligibles.

4. Western Michigan Comprehensive Health
Services

This facility provides direct medical, health,
home, mental, environmental, social, educa-
tional and economic services. Five full-time
salaried physicians are employed plus neces-
sary paramedical, social and community

Lansing Model Cities Director Jacqueline Warr gives
MSMS staffer Herb Mehler an update on the health
care goals and current clinic set-up of her program,
one of those studied by Mr, Mehler on his series of
visits.

MEDICAL CARE PROGRAMS/Continued

workers. An employee training program is
available to up-grade health and other skilled
positions. Satellite clinics throughout the area
are utilized to provide dental, medical, alco-
holic and family services.

5. Model Neighborhood Comprehensive
Health Program, Inc.

This Detroit inner-city facility recently con-
tracted with Social Services to provide com-
prehensive medical health services to 10,000
Group One Medicaid recipients within the
target area. This unique demonstration proj-
ect could be the model for providing similar
services throughout Michigan. Full and part-
time physicians and consultants are salaried
employees providing a comprehensive scope
of benefits. A Citizen’s Government Board
and Health Council played an important role
in devising this program.

6. Community Health Association

The Boards of Michigan BC/BS/CHA agreed
on a new Metropolitan Program. If success-
ful, the development of a variety of prepaid
group practice programs in other parts of the
State of Michigan is expected with the ob-
jective of broadening the availability of a
variety of medical care delivery methods.
This insurance program provides compre-
hensive, preventive, emergency medical and

health services in hospitals and five satellite
clinics.

Many other neighborhood and community health
programs are emerging. They will be monitored by
MSMS staff to provide progress reports on a pe-
riodic basis.

Manistique
has new, private
medical center

The city of Manistique in Schoolcraft County in
the Upper Peninsula is boasting a new medical-
dental center constructed to upgrade the county
medical facilities and to attract new physicians to
the region.

The privately-owned center is located on private
property adjacent to the Schoolcraft Memorial Hos-
pital, which in turn is next to the Schoolcraft Medi-
cal Care Facility.

The center’s 18,000 square feet include five
suites for general practitioners, two dental suites,
one oral surgery suite, a coffee shop, a hospital
pharmacy, medical records and hospital adminis-
tration offices.

The treatment of

impotence

due to androgenic deficiency in the American male.
The concept of chemotherapy plus the
physician’s psychological support is confirmed
umm as effective therapy.

m

The Treatment of Impotence
with Methyltestosterone Thyroid
(100 patients — Double Blind Study)
T. Jakobovits

Fertility and Sterility, January 1970
i Official Journal of the
American Fertility Society

Double-Blind Study and Type of Patient:

100 patients suffering from impotence. Of
the patients receiving the active medication
(Android) a favourable response was seen
in 78%. This compares with 40% on
placebo. Although psychotherapy is indi-
cated in patients suffering from functional
impotence the concomitant role of chemo-
therapy (Android) cannot be disputed.

Contraindications: Android is contraindicated in patients with prostatic carcinoma, severe cardiorenal
disease and severe persistent hypercalcemia, coronary heart disease and hyperthyroidism. Occasional
cases ot jaundice with plugging biliary canaliculi have occurred with average doses of Methyl Testos-
terone Thyroid is not to be used in heart disease and hypertension.

Warnings: Large dosages may cause anorexia, nausea, vomiting abdominal pain, diarrhea, headache,
dizziness, lethargy, paresthesia, shm eruptions, loss of libido in males, dysuria, edema, congestive heart
failure and mammary carcinoma in males

Precautions: If hypothyroidism is accompanied by adrenal insufficiency the latter must be corrected prior
to and during thyroid administration.

Adverse Reactions Since Androgens, in general, tend to promote retention of sodium and water, patients
receiving Methyl Testosterone, in particular elderly patients, should be observed for edema.
Hypercalcemia may occur, particularly in immobilized patients: use of Testosterone should be discontinued
as soon as hypercalcemia is detected

References: 1. Montesano, P . and Evangelista, I. Methyltestosterone-thyroid treatment of sexual
impotence Clin Med 12 69, 1966 2 Dublin, M F Treatment of impotence with methyltestosterone-
thyroid compound West Med 5 67, 1964 3 Titeff, A. S. Methyltestosterone-thyroid in treating impotence.
Gen Prac 25 6. 1962 4 Heilman, L.. Bradlow, H L , Zumoff, B , Fukushima, D. K., and Gallagher, T. F.
Thyroid-androgen interrelations and the hypocholesteremic effect of androsterone. J Clin Endocr 19 936,
1959 5 Farris. E. J., and Colton, S W. Effects of L-thyroxine and liothyronine on spermatogenesis.
J Urol 79:863, 1958 6 Osol, A , and Farrar, G. E. United States Dispensatory (ed. 25). Lippincott, Phila-
delphia, 1955, p. 1432. 7. Wershub, L. P. Sexual Impotence in the Male. Thomas, Springfield,

III., 1959, pp. 79-99.

Write lor literature and samples THE BROWN PHARMACEUTICAL CO., INC. 2500 West 6th Street, Los Angeles, California 90057

Choice of 4 strengths:

Android Android-HP

Each yellow tablet contains:
Methyl Testosterone . 2.5 mg.
Thyroid Eit. (1/6 gr.) . 10 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 tablet 3 times daily.
Available:

Bottles of 100, 500, 1000.

HIGH POTENCY

Each red tablet contains:
Methyl Testosterone . 5.0 mg.
Thyroid Eit. (Va gr.) ... 30 mg.

Glutamic Acid 50 mg

Thiamine HCL 10 mg.

Dose . 1 tablet 3 times daily.
Available:

Bottles o! 100, 500, 1000.

Android-K

EXTRA HIGH POTENCY

Each orange tablet contains:
Methyl Testosterone .12.5 mg.
Thyroid Eit. (1 gr.) .. . 64 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 or 2 tablets daily.
Available:

Bottles of 60, 500.

Android-Plus

WITH HIGH POTENCY
B COMPLEX AND VITAMIN C

Each white tablet contains:
Methyl Testosterone . 2.5 mg.
Thyroid E«t.('/4 gr.) . 15 mg.

Ascorbic Acid (Vit. C) .250 mg.

Thiamine HCL 25 mg.

Glutamic Acid 100 mg.

Pyridoxme HCL 5 mg.

Niacinamide 75 mg.

Calcium Pantothenate . 10 mg

Vitamin B-12 2.5 meg.

Riboflavin 5 mg.

Dose: 2 tablets daily.
Available: Bottles of 60. 500.

360 MICHIGAN MEDICINE APRIL 1972

POTASSIUM mHETACI LLIN
the ampicillin derivative

Each capsule contains potassium hetacillin equivalent to
225 mg. or 450 mg. ampicillin.

Something new
in ampicillin
therapy:

low cost

nniPTni BRISTOL LABORATORIES
BRISTOL Division of Bristol-Myers Company
Syracuse, New York 13201

MSMS takes active legislative role

The City Club of Lansing was the setting of an im-
portant meeting between MSMS leaders and mem-
bers of the Subcommittee on Social Services of the
House Appropriations Committee. Bruce W. Ambrose,
manager, MSMS Department of Government Rela-

New member Leonard R. Howard, MD, Battle Creek,
left, was welcomed to the Committee on Govern-
mental Medical Care Programs by chairman Robert
E. Rice, MD, Greenville, second from right, and D.
Bonta Hiscoe, MD, Lansing, committee member.

tions, standing center, opened the meeting. Follow-
ing the discussion by the 12 persons present, the
subcommittee recommended to the House Medicaid
legislation with full pay for all providers.

Key persons involved in the meeting with the Sub-
committee on Social Services were, from left, Charles
C. Vincent, MD, Detroit, Metropolitan representative;
Thomas R. Berglund, MD, Kalamazoo, representing
Michigan's medium-sized cities; Rep. Raymond C.
Kehres, subcommittee chairman; Rep. James Farns-
worth, Republican vice chairman of the House Ap-
propriations Committee, and Robert E. Rice, MD,
Greenville, representing Michigan’s rural areas.

362 MICHIGAN MEDICINE APRIL 1972

ivertise/nent

“ The history of science, and in
particular the history of medicine ...is...

the history of man's reactions to the
truth, the history of the gradual revelation
of truth, the history of the gradual
liberation of our minds from darkness
and prejudice.”

— George Sarton, from “The History

of Medicine Versus the History of Art ”

82.8%

Physicians should play a role

78.3%

Independent scientists should
play a role

69.8%

Medical academicians should
play a role

Should nongovernment scientists and physicians
play a role in drug regulation?

Doctor

of

Medicine

Herbert L. Ley, Jr.,

M.D., Formerly

Commissioner, F.D.A.

(1968-1969)

Currently Medical Consultant

In order for drug regula-
tion to be effective, partici-
pation in the regulatory
process from nongovern-
ment physicians and scien-
tists must be encouraged.
Without such involvement,
there will continue to be a
high degree of controversy
surrounding any regula-
tions promulgated by the
Food and Drug Adminis-
tration.

There are two areas in
which participation and
communication by non-
government physicians and
scientists could signifi-
cantly improve the process
of regulation. First, scien-
tists and physicians
throughout the country
could become involved in
consulting relationships
with the Food and Drug
Administration in impor-
tant scientific areas while
regulatory policies are be-
ing evolved. If nongovern-
ment professionals could
bring their expertise and
experience to bear early in
the decision-making proc-
ess, they would have less
reason to criticize the final
outcome.

Secondly, practicing
physicians, academic phy-
sicians, and academic-
based scientists could make
it their business to com-
ment on proposed regu-
lations appearing in the

Federal Register. Ideally,
a system could be instituted
whereby medical, scientific
and technical people could
see the Federal Register
regularly, and provide the
Food and Drug Administra-
tion with a body of opinion
that has so far gone un-
heard. The FDA is caught
among pressures from in-
dustry, Congress, the Pres-
idential Administration
and consumers. It should
also feel pressures from
practicing physicians and
scientists.

In order to become more
involved in these stages of
the drug regulatory process,
nongovernment physicians
and scientists should begin
to exercise their influence
through their respective
professional organizations,

state and national medical
societies, and specialty
groups. Logically, a letter
from these organizations
representing a collective
opinion has far greater
weight in the regulatory
process than individual let-
ters. If the Food and Drug
Administration receives
opinions from these organi-
zations early, before a reg-
ulation gets into the Fed-
eral Register, they are in a
good position to respond
with further study and re-
view. Without such dissent-
ing opinions, there is very
little incentive to make

changes in proposed regu-
lations.

One instance in which
practitioners did influence
drug regulatory affairs in
this way is the recent con-
troversy that arose over the
legitimacy of drug combi-
nations. The strong opinion
of practitioners on the
value of such medication
in clinical practice played
a very prominent role in
making the Food and Drug
Administration modify its
rather restrictive policy.

Another way in which
practitioners can effectively
influence drug regulations
is by working with drug
manufacturers conducting
clinical trials of chemo-
therapeutic agents. When a
drug is rated other than ef-
fective it may only mean
that there is a lack of con-
trolled clinical evidence as
to efficacy. Thus, physicians
might offer to conduct clin-
ical studies that could help
keep a truly effective drug
in the marketplace. The
treatment of diseases such
as diabetes and angina are
areas where the practi-
tioner can aid in clinical
studies because patients
suffering from these dis-
eases are rarely found in
the conventional hospital
setting.

By working with ethi-
cally and scientifically
sound study designs in his
everyday practice, the
practitioner could begin to
play an important part in
determining official ratings
on drug efficacy.

Nongovernment physi-
cians and scientists and the
FDA should also improve
their lines of communica-
tion to the public. The
medical community must
develop a voice every bit as
loud as that of the consum-
erists, the press, and others
who sometimes criticize
without complete informa-

tion. If not, much of what
the medical community
and federal regulators do
will often be represented in
simplistic and somewhat
misleading terms.

One illustration of the
misuse of the media in this
regard is the recall of anti-
coagulant drugs several
years ago. This FDA action
was given publicity by the
press and television that
went far beyond its prob-
able importance. The result
was a very uncomfortable
situation for the practi-
tioner who had patients
taking these medications.
Since the practitioner and
pharmacist had not been
informed of the action by
the time it was publicized,
in most states they were
deluged with calls from
worried patients.

The practitioner can at->
tempt to solve these prob-
lems of inadequate commu-
nication in several ways.
One would be the creation
of a communications line
in state pharmacy societies.;
When drug regulation news
is to be announced, the so-;
ciety could immediately
distribute a message to ev-
ery pharmacist in the state.
The pharmacist, in turn,
could notify the physicians
in his local community so
that he and the physician
could be prepared to an-
swer inquiries from pa-
tients. Another approach
would be to use profes-
sional publications the
practitioner receives.

All of this leads back to
my opening contention: if
drug regulation is to be ef-
fective, timely, and related
to the realities of clinical
practice, a better method ol
communication and feed-
back must be developed be-
tween the nongovernment
tal medical and scientific;
communities and the regu-|
latory agency.

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Advertisement

One of a series

Henry W. Gadsden,
Chairman & Chief Executive
Officer, Merck & Co., Inc.

In my opinion, it is the
responsibility of all physi-
cians and medical scientists
to take whatever steps they
think are desirable in a law-
and regulation-making
process that can have far-
reaching impact on the
practice of medicine. Yet
many events in the recent
past indicate that this is
not happening. For exam-
ple, it is apparent from
drug efficacy studies that
the NAS/NRC panels gave
little consideration to the
evidence that could have
been provided by practic-
ing physicians.

There are several current
developments that should
increase the concern of
practicing physicians about
drug regulatory affairs. One
is the proliferation of mal-
practice claims and litiga-
tion. Another is the effort
by government to establish
the relative efficacy of
drugs. This implies that if
a physician prescribes a
drug other than the “estab-
lished” drug of choice, he
may be accused of practic-
ing something less than
first-class medicine. It
would come perilously
close to federal direction of
how medicine should be
practiced.

In order to minimize this
kind of arbitrary federal
action, a way must be
found to give practitioners
both voice and represen-

tation in government af-
fairs. Government must be
caused to recognize the
essentiality of seeking their
views. One of the difficul-
ties today, however, is that
there is no way for con-
cerned practitioners to par-
ticipate in the early stages
of decision-making proc-
esses. They usually don’t
hear about regulations until
a proposal appears in the
Federal Register, if then.
By that time a lot of con-
crete has been poured, and
a lot of boots are in the con-
crete.

Physicians in private
practice, and particularly
clinicians, should press for
representation on the ad-
visory committees of the
Food and Drug Admin-
istration, joining with
academic and teaching hos-
pital physicians and scien-
tists who are already serv-
ing. Though practitioners
may not have access to all
available information, the
value of their clinical expe-
rience should be recognized.
Clinicians, for example,
rightly remind us that diffi-
culty in proving precise ef-
fects does not necessarily
mean a drug is ineffective.

Unless practitioners are
more involved in drug reg-
ulations, it will be increas-
ingly difficult for the phar-
maceutical industry and
scientists elsewhere to

make optimal progress in
drug development. The
benefit/ risk ratio must be
re-emphasized, and as part
of this it must be acknowl-
edged that benefit can come
from the judgments of med-
ical science as a whole.
Even this concept, unfor-
tunately, is not always ac-
cepted in drug regulatory
processes. For example, if
current medical opinion
holds that an excess of total
lipids and cholesterol in the
blood is probably predis-
posing to atherosclerosis,
and if a drug is discovered
which reduces total lipids
and cholesterol, the drug
ought to be accepted prima
facie as a contribution to
medical science . . . until
someone disproves the
theory. The sponsor should
not have to prove the the-
ory as well as to develop
and test the drug.

I feel a major new effort
must also be made to erase
the feeling of mistrust of
medicine and of medicines

that seems to be growing in
the public consciousness.
Triggered primarily by stri-
dent announcements in
Washington, people are
reading and hearing con-
fidence-shaking things
almost continuously. Al-
though challenge and
awareness are essential to
medical advancement, our
long-term goal is construc-
tively to build, not destroy.
This means strengthening
patient-physician relation-
ships based on mutual con-
fidence and trust. And in
matters of health policy, it
means working toward par-
ticipatory rather than ad-
versary proceedings— where
everyone with an interest
and a capacity to contrib-
ute has an opportunity to
be heard . . . and, if that op-
portunity is not spontane-
ously afforded him, he may
seek it.

Opinion

What is your opinion, doctor?

We would welcome your comments.

The Pharmaceutical Manufacturers Association
1155 Fifteenth Street, N.W., Washington, D.C. 20005

Couqty" scenes

Regional symposium
on drug abuse
scheduled in Genesee

“Drug Abuse — Recognition and Management,” is
the title of an important symposium planned April
26 by the Genesee County Medical Society. Invita-
tions have been extended to 2,500 physicians and
osteopaths from 16 surrounding counties to attend
the session at the Pick-Durant Motor Hotel, Flint.

Donald R. Canada, MD, program chairman, has
arranged for morning sessions on operation and
management of a methadone program, the current
status of marijuana as a drug of abuse, and the
discontent of today’s youth. Afternoon sessions will
take up the rehabilitation of an addict, a survey of
hallucinogens of natural origin and the desire for
drugs.

Speakers will be Aidan Cockburn, MD, medical-
dental director of the Detroit Mayor's Committee
for Human Resources Development Agency; David
E. Smith, MD, assistant clinical professor with the
Department of Pharmacology at the University of
California Medical Center and medical director of
the Haight-Ashbury Medical Clinic in San Fran-
cisco, and Norman R. Farnsworth, PhD, head of
the Department of Pharmacology at the University
of Illinois Medical Center in Chicago.

Richard L. Rapport, MD, GCMS president, is
chairman of the symposium, while Clayton K.
Stroup, MD, will moderate.

Muskegon physicians
hold annual
trauma symposium

The Muskegon County Medical Society’s 12th
Annual Symposium on Trauma attracted area phy-
sicians to the local Holiday Inn March 29. Sponsors
were the Muskegon chapter, Michigan Committee
on Trauma of the American College of Surgeons
and the MCMS Medical Foundation. G. W. Annessa,
MD, was chairman.

Program topics were the kidney and ureter in
trauma, ski injuries, shock unit-stress bleeding, the
use of osmonetry in the management of the trauma
patient and the multiply injured patient. Following
dinner, David Boyd, MD, professor of general sur-
gery at the University of Illinois School of Med-
icine, discussed the Illinois State Trauma Program.

County societies
arranging meetings
at MSMS building

Four county medical societies have made ar-
rangements to conduct a regular monthly meeting
at MSMS headquarters this spring, to become bet-
ter acquainted with the MSMS building, staff and
projects.

4

The county societies are Eaton, which met
March 23 in East Lansing; Shiawassee, April 11;
Barry, April 17, and Livingston, June 6.

The county society members have made arrange-
ments with a caterer for their own dinners. They
and their wives will then take part in a question-
and-answer program with MSMS staff about the
state society, its goals and projects.

Their meetings at state headquarters were
sparked by an idea proposed by the MSMS De-
partment of Communications and Professional In-
formation, to improve the state society’s communi-
cations with its members.

Nine major committees
heading all work
of Washtenaw Society

An experiment in county society structure is be-
ing conducted by the Washtenaw County Medical
Society under the leadership of President Dean P.
Carron, MD, Ann Arbor.

Doctor Carron organized the Washtenaw Society
under nine major-area committees when he took
office in January. Task forces will take on specific
problems as they are needed and will disband
when the problems are solved.

The nine major areas are membership and cre-
dentials; public and interprofessional relations; spe-
cial health services; school health services; med-
ico-socio-economics; health care delivery; finance,
ways and means and planning; program and com-
missary, and ethics.

The committee chairmen are automatically mem-
bers of the county society’s executive committee
and report directly to it.

“We reorganized because the former committee
structure was so cumbersome and very uncoor-
dinated,” says Doctor Carron. “We had people ap-
pointed who never met.

“Now we are cooperating closely and I think
things are working well. The people involved seem
to be very enthusiastic.”

The experiment will continue at least two years,
as president-elect Neal A. Vanselow, MD, Ann Ar-
bor, also is committed to it.

366 MICHIGAN MEDICINE APRIL 1972

Bay doctors
actively recruiting
new physicians

New physicians for the Bay City area was the
object when members of the Bay-Arenac-losco
counties Medical Society entertained six medical stu-
dents in their community late in February. While
the MSU and WSU medical students were being
entertained by the Bay physicians, the students’
spouses were introduced to the city by members
of the medical society’s auxiliary.

The students were given lunch, taken on tours of
the community, General and Mercy Hospitals and
then entertained at the Bay City Country Club.
Their hosts were members of the county society’s
medical procurement committee, chaired by Rich-
ard Bickham, MD.

The Bay society also carries on an extern pro-
gram. Medical students spend up to two months
each summer in an intensive teaching program
handled by staff doctors in all phases of medical
practice in the Bay City hospitals.

These projects are funded by the Bay County
Foundation for Medical Progress, a non-profit cor-
poration established with the donations of citizens
taking part in the local polio immunization drive in
1964.

MSMS urging county societies
to establish
consumer committees

All component medical societies are being “en-
couraged and challenged” by MSMS to appoint
and activate their own consumer committees “in
an attempt to create a two-way communications
pathway between the consumer and the profes-
sion.”

The urging comes by way of a letter from the
MSMS Committee on Public Relations, sent March
15 to county medical society secretaries, presi-
dents and executive secretaries.

At the 1971 MSMS House of Delegates meeting,
the House passed Resolution 28 encouraging the
county consumer committees, which would provide
the manpower and impetus for a state-wide con1
sumer committee. The county committees are to be
made up of local citizens who would speak for the
profession.

Macomb physicians
invite osteopaths
to all meetings

All 204 Macomb county osteopaths have been
formally invited to meetings of the Macomb County
Medical Society. The Macomb society members
voted at their February meeting to open their ses-
sions to the DOs. Letters were mailed on March 7
asking the osteopaths to attend the MCMS meet-
ing of March 21.

The letter expressed the Macomb MDs’ belief
that the DOs would be interested in scientific meet-
ings and discussions of medical socio-economics.
It cited the cooperation of MDs and DOs at the
state level.

“We sincerely hope you will accept this invita-
tion to participate in our membership meetings in
a new effort to improve the health of Michigan’s
residents and identify areas of mutual concern,”
read the letter.

NEW MSMS MEMBERSHIP

MSMS now has available a gold-
filled Official MSMS Membership
Pin for use in the coat lapel, as a
tie tack, etc. Send check made
out to MSMS for $3.00 to Michi-
gan State Medical Society, 120
West Saginaw, East Lansing, Mich-
igan 48823.

MICHIGAN MEDICINE APRIL 1972 367

Journal

of a Neurosurgeon :

A book review

By Louis Graff, Director
Health Sciences Relations
University of Michigan

Reading the Journal of a Neurosurgeon by Edgar
(Eddie) A. Kahn, MD, is like going on global, grand
rounds of an exciting era with a copy of Baed-
eker under one arm and the notes of William Beau-
mont under the other. In the flight bag is a bottle
of fine cognac, a few basic surgical instruments,
and a 35mm camera.

Even the most seasoned traveler of memoirs and
autobiographies will enjoy a return visit to the lit-
erary landmarks of a journal genre, written this
time by a man who had nearly all that life could
offer and made the most of it. Kahn’s father, patri-
architect Albert, designed automotive plants, Hill
Auditorium, the University Hospital, and mansions
for magnates. His family was studded with talent,
taste and a certain amount of Old World tempera-
ment, as when young Eddie’s mouth was soaped by
an indignant mother for a suspected off-color con-
versation with a comely cousin.

The New England prep school is there, though
at the beginning the grades were not. World
War II, France in 1940, and the Red Cross; Dr.
Harry Towsley curing the child of a British soldier
of meningitis with early and then rare penicillin;
removing an unexploded anti-aircraft shell from the
spine of a paralyzed Gl: elements of the novel lurk
latently within the pages of this Journal.

Dr. Kahn did not write a technical treatise on
neurosurgery, although many unusual cases are de-
scribed briefly and explained parenthetically for the
layman. Rather, these are the random and some-
what chronological recollections about neurosur-
geons, notably his teachers, his students and him-
self. For the men and women of medical science
whose community is a curious mixture of mythology
and fact the book will be a heartwarming conversa-
tion. Undaunted by the critics of his profession and
by an unpredictable readership, Dr. Kahn recites
time and again the failures as well as the suc-
cesses in the operating room with a candor that
may eventually qualify his Journal as required read-
ing for future physicians and surgeons.

Compassion as well as candor punctuate his

pages. Neurosurgery in the 30’s was a grueling
series of patients many of whom were as sure to
die without surgery as they were almost sure to
die during or after it. These were patients who
were paralyzed, blind, suffering from epilepsy or a
crushed skull, harboring a deeply embedded tumor,
or afflicted with an irreversible congenital condi-
tion.

In those days surgery was a slim hope for cer-
tain of these patients, and the neurosurgeon’s
stamina and self-confidence were the only remain-
ing lifeline. If at the end he was exhausted, sick at
heart, angry, arrogant or depressed — all or any of
which he often was — he sought relief at a hockey
game, at an art gallery, or listening to music with
his friends until the sun came up again.

Beneath the tension, the training and the tedious
technical developments was a sense of adventure,
of restlessness, of Rabelaisian robustness. The
Journal recalls a night spent on board ship in the
West Indies at the outbreak of war with a bevy of
stranded Copacabana chorus girls with whom the
neurosurgeon and his companions danced and
sang in a conveniently blacked-out ballroom.

Another time, less delicious but equally invig-
orating, Kahn recalls the tremendous thrill of riding
in a plane piloted by no less than Charles Lind-
berg. In an uncharacteristic moment of mischie-
vousness the Lone Eagle buzzed the hills along
the Huron River west of Ann Arbor in a low-flying
single engine Fairchild. As if to memorialize that
rare experience, the neurosurgeon later bought the
plane.

But it will doubtless be to friends, alumni, former
students and professors associated with the Uni-
versity of Michigan Medical School that Dr. Kahn’s
Journal will impart the warmest associations. Time
after time he briefly met his commitments, always
to return to the alma mater he so deeply loved. He
writes proudly and affectionately about the Univer-
sity Hospital, and about the teachers of medicine
and surgery whose classes, students and interna-
tional reputations clearly marked his era as one of
the greatest in the history of the institution.

From the ingenious Dr. Max Peet to the incred-
ible Dr. Elizabeth Crosby, Kahn’s recital is more
than a sentimental typographical tribute. It is a
tender memorial to the art of teaching and a forth-
right testimonial to a tough profession.

For those who dream of world travel, or fantasy
themselves striding into a surgical amphitheater;
for those who enjoy good music, painting and
sculpture; for those who need to anchor their af-
fection for such human values as family, friends
and work against the alienating onslaught of tech-
nology; and for those who wish to refortify their
awe of the surgeon with an intimate portrait of
him as a human being, Dr. Kahn’s Journal is total
refreshment. It is being published by Charles C.
Thomas and will be on the shelves in February.

The Journal of a Neurosurgeon is reading for the
tough and tender alike, requiring apology from
neither.

368 MICHIGAN MEDICINE APRIL 1972

MSMS at work ...

. . . COMMUNICATING WITH
PUBLIC AND PROFESSION

The Department of Communications and Professional Information
keeps MSMS members informed of activities within the society. It also
seeks to make the public aware of progressive medical thinking through
the news media, conferences, etc.

All new members receive a certificate of membership . . . MSMS mem-
bers receive Michigan Medicine, a monthly publication which carries cur-
rent medical articles, selected by physician-scientific editor . . . Several
pertinent columns by MSMS staff and officers also appear each month . . .
Medigram, a capsulized two-page news sheet, is also mailed twice each
month to members to inform them of late-breaking medical news. Each
week a sheaf of clippings about medical news is sent to various Michigan
leaders in the health professions.

The Department also services the news media. News releases are
sent regularly to 50 dailies and 300 weeklies. News writers call almost
daily to obtain background information and news sources for feature
stories.

Aware of the need to keep news media updated, MSMS sponsors an
annual Medical Writers Conference for Michigan science and free-lance
writers. News conferences are called periodically to give the MSMS view-
point on current topics. Recent meetings dealt with the physician assistant
program, efforts to decrease infant mortality, and positive suggestions for
handling Medicaid payments.

A weekly radio program, “Prescription for Health,” sponsored by
MSMS, is produced by station WUOM, Ann Arbor, and sent to 30 other
stations.

The Department provides liaison with many groups and leaders from
such fields as education, youth service, health agencies, community
groups, etc.

MICHIGAN MEDICINE APRIL 1972 369

About 100 Detroit school counselors and social cal Society-sponsored “Adolescent Drug Treat-

workers participated in the Wayne County Medi- ment Conference” March 8.

County in the spotlight

Wayne County doctors fight drug abuse
with knowledge and understanding

Richard Henderson, MD, chairman of
the Wayne County Medical Society
Committee on Drug Addiction dis-
cusses the workshop purposes.

In recent years, the problem of adolescent drug
abuse has been a growing concern for parents,
educators and physicians.

At present, the adolescent tends to seek assist-
ance from his contemporaries rather than the med-
ical profession. In Wayne County, the physicians
who recognize this fact believe there is a need to
provide the adolescent drug abuser with a compre-
hensive treatment and rehabilitation program with
professional direction.

And those physicians are working to alleviate
that need.

School counselors and social workers are, many
times, the front line of professional contact with
youth. As such, they serve not only in an impor-
tant counseling role but as important resource re-
ferral persons.

With this in mind the Wayne County Medical
Society’s Committee on Drug Addiction and the
Detroit Board of Education sponsored a recent
adolescent drug treatment conference.

One hundred school counselors and social work-
ers in the Detroit school system participated. They
were divided into four small groups for a better
exchange of views.

Seminar topics included adolescence and its
problems, psychodynamics of drug dependence,
adolescent drug treatment in the community, rela-
tionship of the drug treatment center to the
schools, and the adolescent drug abuser and fam-
ily. Emphasis was on adolescent behavior with

370 MICHIGAN MEDICINE APRIL 1972

drug abuse as one facet. Drugs, per se, were not
emphasized.

“The program was well received,” reports Doc-
tor Henderson. “The participants appreciated both
the opportunity to listen to qualified professionals
and to discuss with them the problems of adoles-
cents and how the community can best address
these problems. Also, the participants acquired an
increased awareness of the services already avail-
able in the community and how these services can
best be utilized.”

The Wayne County Society appointed its special
committee for drug addiction in January, 1971. Its
first chairman was Frank B. Walker, II, MD, who
was succeeded in January by Doctor Henderson.

On the committee are representatives of the
Wayne County Association of Osteopathic Physi-
cians and Surgeons, the Detroit Medical Society,
the Detroit Health Department, the Greater Detroit
Area Hospital Council and the Detroit Board of
Pharmacy, as well as medical society members.

Since its appointment, the 18-member committee
has initiated a continuing series of informative and
productive projects.

First, it polled the WCMS membership to find out
how many and which physicians are involved in
drug treatment programs, which physicians would
like to be involved, what they wanted to know and
how they would like to help.

The poll led to a morning workshop for Wayne

County physicians on counseling and treatment of
drug addicts.

Then followed a series of three workshops, co-
sponsored with the Greater Detroit Area Hospital
Council and the Detroit Health Department, de-
(Continued on page 372)

Suggestions for component medical
societies which mag become more
involved in problems of drug abuse

(from H. Richard Henderson, MD, Detroit)

1. Each county is unique, so first define
your problem.

a. Poll physicians in your society to deter-
mine the magnitude of the problem as they
view it.

b. Consult with other agencies — the health
department, school system, and police de-
partment, for example.

2. Encourage a broadly-based community
and team approach, utilizing expertise of pro-
fessionals, such as the educator, social work-
er, nurse and pharmacist, as well as com-
munity people with special skills and in-
terests.

3. Investigate various avenues for obtain-
ing funds — local, state, federal and private.
Money, or lack of it, seems to be a major ob-
stacle in initiating programs.

PROFESSIONAL LIABILITY INSURANCE

ii a hi^li mark oj- diitinction

tized Se

S

'jjecici

: ^

eruice

Professional Protection Exclusively since 1899

DETROIT OFFICE: R. K. Wind and J. K. Galloway, Representatives
27200 Lahser Road, Southfield 48076, Telephone: (Area Code 313) ELgin 3-4848 or 444-1439

GRAND RAPIDS OFFICE: G. J. Haworth, Representative
422 Federal Square Building, Grand Rapids 49502 Telephone: 616-454-4477

MICHIGAN MEDICINE APRIL 1972 371

COUNTY SPOTLIGHT/Continued

Thomas Sullivan, MD, Detroit, works with a
forum group on “Psychodynamics of Drug De-
pendence.” Each school counselor and social
worker participated in four different forums
during the day.

in f

!j I

id;' :

f c
h\

Wayne County Medical Society President Homer
Smathers, MD, standing left, is introduced by
WCMS Chairman Richard Henderson, MD, to
two forum leaders, Thomas Sullivan, MD, right,
and Kemal Gaknar, MD, left, during the luncheon
break.

signed to encourage the formation of drug treat-
ment programs in Detroit hospitals.

The committee anticipates that its role will con-
tinue to expand.

Its next project, to be accomplished by summer,
will be to draw up minimum standards for treat-
ment and rehabilitation for the Methadone mainte-
nance programs in Wayne County. This will extend
to developing “criteria for success” as well as an
evaluation team to insure minimum standards and
the future success of drug treatment programs. In
this respect, the committee plans to work closely
with local public and private agencies as well as
Wayne State University Medical School.

In line with these objectives the committee is
planning a symposium for Wayne County physi-
cians who are working in Methadone maintenance
programs. The symposium will focus on medical
management with Methadone, alternatives to Meth-
adone maintenance such as detoxification and the
use of chemical substitutes, and treatment of the
pregnant addict.

As it has in the past year, the committee will
continue to work for the establishment of a Meth-
adone detoxification program at the Wayne County
Jail, for the development of more hospital-based
drug treatment programs, and for ambulatory de-
toxification programs on an out-patient basis.

372 MICHIGAN MEDICINE APRIL 1972

MSMS workshop
strengthens ties with
county secretaries

Secretaries of county medical societies
met March 1 at MSMS headquarters for
a workshop session. Van O. Keeler, MD,
right, secretary of the Allegan Society,
and Donald Fairfield, executive secretary
of the Muskegon society, looked over a
table of informational materials prepared
by the MSMS staff for use in county so-
ciety business.

As the meeting got underway, welcoming hand-
shakes were exchanged by Thomas A. Kelly, MD,
left, secretary, Eaton County, and John M. Jacobitz,
MD, secretary, St. Joseph County. A major topic
of the day was how county secretaries can play
a more prominent role in recruiting, involving and
retaining medical society members.

The importance of a strong relationship between
MSMS and its component societies was stressed by

The county society secretaries had the chance to
meet MSMS staff members and to suggest ways that
the state society could help its component societies
more. Doctor Keeler acted as spokesman for the
county society leaders.

MSMS Council Chairman Brooker L. Masters, MD,
Fremont.

Welcome

Members of the Michigan State Medical Society
join in welcoming the following new members into
a progressive state medical organization.

Edward Alpert, MD, 2301 Huron Parkway, Ann Ar-
bor 48104

Jerry W. Brackett, MD, 1731 Seminole, Detroit
48214

James Broselow, MD, 2521 Dow Place, Saginaw
48602

Norman J. Breuer, MD, 23300 Greenfield Rd., Oak
Park 48237

Matthew L. Burman, MD, 26356 Franklin Pte. Dr.,
Southfield 48076

E. R. Cleveland, MD, 1500 Weiss St., Saginaw

48602

Jack W. DeLong, MD, 144 W. 26th St., Holland
49423

Lenard E. Fouche, MD, 2901 S. Westnedge, Kala-
mazoo 49001

Paul L. Ginther, MD, 5105 N. Kentford Dr., Sag-
inaw 48602

Jose B. Gotay, MD, 4365 Kirkwood Dr., Saginaw

48603

Leroy B. Green, MD, 114 W. North, Owosso 48867

John R. Gruca, MD, 108 S. Christine Circle, Mt.
Clemens 48403

Loyde H. Hudson, MD, 721 W. Sixth Ave., Flint
48503

Ihsan Kent, MD, 9880 E. Michigan, Galesburg
49053

Efrain E. Leguizamon, MD, 1631 Gull Rd., Kala-
mazoo 49001

L. A. Lindquist, MD, 113 E. Williams, Owosso 48867

Tomas A. Macatangay, MD, 22532 Meadowbrook
Rd., Novi 48050

Azizolah Malakuti, MD, 140 Elizabeth Lake Rd.,
Pontiac 48053

Irineo C. Matias, MD, Wm. Beaumont Hosp., Royal
Oak 48072

John D. Mellen, MD, Wm. Beaumont Hosp., Royal
Oak 48072

Lance E. Nelson, MD, 575 Robbins Rd., Grand
Haven 49417

Richard E. Noon, MD, 726 Parkman Dr., Bloom-
field Hills 48013

Sai Rok Park, MD, Wm. Beaumont Hosp., Royal
Oak 48072

D. M. Rubino, MD, 113 E. Williams, Owosso 48867

Vidal J. Sanchez, MD, 13624 Murthum Dr., Warren
48093

William M. Slater, MD, 212 Medical Arts Center,
Muskegon 49440

Gloria M. Strutz, MD, 27827 Thirty Mile Rd., Rich-
mond 48062

Ralph Ten Have, Jr., MD, 425 Cherry St., S.E.,
Grand Rapids 49502

Gertraud Wollschlaeger, MD, 5885 Wing Lake Rd.,
Birmingham 48010

Paul B. Wollschlaeger, MD, 5885 Wing Lake Rd.,
Birmingham 48010

H. Kenneth Wong, MD, 23023 Orchard Lake Rd.,
Farmington 48024

374 MICHIGAN MEDICINE APRIL 1972

PFIZIRPEN
DOSAGE FORMS

Orange-flavored

Pfizerpen VK for Oral Solution

(potassium phenoxymethyl penicillin)

1 25 mg. (200,000 units)/ 5 cc.:
bottles of 1 00 cc. and 1 50 cc.

250 mg. (400,000 units)/ 5 cc.:
bottles of 1 00 cc. and 1 50 cc.

Pfizerpen VK Tablets

(potassium phenoxymethyl penicillin)

250 mg. (400,000 units): bottles of 100.
500 mg. (800,000 units): bottles of 100.

Butterscotch-caramel-flavored
Pfizerpen G Powder for Syrup
(potassium penicillin G)

400,000 units/ 5 cc.:

bottles of 1 00 cc. and 200 cc.

Pfizerpen G Tablets
(potassium penicillin G)

200.000 units: bottles of 1 00 and 500.

250.000 units: bottles of 1 00.

400.000 units: bottles of 1 00 and 1 000,
and unit-dose pack of 100 (10 x 10's).

800.000 units-, bottles of 100.

LABORATORIES DIVISION

PFIZER INC NEW YORK N Y 10017

Now there are two ways to cut the cost of brand-name penicillin therapy.

Pfizerpen VK now joins Pfizerpen G (potassium penicillin G) for true economy in brand-name
penicillin therapy.

When you write penicillin VK, it's for acid stability, solubility and rapid absorption. But when
you write Pfizerpen VK, you add economy. Pfizerpen VK, more economical than the two lead-
ing brand-name penicillin VK products. G or VK. Just make sure it's Pfizerpen.

Tablets and Powder for Syrup

, PFIZERPEN VK ,

(POTASSIUM PHENOXYMETHYL PENICILLIN)

G OR VK. JUST
MAKE SURE IT’S PFIZERPEN.

c^Aqcillarjr

Here 's a tale

of a non - smoking project
that also makes money

By Hugh Hufnagel
Lansing General Hospital

Any third grade arithmetic teacher will tell you
that you can’t add apples and cigarettes. But at
Lansing General Hospital patients and employees
are finding out that it’s possible to subtract cig-
arettes and add apples.

Here is what happened.

Last fall, the Michigan State Medical Society
(MSMS) urged “all hospitals to campaign against
smoking in patient care areas.” Further, the MSMS
Committee on Cardiac Disease recommended “ces-
sation of the sale of all cigarettes inside the hos-
pital."

These two proposals not only received the im-
mediate endorsement of the administration and
medical staff at Lansing General Hospital, but the
no smoking movement was carried a little further.

A list of smoking rules were developed:

1. The sale of smoking materials is prohibited
in the hospital.

2. Patients not confined to bed must get out of
bed to smoke.

3. All sedated patients desiring to smoke must
be attended by hospital personnel.

4. No visitor smoking is permitted in patient
rooms.

5. No smoking is allowed in elevators or halls.

6. Smoking is not permitted in public areas or
departments directly associated with care and
treatment of patients.

The finished list of rules was then approved by
the hospital’s Employee Council and put into ef-
fect.

Without fanfare, the cigarette machine disap-
peared as did the gift shop’s stock of cigarettes.

For the hospital service league, which sold over
24,000 packages of cigarettes in the gift shop dur-
ing 1971, this meant an immediate drop in revenue.
Then along came the apple idea.

Marian Renaud, manager of the gift shop, ex-
plained: “At first, we just brought a few in our-
selves to see how they would sell. It wasn’t long
before the word spread and the apple business
caught fire. Now we sell 100 to 120 per day.”

Because of a higher margin on the apples, rev-
enues are anticipated to be 150% of those on cig-
arettes.

“The transition from cigarettes to apples wasn’t
completely smooth,” said Mrs. Renaud. “But after
a few minor grumblings, the career smokers seem
to have adjusted.”

French surgeon
keynote speaker
for kidney symposium

The surgeon who performed the world’s first
kidney transplant will be a guest speaker at the
11th annual Kidney Disease Symposium scheduled
May 19 and 20 at the Mercy College Conference
Center.

Jean Hamburger, MD, of Necker Hospital, Paris,
France will be the opening speaker in the morning
session devoted to renal transplantation. Also
participating in the discussion, will be John R.
Ackermann, MD; Stanley G. Dienst, MD; Jerry C.
Rosenberg, MD; Thomas E. Starzl, MD and Bruce
H. Stewart, MD.

In addition to renal transplantation there will be
sessions on the diagnosis of renal disease and
hypertension, a session on pediatric nephrology,
as well as newer concepts in therapy. Dr. George
Schreiner, past president of the National Kidney

Foundation, will be one of several speakers Satur-
day afternoon discussing the therapy of drug
overdose.

A total of 23 have been invited to speak at
sessions aimed at physicians, nurses, technicians
and other allied health personnel.

Sidney Baskin, MD, director of Kidney Center,
Mt. Carmel Mercy Hospital and Medical Center,
Detroit, is chairman of the symposium. Mt. Carmel
is co-sponsoring the event.

Mercy College is at 8200 West Outer Drive, De-
troit. Persons from nine states and the eastern
section of Canada are expected to attend. On-
campus housing is available by contacting Mercy
College Conference Center, area code (313) 531-
7820, Ext. 272.

Bob Talbert of the Detroit Free Press will be
guest speaker at the dinner and guests will be
entertained by a “mechanical man.”

Further information regarding the symposium
program may be obtained by contacting the Kid-
ney Foundation of Michigan’s central office in
Ann Arbor, telephone area code (313) 971-2800.

376 MICHIGAN MEDICINE APRIL 1972

On the next two pages:
An important announcement
for you and your patients.

New from Colgate:

Superior Gram negative

P

ANTI-BACTERIAL DEODORANT SOAP

1

Effective against Gram positive bacterial
and Gram negative bacteria.

As mild as any other toilet soap.

With unsurpassed substantivity for
long-lasting antibacterial action.

Active ingredients: 3, 4', 5-tribromosalicylanilide and 4, 2',4'-trichloro-2-hydroxy diphenyl ether.
Together these agents produce a synergistic effect that provides broad spectrum protection
against skin bacteria. (P-300 does not contain hexachlorophene.)

The new all-purpose soap for homes, offices, hospitals, schools,
restaurants, food processing plants, laboratories, etc.

P"300: Superior protectior

>acteriostasis in a bar soap.

P-300 -superior to other antibacterial bar soaps. Proven
effective against 25 of 31 cultures representing bacteria of
major concern in nosocomial infections and cross-infections.*

BACTERIA

A.T.C.C.

No.

P-300

Soap “D”

Soap “S”

Gram Positive

Staphylococcus aureus

8094

• ••

9

•

Staphylococcus aureus

11371

• ••

9

9

Staphylococcus aureus

8096

9 99

9

9

Staphylococcus aureus

10390

• ••

9

9

Staphylococcus aureus

6342

• ••

9

9

Staphylococcus epidermidis

17917

• ••

•

9

Staphylococcus sp.

13565

9 99

•

• 9

Mycobacterium smegmatis

19420

• ••

9 9

• 9

Listeria monocytogenes

13932

• ••

• 9

999

Streptococcus pyogenes

7958

9

9

9

Streptococcus mitis

903

9

9

9

Streptococcus sp.

12403

9

9

9

Bacillus anthracis

14578

9

99

99

Gram Negative

Alcaligenes tolerans

19359

999

• 9

9 9 9

Neisseria gonorrhoeae

19424

99

9

9

Neisseria menigitidis

13077

9 99

9

9

Proteus vulgaris

8427

• ••

#

O

Escherichia coli

10536

•

O

O

Escherichia coli

11229

9

O

o

Escherichia coli

11698

9

o

o

Klebsiella pneumoniae

12833

9

o

o

Salmonella typhi

9993

•

o

o

Salmonella typhi

6539

•

o

o

Salmonella typhimurium

13311

•

o

o

Herellea sp.

11959

9

o

o

Pseudomonas aeruginosa

10145

o

o

o

Pseudomonas aeruginosa

7700

‘ O

o

o

Pseudomonas aeruginosa

9027

O

o

o

Pseudomonas aeruginosa

14210

o

o

o

Proteus rettgeri

9250

o

o

o

Proteus morganii

9237

° A

O

o

KEY: ZONE OF INHIBITION

9 9 9 = 18.0 mm or larger
9 = 12.0 mm to 17.9 mm
• = Less than 1 1 .9 mm
o = No Inhibition

or you and

Test Method; The three antibacterial soaps 'were evaluated by
means of tiie standard.|Yotein Adsorption Test, conducted by a
recognized independent laboratory, using A.T.C.C. organisms.

*The bacteria were those most frequently named in a nationwide
survey of 334 hospitals. ;

samples of P~300 and product literature,

please write:

Professional Services Department
COLGATE-PALMOLIVE COMPANY
740 North Rush Street
Chicago, Illinois 6061 1

(diethylpropion hydrochloride, N. F.)

When girth gets out of control, TEPANIL can provide sound
support for the weight control program you recommend.
TEPANIL reduces the appetite — patients enjoy food but eat
less. Weight loss is significant— gradual — yet there is a rela-
tively low incidence of CNS stimulation.

Contraindications: Concurrently with MAO inhibitors, in patients hypersensitive to
this drug,- in emotionally unstable patients susceptible to drug abuse.

Warning: Although generally safer than the amphetamines, use with great caution in
patients with severe hypertension or severe cardiovascular disease. Do not use dur-
ing first trimester of pregnancy unless potential benefits outweigh potential risks.
Adverse Reactions: Rarely severe enough to require discontinuation of therapy, un-
pleasant symptoms with diethylpropion hydrochloride have been reported to occur
in relatively low incidence. As is characteristic of sympathomimetic agents, it may
occasionally cause CNS effects such as insomnia, nervousness, dizziness, anxiety,
and jitteriness. In contrast, CNS depression has been reported. In a few epileptics
an increase in convulsive episodes has been reported. Sympathomimetic cardio-
vascular effects reported include ones such as tachycardia, precordial pain,

orrhythmia, palpitation, and increased blood pressure. One published report
described T-wave changes in the ECG of a healthy young male after ingestion of
diethylpropion hydrochloride,- this was an isolated experience, which has not been
reported by others. Allergic phenomena reported include such conditions as rash,
urticaria, ecchymosis, and erythema. Gastrointestinal effects such as diarrhea,
constipation, nausea, vomiting, and abdominal discomfort have been reported.
Specific reports on the hematopoietic system include two each of bone marrow
depression, agranulocytosis, and leukopenia. A variety of miscellaneous adverse
reactions hove been reported by physicians. These include complaints such as dry
mouth, headache, dyspnea, menstrual upset, hair loss, muscle pain, decreased
libido, dysuria, and polyuria.

Convenience of two dosage forms: TEPANIL Ten-tab tablets: One 75 mg. tablet
daily, swallowed whole, in midmorning (10 a.m.); TEPANIL: One 25 mg. tablet three
times daily, one hour before meals. If desired, an additional tablet may be given in
midevening to overcome night hunger. Use in children under 12 years of age is not
recommended. 1-3325 ( 2876)

(jMerrell^

MERRELL- NATIONAL LABORATORIES

Division of Richardson- Merrell Inc.
Cincinnati, Ohio 45215

Painful
night leg
cramps...

unwelcome bedfellow
for any patient-

including those with arthritis,
diabetes or PVD

□ Prevents painful night
leg cramps

□ Permits restful sleep

□ Provides simple
convenient dosage —
usually just one tablet
at bedtime

Prescribing Information — Composition: Each white, beveled, compressed tablet
contains: Quinine sulfate, 260 mg., Aminophylline, 195 rag. Indications: For the
prevention and treatment of nocturnal and recumbency leg muscle cramps, includ-
ing those associated with arthritis, diabetes, varicose veins, thrombophlebitis,
arteriosclerosis and static foot deformities. Contraindications: Quinamm is con-
traindicated in pregnancy because of its quinine content. Precautions/ Adverse
Reactions: Aminophylline may produce intestinal cramps in some instances, and
quinine may produce symptoms of cinchonism, such as tinnitus, dizziness, and gas-
trointestinal disturbance. Discontinue use if ringing in the ears, deafness, skin rash,
or visual disturbances occur. Dosage: One tablet upon retiring. Where necessary,
dosage may be increased to one tablet following the evening meal and one tablet
upon retiring. Supplied: Bottles of 100 and 500 tablets.
MERRELL-NATIONAl LABORATORIES t-ssostsoso)

Merrell ) Division of Richardson-Merrell Inc.

Cincinnati, Ohio 45215 Trademark: Quinamm

^Merrell ^

Quinamm

Specific therapy for night leg cramps.

ANCILLARY/Continued

Here is program

for Medical Staff- Trustee -

Administrator Forum

The changing roles of hospital staffs, governing
boards, and management; group practices and
HMOs will be explored at the annual Medical Staff-
Trustee-Administrator Forum May 24-26 at Boyne
Mountain Lodge. Co-sponsors are the Michigan
Hospital Association, MSMS, the Michigan Osteo-
pathic Hospital Association and the Michigan Asso-
ciation of Osteopathic Physicians and Surgeons.

“Health Care in A Time of Change” is the gen-
eral theme of the talks which will feature round-
table discussions. A nationally prominent speaker
is being arranged for the May 24 convening dinner.

On the morning of May 25, the topic will be
“The Changing Responsibilities of Governing
Boards and Management,” with Charles Jacobs,
JD, assistant director, Joint Commission on Accred-
itation of Hospitals. “Medical Staff Responsibilities
Redefined,” with Walter W. Carroll, MD, associate
director, Joint Commission on Accreditation of
Hospitals; and “Medical Staff Bylaws, Rules and

I Regulations,” with Doctor Jacobs, will be presented
in the afternoon.

On May 26, the topic will be “Group Practice
and HMOs — Changing Emphasis in Health Care.”
Among the speakers will be Charles R. Goulet, for-
mer director of the University of Chicago Hospitals
and Clinics, and now vice president of the Hos-
pital Service Corporation of Chicago, and William
Flaherty, vice president for administration of Mich-
igan Blue Cross.

On the planning committee for the forum are
Lewis Simoni, MD, Flint, and Leo Walker, MD, Lan-
sing, representing MSMS.

Rheumatologists

may prepare

for first certification

The American Board of Internal Medicine has
established a new subspecialty area of rheuma-
tology, with the first examination for certification
to be given by the board on Oct. 17, 1972.

As an aid to its members and others interested,
the American Rheumatism Association Section of
the Arthritis Foundation will offer a Review Session
in Rheumatology in conjunction with its annual
meeting at the Fairmont Hotel in Dallas June 10.

Reservations may be sent to the executive secre-
tary, American Rheumatism Association Section, the
Arthritis Foundation, 1212 Avenue of the Americas,
New York, 10036, no later than May 25. The ses-
sion will cost $50.

Woman's Auxiliary
planning April 19
Legislative Day

The emphasis will be on state medical legisla-
tion at the annual Legislative Day planned April 19
at the Hospitality Inn, East Lansing, by the Wom-
an’s Auxiliary to the MSMS.

A rundown on important bills passed or pending
in the state legislature will be provided for the
women’s group by John J. Coury, MD, Port Huron,
MSMS president-elect. A brief description of activ-
ities of the Michigan Doctors Political Action Group
will be given by Louis R. Zako, MD, Allen Park,
MSMS councillor and MDPAC chairman.

Invitations have been extended by the auxiliary
to Sidney Adler, MD, Detroit, MSMS president, and
Brooker L. Masters, MD, Fremont, MSMS Council
chairman, and their wives; to Warren F. Tryloff,
MSMS director; Bruce Ambrose, director, MSMS
Department of Government Affairs and Mrs. Sherry
Hall, MSMS special assistant, Legislative Liaison.

State legislators will be invited to lunch with the
auxiliary members. Nearly 40 senators and repre-
sentatives attended the 1971 event.

MSMS members may obtain copies of the
AMA “Horizons Unlimited” career handbook
with an eight-page Michigan insert by
writing to MSMS, P.O. Box 950, East Lan-
sing 48823.

MICHIGAN MEDICINE APRIL 1972 383

In acute gonorrhea

(urethritis, cervicitis, proctitis when due
to susceptible strains of N. gonorrhoeae)

Sterile Trobicin®

(spectinomycin dihydrochloride pentahydrate)— For Intramuscu-
lar injections, 2 gm vials containing 5 ml when reconstituted
with diluent. 4 gm vials containing 10 ml when reconstituted with
diluent.

An aminocyclitol antibiotic active in vitro against most strains of
Neisseria gonorrhoeae (MIC 7.5 to 20 mcg/ml). Definitive in vitro
studies have shown no cross resistance of N. gonorrhoeae be-
tween Trobicin and penicillin.

Indications: Acute gonorrheal urethritis and proctitis in the male
and acute gonorrheal cervicitis and proctitis in the female when
due to susceptible strains of N. gonorrhoeae.

Contraindications: Contraindicated in patients previously
found hypersensitive to Trobicin. Not indicated for the treatment
of Syphilis. ®1972 The Upjohn Company

Warnings: Antibiotics used to treat gonorrhea may mask or
delay the symptoms of incubating syphilis. Patients should be
carefully examined and monthly serological follow-up for at
least 3 months should be instituted if the diagnosis of syphilis is
suspected.

Safety for use in infants, children and pregnant women has not
been established.

Precautions: The usual precautions should be observed with
atopic individuals. Clinical effectiveness should be monitored to
detect evidence of development of resistance of N. gonorrhoeae.

Adverse reactions: The following reactions were observed
during the single-dose clinical trials: soreness at the injection site,
urticaria, dizziness, nausea, chills, fever and insomnia.

During multiple-dose subchronic tolerance studies in normal
human volunteers, the following were noted: a decrease in hemo-

384 MICHIGAN MEDICINE APRIL 1972

IrobKin

sterile spectinomycin dihydrochloride
penta hydrate, Upjohn

High cure rate:* 96% of 571 males, 95% of 294 females

(Dosages, sites of infection, and criteria for diagnosis and cure are defined below.)**

Assurance of a single-dose, physician-controlled treatment schedule

No allergic reactions occurred in patients with an alleged history of penicillin sensitivity
when treated with Trobicin, although penicillin antibody studies were not performed

Active against most strains of Neisseria gonorrhoeae in vitro (M I C. 7.5-20 mcg/ml)

A single two-gram injection produces peak serum concentrations averaging about
100 mcg/ml in one hour (average serum concentrations of 15 mcg/ml present 8 hours after dosing)

Note: Antibiotics used in high doses for short periods of time to treat gonorrhea may mask or delay the
symptoms of incubating syphilis. Since the treatment of syphilis demands prolonged therapy with any
effective antibiotic, and since Trobicin is not indicated in the treatment of syphilis, patients being treated for
gonorrhea should be closely observed clinically. Monthly serological follow-upforatleast3 months should
be instituted if the diagnosis of syphilis is suspected. Trobicin is contraindicated in patients previously found
hypersensitive to it.

*Data compiled from reports of 14 investigators. **Diagnosis was confirmed by cultural identification of N. gonorrhoeae on Thayer-
Martin media in all patients. Criteria for cure: negative culture after at least 2 days post-treatment in males and at least 7 days post-
treatment in females. Any positive culture obtained post-treatment was considered evidence of treatment failure even though the

follow-up period might have been less than the periods cited above under "criteria for cure" except when the investigator determined
that reinfection through additional sexual contacts was likely. Such cases were judged to be reinfections rather than relapses or
failures. These cases were regarded as non-evaluatable and were not included JA72 1848-6

globin, hematocrit and creatinine clearance; elevation of alka-
line phosphatase, BUN and SGPT. In single and multiple-dose
studies in normal volunteers, a reduction in urine output was
noted. Extensive renal function studies demonstrated no con-
sistent changes indicative of renal toxicity.

Dosage and administration: Keep at 25°C and use within
24 hours after reconstitution with diluent.

Male — single 2 gram dose (5 ml) intramuscularly. Patients with
gonorrheal proctitis and patients being re-treated after failure
of previous antibiotic therapy should receive 4 grams (10 ml). In
geographic areas where antibiotic resistance is known to be pre-
valent, initial treatment with 4 grams (10 ml) intramuscularly is
preferred.

Female — single 4 gram dose (10 ml) intramuscularly.

How supplied: Vial s, 2 and 4 grams — with ampoule of Bacterio-

satic Water for Injection with Benzyl Alcohol 0.9% w/v. Recon-
stitution yields 5 and 10 ml respectively with a concentration of
spectinomycin dihydrochloride pentahydrate equivalent to 400
mg spectinomycin per ml. For intramuscular use only.
Susceptibility Powder — for testing in vitro susceptibility of N.
gonorrhoeae.

Human pharmacology: Rapidly absorbed after intramuscular
injection. A two-gram injection produces peak serum concentra-
tions averaging about 100 mcg/ml at one hour with 15 mcg/ml
at 8 hours. A four-gram injection produces peak serum concen-
trations averaging 160 mcg/ml at two hours with 31 mcg/ml at
8 hours.

For additional product information, see your Upjohn representa-
tive or consult the package insert. med-b-i-s ilwb]

Upjohn

The Upjohn Company, Kalamazoo, Michigan 49001

MICHIGAN MEDICINE APRIL 1972 385

ANCILLARY/ Continued

Immediate Past MDPAC Chairman Donato F. Sarapo,
and Mrs. Sarapo, right, met at the reception with
their congressman, Marvin L. Esch (R-Ann Arbor)
and Mrs. Esch, and then took the Esches out to
dinner as their official hosts for the evening. The
pattern was followed by many of the MDPAC
couples designated as official hosts of their congress-
men for the evening.

A delegation of over 60 persons —
MDPAC members, their wives and fam-
ilies— made the trip to Washington, D.C.,
in mid-March for the annual AMA-
AMPAC Public Affairs Workshop. Pre-
ceding the weekend workshop, the Mich-
igan physicians and their families met
their congressmen at a Capitol Hill Club
reception. Louis R. Zako, MD, Allen Park,
MDPAC chairman, left, and Robert D.
Allaben, MD, Detroit, center, met with
Rep. Philip E. Ruppe, R-Houghton for an
informal talk.

Washington Weekend'
a hit with MDPAC

Other key people at the MDPAC reception were,
from left, William G. Zimmerman, MD, Grand Rap-
ids; Rep. Gerald R. Ford (R-Grand Rapids), minority
leader of the House; Rep. William S. Broomfield (R-
Royal Oak), and Brooker L. Masters, MD, Fremont,
MSMS Council chairman. During their Washington
Weekend, members of the MDPAC delegation took
in a Van Cliburn concert at Kennedy Center for the
Performing Arts, heard AMA heads including Presi-
dent Wesley W. Hall, MD; were addressed by AM-
PAC leaders and heard national legislative figures.

Senator Philip A. Hart (D-Mackinac Is-
land) attended the MDPAC reception,
where he was the guest of Dr. and Mrs.
Robert Solomon of Grosse lie. Sen. Hart
was among 13 members of the Michigan
congressional delegation who were pres-
ent at the reception.

386 MICHIGAN MEDICINE APRIL 1972

Emergency physicians
introduce JACEP,
their official journal

The “maiden” issue of JACEP, Journal of the
American College of Emergency Physicians, has
been introduced to the emergency room physicians
who are members of the four-year-old college,
and other interested medical personnel.

Th January-February issue of the journal (to be
published every two months) features a modern,
up-dated makeup style and departments on books,
dates, editorials, letters, members, news, placement
and products.

Feature articles take up the topics of emergency
management of drug abuse, dental procedures
and acute eye problems. “Health Care’s Hidden
Crisis,” and “Arrhythmias in Myocardial Infarction”
are two more topics.

“ACEP has only one goal in mind in publishing
this journal,” writes John H. van de Leuv, MD,
JACEP editor. “That is to provide a publication
which will effectively serve the medical and an-
cillary personnel who are involved in the delivery
of emergency medical services.

“JACEP will provide a medium for the exchange
of ideas, problems, helpful hints, scientific articles,
opinions and news relating not only to ACEP ac-
tivities and goals but to the entire field of emer-
gency medical care,” continues Doctor van de
Leuv. “JACEP will be professional, practical, and
progressive.”

Consulting editors for JACEP include Charles F.
Frey, MD, associate professor of surgery, Univer-
sity of Michigan Medical Center, Ann Arbor, and
Michael C. Kozonis, MD, Kozonis-Overy Clinic, PC,
Pontiac.

Doctor van de Leuv is a member of the board of
directors of the 2,800 member ACEP.

MD Placement Notice

— Looking for a smaller town that needs
and wants a physician?

— Do you need an associate or assistant in
your practice?

— Are there towns in your area in need of
additional physicians?

— If your answer is YES to any of the above
questions, contact

Michigan Health Council
John A. Doherty, Executive Secretary
712 Abbott Rd., P.O. Box 431
East Lansing (Phone: 337-1615)

(No charge for this service)

Michigan's
medical assistants
to meet April 27-30

Members of the American Association of Medical
Assistants, State of Michigan branch, will meet in
Kalamazoo April 27-30 for their annual meeting.
Highlights of the three-day event will be election
and installation of officers and presentation of
awards.

The medical assistants will stage a special re-
ception April 28 for Glenn E. Millard, MD, Detroit,
who is retiring after 14 years as an advisor to the
state medical assistants’ group, 12 of them as
chairman of the advisory committee. Doctor Millard
also served two years as chairman of the physi-
cians’ advisory committee to the national medical
assistants organization. Hostesses for the reception
will be the 1971-72 officers and active past presi-
dents.

Topics of talks during the medical assistants’
meeting will include air pollution, medical assist-
ant programs in high schools and the alcoholic
woman. An arts and crafts show featuring work by
medical assistants also will be staged.

Wayne med students
developing catalogue
for loan program

Wayne State University Medical students are
compiling a catalogue of communities interested
in their innovative and successful Wayne State-
Community-Student Loan Program.

Under the program, a community offers to pay
education expenses for a medical student in ex-
change for his guarantee that he will practice in
that community on graduation.

Included in the catalogue is information regard-
ing the availability of summer jobs, existing medi-
cal facilities and personnel, possibilities of group
practice, and a brief description of each com-
munity. The catalogue is an outgrowth of the
loan program established in the fall, 1970.

It is available by writing the Wayne State-Com-
munity Loan Program, c/o Douglas R. Jackson,
540 E. Canfield Ave., Detroit, 48201; or John A.
Doherty, Michigan Health Council, 712 Abbott
Road, East Lansing 48823.

MICHIGAN MEDICINE APRIL 1972 387

ANCILLARY /Continued

25 orthopedic
physician assistants
training at Marygrove

Marygrove College in Detroit accepted its first
class of 25 students in September in a two-year
course to train orthopedic physician’s assistants.
Marygrove is now a coeducational college and
trains different kinds of people in the allied health
fields.

Marygrove worked out the curriculum with the
support of the Michigan Orthopedic Society; and
has affiliations with five hospitals for training.

Of 65 applicants for the class, 25 were chosen,
both men and women. The Marygrove college grad-
uates will get an associate of arts degree. They will
be employed primarily, it is believed, by hospitals
and orthopedic physician groups.

The students are getting special training in five
areas of orthopedic work — plaster, traction, emer-
gencies, surgery, and the orthopedic surgeon's of-
fice. Maurice Castle, MD, is co-director for the
curricula.

Marygrove has applied to the AMA for certifica-
tion of this program, and has applied to HEW for
special funding. The college did not need approval
of the State Department of Education to begin the
course.

There are only five such programs in operation
in the nation, with others on the planning boards.

Michigan physicians
may use Missouri center
for bone tumor referrals

One of three newly established Bone Tumor Re-
ferral Centers in the nation is located in the De-
partment of Radiology at the University of Missouri
Medical Center, Columbia, Missouri. Designed to
help physicians in the diagnostic evaluation of
bone tumor X-rays, the Centers (also in Los An-
geles and Philadelphia) were established at the
recommendation of the Commission on Cancer of
the American College of Radiology.

Radiographs and patient resumes may be sent
to Gwilym S. Lodwick, MD, professor and chair-
man of the Department of Radiology, University of
Missouri Medical Center, Columbia, Missouri 65201.
There is no charge for the service.

Great Lakes
health manpower
conference April 1 2

The nation’s only full-blooded American Indian
dentist, who recently was named to head a nation-
al effort to recruit minority groups into health ca-
reers, will keynote the Great Lakes Health Man-
power Conference April 12 at Kellogg Center, East
Lansing.

George Blue Spruce, DDS, director, Office of
Health Manpower Opportunity, Bureau of Health
Manpower Education, HEW, Bethesda, Md., will
lead the conference co-sponsored by the Mich-
igan Health Council and Michigan State University.

Guidance counselors, directors of vocational ed-
ucation, health professionals and administrators of
allied health training programs in high schools,
colleges, and universities are being invited to at-
tend. Special emphasis will be given to the impor-
tance of attracting and counseling more black,
American Indian and Chicano students into health
professions and occupations.

Emergency care
topic of two
Michigan meetings

Two important three-day courses on the emer-
gency treatment of seriously injured or ill patients
are planned late this spring.

The first is the 7th annual Conference on the
Initial Management of the Acutely III or Injured
Patient scheduled June 5-7 in Ann Arbor. Emphasis
will be made on the practical aspects of emer-
gency care, with a variety of workshops, demon-
strations and lectures planned. On the committee
are representatives of police, fire, medical person-
nel, the Red Cross, industrial and other emergency
agencies.

The second, designed for physicians, is the
American College of Surgeons Committee on Trau-
ma’s continuing medical education course on the
“Treatment of the Seriously Injured or III in the
Emergency Department.” It is planned May 31-
June 3 at Wayne County Medical Society head-
quarters. Registration is limited to 200 persons.

Medical assistants
selling dessert cookbook

Sales of a new “Fabulous Dessert Cookbook”
are being promoted by members of the American
Association of Medical Assistants, State of Mich-
igan. Orders are being taken by Mrs. Anita Snyder,
344 Center St., Michigan Center 49254, with pro-
ceeds to go to the Michigan Maxine Williams
Scholarship Fund to help girls wishing to receive
their education in the medical assistant field.

388 MICHIGAN MEDICINE APRIL 1972

70 medical students
in SAM A - MECO project
this summer

Come June, nearly 70 Michigan medical stu-
dents, most of them pre-sophomores, will begin
a summer of clinical experience in community hos-
pitals all around the state.

They will be the largest group yet to take part
in Michigan’s Student American Medical Associa-
tion Medical Education Community Orientation pro-
gram. The SAMA-MECO project is designed to
give students firsthand involvement in the medical
field early in their academic careers, and to en-
courage them to practice on graduation in the
outstate communities so desperately wanting phy-
sicians.

An additional 90 students interested in the 1972
SAMA-MECO project could not be placed because
there weren’t enough openings.

The number of participating students has ex-
panded from 11 in the summer of ’70, the first year
of Michigan involvement, to 50 in 1971 and nearly
70 this supper. The number of hospitals sponsor-
ing the students is 60 this year, with three of them
in the upper peninsula.

Most of the students are gaining clinical ex-
perience in smaller communities, though two will
be based in Detroit. Many of the students are
returning to their home towns for the summer
session.

In each case, the students are supervised by
a physician-program director, many of them family
practitioners.

Coordinating the program is the MSMS Depart-
ment of Communications and Professional Infor-
mation, in cooperation with the Michigan Hospital
Association and the Michigan Academy of Family
Practice. The project is directed by the MSMS
Education Liasion Committee, chaired by Brock
E. Brush, MD, Detroit.

The medical students are from all three Michigan
medical schools. Student coordinators are John
Bruder, Wayne State University, and Bryan Schu-
maker, Michigan State University, both of whom are
taking part in this year’s program, and Randy
Nesse, University of Michigan, who participated
in the summer of ’71.

Established 1924

MERCYWOOD HOSPITAL

4038 Jackson Road Conducted by Sisters of Mercy Ann Arbor, Michigan

Telephone - — -313 663-8571

Mercywood Hospital is a private neuropsychiatric hospital
licensed by the Michigan Department of Mental Health.
Mercywood specializes in intensive, multi-disciplinary
treatment for emotional and mental disorders.

Accredited by the Joint Commission on Accreditation of
Hospitals and the National League of Nursing. A full Blue
Cross participating hospital.

Certified for: Medicare and M.A.A. programs

Robert J. Bahra, M.D.

Dean P. Carron, M.D.
Francis M. Daignault, M.D.
Gordon C. Dieterich, M.D.
James R. Driver, M.D.

(Active & Associate)
Robert L. Fransway, M.D.
Stuart M. Gould, Jr., M.D.
Sydney Joseph, M.D.
Hubert Miller, M.D.

Jacob J. Miller, M.D.
Rudolf E. Nobel, M.D.

Gerard M. Schmit, M.D.
Joseph J. Tiziani, M.D.
Prehlad S. Vachher, M.D.
Richard D. Watkins, M.D.
Robert M. Zimmerman, M.D.

MICHIGAN MEDICINE APRIL 1972 389

ANCILLARY/ Continued

Consultation skills,
community relations
topics of U - M meetings

Full-time health personnel with voluntary or of-
ficial agencies are eligible for two continuing ed-
ucation courses planned by the Department of
Community Health Services and the Health Educa-
tion Program, School of Public Health, the U-M.

The first course, on consultation skills, is sched-
uled July 9-14, for persons responsible for plan-
ning and implementing health programs. Completed
applications are due by May 30. The second
course, on community and professional relations,
is for persons with responsibilities in community
organization, planning, or programming.

Both courses will cost $135, will be held at
Weber’s Inn, Ann Arbor, and are limited to 50 per-
sons. Forms are available through Anna B. Brown,
PhD, assistant professor of public health adminis-
tration, M4234 School of Public Health II, U-M, Ann
Arbor, 48104.

U-M Hospital certified
as rare blood facility

The University of Michigan Hospital is the 10th
in the nation to be certified by the American Asso-
ciation of Blood Banks with a reference laboratory
with facilities and trained personnel to identify and
match rare blood. Only 27 such laboratories exist
around the country, 10 of them in hospitals. The
U-M hospital transfuses 20,000 pints of blood each
year, keeps 300 pints of blood on hand at all times
and has a file of 1,600 local donors. In addition,
the U-M lab keeps a supply of frozen blood cells
to identify rare blood.

Doctor Shumway
to headline

Heart Days April 14-15

Norman E. Shumway, MD, the national heart
transplant authority who is a Kalamazoo native,
will return to Michigan to lecture at the Michigan
Heart Association’s Annual Heart Days and Sci-
entific Sessions April 14-15 at Cobo Hall, Detroit.

Doctor Shumway, chief, Division of Cardio-
vascular Surgery at Stanford University, will dis-
cuss the surgeon’s role in the treatment of cor-
onary artery disease. He will speak the morning of
the 15th. General theme of the two-day sessions is
atherosclerosis and its complications.

WSU Cancer Symposium
scheduled April 28

Eight out-of-state physicians, from Toronto; Ber-
keley and Davis, California; New York; Boston;
Pittsburgh and Houston, will join Michigan doctors
in presenting the fifth annual Cancer Symposium
of Wayne State University’s School of Medicine
April 28.

“Early Cancer of the Breast” is the subject of
the symposium, which will waive the $25 registra-
tion1 fee for students, interns and residents. Melvin
L. Reed, MD, is chairman of the symposium, to be
held at Wayne County Medical Society headquar-
ters, 1010 Antietam, Detroit.

AMA recruitment effort
to involve Michigan

State medical associations, including Michigan's,
will assist the AMA in a membership recruitment
program to be conducted this year. The AMA board
of trustees approved a $150,000 campaign late in
January. Preliminary data show that between year-
end 1970 and year-end 1971, AMA membership de-
creased by 4%. Dues-paying membership declined
from 168,214 in 1970 to 156,943 in 1971, a drop
of 7%.

MARMP has new
acting coordinator

The Michigan Association for Regional Medical
Programs is continuing its search for a permanent
program coordinator to replace Albert E. Heustis,
MD, who retired from the post Sept. 1.

New acting program coordinator is Theodore
Lopushinski, PhD, who took over Jan. 1 from
Gaetane LaRocque, PhD. Doctor LaRocque had
filled in since Doctor Heustis’s retirement.

Cardiac care instruments
topic of May 22-23 meeting

A National Conference on Instrumentation and
Hazards in Cardiac Care is scheduled May 22-23
at the Towsley Center for Continuing Medical Ed-
ucation, University Medical Center, Ann Arbor.

The conference has four main sections — elec-
trical hazards, equipment selection and mainte-
nance, effective utilization of instruments, and new
trends in patient care systems. It is chaired by
Henry L. Green, MD, Detroit cardiologist and chair-
man of the Instrumentation Study Group, Inter-
Society Commission on Heart Disease Resources.

390 MICHIGAN MEDICINE APRIL 1972

Mylanfa

24 million hours

a day*

Through the day, every day,
ulcer patients take
one million doses of Mylanta
for relief of ulcer pain.

- - •

1 '

aluminum and magnesium hydroxides plus simethicone

Good taste = patient acceptance
Relieves G.I.gas distress*
Non-constipating

*with the defoaming action of simethicone

PHARMACEUTICALS Pasadena, Calif. 91109

Division of Atlas Chemical Industries, Inc., Wilmington, Del. 19899

Though Talwin® can be compared
to codeine in analgesic efficacy, it is not
a narcotic. So patients receiving Talwin
for prolonged periods face fewer of
the consequences you’ve come to expect
with narcotic analgesics. And that, in
the long run, can mean a better outlook
for your chronic-pain patient.

Talwin Tablets are:

• Comparable to codeine in analgesic efficacy:
one 50 mg. Talwin Tablet appears equivalent in analgesic
effect to 60 mg. (1 gr.) of codeine. Onset of significant anal-
gesia usually occurs within 15 to 30 minutes. Analgesia

is usually maintained for 3 hours or longer.

• Tolerance not a problem: tolerance to the analgesic
effect of Talwin Tablets has not been reported, and no
significant changes in clinical laboratory parameters
attributable to the drug have been reported.

• Dependence rarely a problem: during three years of
wide clinical use, only a few cases of dependence have
been reported. In prescribing Talwin for chronic use, the
physician should take precautions to avoid increases in
dose by the patient and to prevent the use of the drug in
anticipation of pain rather than for the relief of pain.

• Not subject to narcotic controls: convenient to
prescribe — day or night — even by phone.

• Generally well tolerated by most patients: infre-
quently cause decrease in blood pressure or tachycardia;
rarely cause respiratory depression or urinary retention;
seldom cause diarrhea or constipation. If dizziness, light-
headedness, nausea or vomiting are encountered, these
effects tend to be self-limiting and to decrease after the
first few doses. (See last page of this advertisement for

a complete discussion of adverse reactions and a brief
discussion of other Prescribing Information.)

a new outlook in

chronic

pant

.JL of moderate to s

severe intensity

Contraindications: Talwin, brand of pentazocine (as hydrochloride),
should not be administered to patients who are hypersensitive to it.
Warnings: Head Injury and Increased Intracranial Pressure. The
respiratory depressant effects of Talwin and its potential for ele-
vating cerebrospinal fluid pressure may be markedly exaggerated in
the presence of head injury, other intracranial lesions, or a pre-
existing increase in intracranial pressure. Furthermore, Talwin can
produce effects which may obscure the clinical course of patients
with head injuries. In such patients, Talwin must be used with ex-
treme caution and only if its use is deemed essential.

Usage in Pregnancy. Safe use of Talwin during pregnancy (other
than labor) has not been established. Animal reproduction studies
have not demonstrated teratogenic or embryotoxic effects. How-
ever, Talwin should be administered to pregnant patients (other
than labor) only when, in the judgment of the physician, the po-
tential benefits outweigh the possible hazards. Patients receiving
Talwin during labor have experienced no adverse effects other than
those that occur with commonly used analgesics. Talwin should be
used with caution in women delivering premature infants.

Drug Dependence. There have been instances of psychological and
physical dependence on parenteral Talwin in patients with a history
of drug abuse and, rarely, in patients without such a history. Abrupt
discontinuance following the extended use of parenteral Talwin has
resulted in withdrawal symptoms. There have been a few reports of
dependence and of withdrawal symptoms with orally administered
Talwin. Patients with a history of drug dependence should be under
close supervision while receiving Talwin orally.

In prescribing Talwin for chronic use, the physician should take pre-
cautions to avoid increases in dose by the patient and to prevent the
use of the drug in anticipation of pain rather than for the relief of
pain.

Acute CNS Manifestations. Patients receiving therapeutic doses of
Talwin have experienced, in rare instances, hallucinations (usually
visual), disorientation, and confusion which have cleared spontane-
ously within a period of hours. The mechanism of this reaction is
not known. Such patients should be very closely observed and vital
signs checked. If the drug is reinstituted it should be done with cau-
tion since the acute CNS manifestations may recur.

Usage in Children. Because clinical experience in children under 12
years of age is limited, administration of Talwin in this age group is
not recommended.

Ambulatory Patients. Since sedation, dizziness, and occasional eu-
phoria have been noted, ambulatory patients should be warned not
to operate machinery, drive cars, or unnecessarily expose them-
selves to hazards.

Precautions: Certain Respiratory Conditions. Although respiratory
depression has rarely been reported after oral administration of
Talwin, the drug should be administered with caution to patients
with respiratory depression from any cause, severe bronchial asth-
ma and other obstructive respiratory conditions, or cyanosis.
Impaired Renal or Hepatic Function. Decreased metabolism of the
drug by the liver in extensive liver disease may predispose to ac-
centuation of side effects. Although laboratory tests have not indi-
cated that Talwin causes or increases renal or hepatic impairment,
the drug should be administered with caution to patients with such
impairment.

Myocardial Infarction. As with all drugs, Talwin should be used
with caution in patients with myocardial infarction who have nau-
sea or vomiting.

Biliary Surgery. Until further experience is gained with the effects

of Talwin on the sphincter of Oddi, the drug should be used with
caution in patients about to undergo surgery of the biliary tract,
Patients Receiving Narcotics. Talwin is a mild narcotic antagonist,
Some patients previously receiving narcotics have experienced mild
withdrawal symptoms after receiving Talwin.

CNS Effect. Caution should be used when Talwin is administered
to patients prone to seizures; seizures have occurred in a few such
patients in association with the use of Talwin although no cause and
effect relationship has been established.

Adverse Reactions: Reactions reported after oral administration
of Talwin include gastrointestinal: nausea, vomiting; infrequently
constipation; and rarely abdominal distress, anorexia, diarrhea
CNS effects: dizziness, lightheadedness, sedation, euphoria, head-
ache; infrequently weakness, disturbed dreams, insomnia, syncope,
visual blurring and focusing difficulty, hallucinations (see Acute
CNS Manifestations under WARNINGS); and rarely tremor, irri-
tability, excitement, tinnitus. Autonomic: sweating; infrequently
flushing; and rarely chills. Allergic: infrequently rash; and rarely
urticaria, edema of the face. Cardiovascular : infrequently decrease
in blood pressure, tachycardia. Other: rarely respiratory depression,
urinary retention.

Dosage and Administration: Adults. The usual initial adult dose is
1 tablet (50 mg.) every three or four hours. This may be increased
to 2 tablets (100 mg.) when needed. Total daily dosage should not
exceed 600 mg.

When antiinflammatory or antipyretic effects are desired in addi-
tion to analgesia, aspirin can be administered concomitantly with
Talwin.

Children Under 12 Years of Age. Since clinical experience in chil-
dren under 12 years of age is limited, administration of Talwin in
this age group is not recommended.

Duration of Therapy. Patients with chronic pain who have receivedl
Talwin orally for prolonged periods have not experienced with-
drawal symptoms even when administration was abruptly discon-
tinued (see WARNINGS). No tolerance to the analgesic effect has!
been observed. Laboratory tests of blood and urine and of liver an
kidney function have revealed no significant abnormalities after
prolonged administration of Talwin.

Overdosage: Manifestations . Clinical experience with Talwin over
dosage has been insufficient to define the signs of this condition.
Treatment. Oxygen, intravenous fluids, vasopressors, and other
supportive measures should be employed as indicated. Assisted or
controlled ventilation should also be considered. Although nalor
phine and levallorphan are not effective antidotes for respiratory1
depression due to overdosage or unusual sensitivity to Talwin, par-
enteral naloxone (Narcan®, available through Endo Laboratories) is
a specific and effective antagonist. If naloxone is not available, par-
enteral administration of the analeptic, methylphenidate (Ritalin®),
may be of value if respiratory depression occurs.

Talwin is not subject to narcotic controls.

How Supplied: Tablets, peach color, scored. Each tablet contains
Talwin (brand of pentazocine) as hydrochloride equivalent to 50 mg.
base. Bottles of 100.

lA//frffyrop | Winthrop Laboratories, New York, N. Y. 10016 (1583)

50 mg. Tablets

Talwin

brand of •

pentazocine

(as hydrochloride)

the long-range analgesic

r LEMON TREE SO VERY PRETTX
AND THE LEMON FLOWER IS SWEET.
BUTONE HUNDRED EIGHTY LEMONS.
IS IMPOSSIBLE TO EAT.

AH-ROB1NS

1 ways to provide a month’s
therapeutic supply of Vitamin C:
180 lemons or 30 Allbee with C

As a source of ascorbic acid, the lemon really hits a high C (50 mg.). But your patient would
still have to eat 180 lemons every month— 6 a day— to get a therapeutic dose. And as the
calypso singer puts it, “one hundred eighty lemons is impossible to eat.” Fortunately, a
bottle of 30 Allbee with C capsules (taken one capsule daily) supplies as much Vitamin C
as all those lemons, plus full therapeutic amounts of the B-complex vitamins. For example,
as much Be as two pounds of corn. Allbee with C is no lemon ! This handy bottle of 30
capsules gives your patient a month’s supply at a very reasonable cost. Also the economy
size of 100. Available at pharmacies on your prescription or recommendation.

A. H. Robins Company, Richmond, Va. 23220

/M-^OBINS

30 Capsules

Allbee withC

Each capsule Contains:
Thiamine mono-
nitrate (Vit. B,) 15 mg

Riboflavin (Vit. B:) 10 mg

Pyridoxine hydro-
chloride (Vit. B6) 5 mg

Niacinamide 50 mg

Calcium pantothenate 10 mg
Ascorbic acid (Vit. C) 300 mg

vacation in
a vial:
the spasm
reactors
in your practice
deserve

“the T>onnatal TLffect”

each tablet, capsule or
5 cc. teaspoonful of elixir ( 23% alcohol 1

each Donnatal

No. 2

each

Extentab®

hyoscyamine sulfate

0.1037 mg.

0.1037 mg.

0.31 1 1 mg.

atropine sulfate

0.0194 mg.

0.0104 mg.

0.0582 mg.

hyoscine hydrobromide

0.0065 mg.

0.0065 mg.

0.0105 mg.

phenobarbital

(warning: may be habit forming)

(W gr.) 16.2 mg.

( 1-2 gr. )32.4 mg. I3

V\ gr. | 48.6 mg.

Brief summary. Side effects: Blurring of vision, dry mouth, difficult
urination, and flushing or dryness of the skin may occur on higher
dosage levels, rarelv on usual dosage. Administer with caution to
patients with incipient glaucoma or urinary bladder neck obstruction
as in prostatic hvpertrophy. Contraindicated in patients with acute
glaucoma, advanced renal or hepatic disease or hypersensitivity to
any of the ingredients.

AH-^OBINS

A. H. ROBINS COMPANY, RICHMOND, VIRGINIA 23220

Socio- economic

Trying to get doctors?
Consider the family,
WA-SAMA urges

Recognizing the influence of the wife as an im-
portant factor in the decision about where doctors
practice, the Woman’s Auxiliary to SAMA has sent
a set of new recommendations to the MD Place-
ment Service of the Michigan Health Council and
similar organizations across the nation.

The results of a recent WA-SAMA survey about
placement services led to this statement: “We be-
lieve that many families would look farther afield if
they could easily obtain information about physi-
cian openings elsewhere.

“Community profiles must be available,” declares
Mrs. Jerrald Kuenn, York, Pa., WA-SAMA president.

Mrs. Kuenn writes, “because time is short and
schedules are busy, the principle of intertia op-
erates and families tend to consider only those
areas already familiar to them — home towns, areas
of medical training, or areas in which they have
previously lived or vacationed.”

WA-SAMA is urging some standardization of in-
formation and points out that only relevant informa-
tion should be sent by placement bureaus when
doctors inquire.

Thirty-eight states, including MSMS, participated
in the recent WA-SAMA survey.

Doctor — Are you tired of
being blamed for the
rise in health care costs?

Your medical society needs facts and fig-
ures to answer these allegations.

Under the direction of the Socio-Economic
Committee the Bureau of Economic Informa-
tion is conducting its second annual physi-
cians’ overhead costs survey. The first was
conducted in the spring of 1971 and its re-
sults reported in the November issue of Mich-
igan Medicine.

When you receive the 1972 Physicians’
Overhead Cost Survey (approximately April
18) please complete it and return it to MSMS
immediately. Your society wants to help you.
We need your help now.

New labor handbook
predicts large increase
in types of health jobs

“Manpower needs in health services will con-
tinue to show rapid growth, largely because of
population growth and the increasing ability of
people to pay for health care.”

So states the recently-published 1972-73 edition
of the Department of Labor’s Occupational Outlook
Handbook. The 900-page book provides career in-
formation about 800 occupations.

The journal of the National Education Associa-
tion recently summarized the book and wrote in
part:

“The professions will be the fastest-growing oc-
cupations during this decade. By 1980, the demand
for professional, technical, and kindred workers
may be about 40 percent greater than in 1970 as
the nation puts greater efforts into socioeconomic
progress, urban renewal, transportation, harnessing
the ocean, and enhancing the beauty of the land.

“Most types of jobs in health work are expected
to increase rapidly. The outlook for doctors and
dentists as well as for dental assistants, physical
therapists, medical lab workers, dietitians, trained
hospital administrators, veterinarians, pharmacists,
and nurses is very good for the 70’s.

“Licensed practical nurses are expected to be
in strong demand during the years ahead. Some
states accept candidates who have completed only
the eighth or ninth grade; other states require a
high school education. Training is offered in many
high schools, junior colleges, health agencies, and
private educational institutions.

“Along with the demand for greater education,
the proportion of youth completing high school has
increased, and an even larger proportion of high
school graduates pursue higher education. This
trend will continue. In 1980, high school enroll-
ment is expected to be 21.4 million — 7 percent
above the 1970 level. College degree credit en-
rollment is projected at 11.2 million — about 48
percent higher than the 1970 level.

“The number of persons in the labor force is a
related aspect of job competition. The number of
all workers and job seekers will increase about 17
percent by 1980, and young men and women be-
tween the ages of 16 and 34 will account for about
four-fifths of the net increase. Thus, in the 1970’s
the number of young workers will increase and
these workers will have more education on the
average than new entrants of previous years.”

MICHIGAN MEDICINE APRIL 1972 397

SOCIO-ECONOMIC/ Continued

1

New procedure
to speed processing
SS disability claims

By David P. Gage, MD

Chief Medical Consultant

Disability Determination Service

State Division of Vocational Rehabilitation

When your patient applies for Social Security
disability benefits, his claim will be processed
much faster thanks to a new procedure called
Simultaneous Development, now being used at the
State Agency.

Formerly, to provide initial medical data, you re-
ceived a four page general medical form sent by
the local Social Security office. Now, the state
agency medical staff initiates an inquiry tailored
when possible to your patient’s major impair-
ments)— hypertension, coronary disease, diabetes,
arthritis. Second requests for additional informa-
tion and costly time-consuming additional examina-
tions are much reduced by this method.

It is already apparent that the physicians of
Michigan will be saved much time and paperwork.
Disability claims, now approximately 60,000 yearly,
will be speeded, to the advantage of the appli-
cants.

Our staff, meanwhile, continues to seek improved
reporting methods. As always, your continuing co-
operation and support are deeply appreciated.

Physician Summer Placement
in

Beautiful Upper Peninsula

Hospital sixty (60) miles east of Mackinac
Bridge is seeking a Physician with Mich-
igan license to provide partial coverage in
Emergency Room during summer months.
References requested with terms to be
negotiated.

Call or write:

Helen Newberry Joy Hospital
Newberry, Michigan
906-293-5181

Jack Vantassel, Administrator

Detroit health teams
searching out children
with lead poisoning

In the second phase of a detection and treat-
ment project, teams from the Detroit Health De-
partment are making follow-up visits to city homes
with high lead paint-poisoning risk.

The first phase of the project was a survey to
discover neighborhoods where high lead levels
occur in the house paint and where there are a
high proportion of children ages one to five. Dur-
ing the second phase, the teams will urge parents
of those children most likely to have eaten the
paint to take their young children to a health cen-
ter for further examination.

If laboratory findings indicate high blood lead
levels, the child is treated as an emergency case
and is immediately referred for hospitalization.
Regine Aronow, MD, of Children’s Hospital and
Filomena Farooki, MD, of Detroit General Hospital
are working closely with the health department
teams.

U-M interns, residents
still waiting word
from Supreme Court

At the time this issue went to press, members
of the University of Michigan Interns-Residehts
Association still were waiting for the Michigan
Supreme Court’s decision on whether to accept
the association’s appeal of the decision that the
interns and residents do not constitute a bargain-
ing unit.

If the Supreme Court decides to hear the appeal,
the interns and residents, together with the Michi-
gan Employment Relations Commission, will pre-
sent briefs and oral arguments in their case with
the University of Michigan.

The State Court of Appeals on Jan. 21 ruled
that the university need not bargain with the in-
tern-resident association as the interns and resi-
dents are not public employes within the meaning
and intent of the law.

The MERC earlier had ruled in favor of the
interns and residents, who have been seeking
bargaining rights at the U-M Medical Center since
early 1970.

398 MICHIGAN MEDICINE APRIL 1972

°Iil small doses

T. B. Coles, Jr., MD, Detroit,

is currently president of the Alumni Association
of the University of Michigan Program in Hos-
pital Administration. Doctor Coles also is asso-
ciate director of the Grace Hospital, Detroit and
is one of more than 200 graduates of the U-M
program who serve in administrative positions
throughout the U.S.

Robert H. Gregg, MD, Detroit,

is new president and member of the board of
trustees for Children’s Hospital. Doctor Gregg
has been associate pediatrician-in-chief of the
hospital since 1961, and succeeds Hugo V. Hul-
lerman, MD, who retired after 15 years of service
as executive vice president.

Herbert E. Hamel, MD, St. Ignace,

has retired after nearly eighteen years as cub-
master of the St. Ignace Cub Scout Pack No.
127. Doctor Hamel has received many scouting
awards and in 1965 was St. Ignace Kiwanis Man
of the Month and received the St. Ignace Fire
Department’s Outstanding Service Award in 1967
for his scouting activities.

(iMicliigaii auttiofs

Stanley H. Schuman, MD, DrPH, Donald C. Pelz,
PhD, Ann Arbor, “Hostility Factors in Dangerous
Driving: Evidence for the Design of Counter-
measure Programs,” page 5, California Medicine,
Feb. 1972.

Martin Lloyd Norton, MD, Ann Arbor, “Law and
the Inhalation Therapist,” page 18, Airway, the
Journal of the Michigan Society for Inhalation
Therapy, December, 1971.

Walter P. Work, MD, Ann Arbor, “The American
Board of Otolaryngology,” page 39, Bulletin of the
Atnerican College of Surgeons, February, 1972.

Frank L. Morton, MD, Ann Arbor, “A county
health department’s role in drug programs,” page
1069, HSMHA Health Reports, December, 1971.

William H. Harrison, MD, Lansing,

was guest of honor at the “W. H. Harrison Day”
dinner Feb. 27 at the Olds Plaza Hotel in Lan-
sing. Sponsors of the event recognizing Lan-
sing’s first black physician were the “Complete
Black Community of Lansing.” Doctor Harrison
is a graduate of Howard University medical
school artd is treasurer of the Ingham County
Medical Society. He is also board president of
the Lansing Housing Foundation of Model Cities
and a member of the staffs of Sparrow, St. Law-
rence and Ingham Medical Hospitals in Lansing.

John R. Rodger, MD, Beliaire,

has been honored with the naming of the local
elementary school after him. The building was
formally dedicated Feb. 20 in his name for the
role he has played in education and community
affairs. Doctor Rodger served 12 years as presi-
dent of the Beliaire Board of Education, and also
led the county and intermediate school boards.
He received a “Citizen of the Year” award in
1967 from Gov. George Romney. Doctor Rodger
is also a former member of the MSMS House of
Delegates and alternate delegate to the AMA.
He has been a member of the MSMS and AMA
committees on highway safety and was chairman
of the MSMS Rural Health Committee for several
years.

Edward D. Sage, MD, Kalamazoo,

was recently honored by the Michigan Legisla-
ture when it passed a resolution on the occa-
sion of his retirement after completing 66 years
of medical practice. The resolution, offered by
Representatives Sackett and Weber, cited Doctor
Sage’s achievements and dedication to the peo-
ple of Kalamazoo and conveyed best wishes for
a happy and well-earned retirement.

Clayton K. Strop, MD, Flint,

has forwarded information and materials on alco-
holism to Nickolas Nemirovich, external relations
officer of the Polytechnical Museum of Moscow,
Soviet Russia. Doctor Strop, with the Group
Therapy Department of Hurley Hospital, Flint, re-
ceived a request for the information from Mr.
Nemirovich.

Emanuel Tanay, MD, Detroit,

was invited to address the Subcommittee on
Criminal Laws and Procedures of the U. S. Senate
Committee on the Judiciary on Feb. 17. The sub-
ject of the hearing was homicide and firearms.
Doctor Tanay is associate professor of psychi-
atry and law at the Wayne State University.

MICHIGAN MEDICINE APRIL 1972 399

°Iri memoriam

William Bromme, MD
Grosse Pointe

A former MSMS Council chairman and alternate
delegate to the AMA House, William Bromme, MD,
died Feb. 9 at the age of 65.

Doctor Bromme had practiced 45 years in the
Detroit area and was affiliated with Woman’s,
Grace and Veteran’s hospitals there. Doctor
Bromme was a urologist and was a graduate of
the University of Michigan.

Doctor Bromme was past president of the De-
troit Urological Society, a trustee of the Michigan
Cancer Foundation, a member of the North Central
Section of the American Urological Association and
the American College of Surgeons, as well as var-
ious medical organizations.

Harrison S. Collisi, MD
Grand Rapids

A past president of the Kent County Medical So-
ciety and former chief of staff at Butterworth Hos-
pital, Grand Rapids, Harrison S. Collisi, MD, died
Feb. 3 at the age of 83.

Doctor Collisi had been manager of the Crile
VA hospital in Cleveland, the Erie, Pa., VA hos-
pital and the VA hospital in Livermore, Calif., since
leaving Grand Rapids in 1942. He was winner of
the Bronze Star for service in France during World
War II.

Doctor Collisi was a graduate of the University
of Michigan Medical School and practiced 30 years
in Grand Rapids, specializing in obstetrics and
gynecology. He was one of the earliest advocates
of birth control and was a member of the American
College of Surgeons, the American Hospital Asso-
ciation and the American College of Hospital Ad-
ministrators.

John Buttrey Engel. MD
Detroit

John Buttrey Engel, MD, Detroit specialist in
industrial medicine, died Jan. 15 at the age of 72.
He was a graduate of Wayne State University
School of Medicine.

Rhoda P. Farquharson, MD
Detroit

Rhoda P. Farquharson, MD, reportedly the oldest
practicing female physician in Michigan, died Feb.
23 at the age of 89.

Doctor Farquharson had been the first woman
intern at Grace Hospital, the first woman physician
for the Juvenile Court in Detroit and the first wom-
an physician for the Women’s House of Correction
in Detroit.

Doctor Farquharson served on the federal parole
board and was an instructor in the prenatal clinic
of the Wayne Medical College. From 1929 to 1968,
she maintained a private practice.

Simon O. Johnson, MD
Detroit

Long-time Detroit psychiatrist Simon O. Johnson,
MD, died Feb. 20 at the age of 75.

Doctor Johnson was a former chairman of the
Section of Psychiatry of the National Medical Asso-
ciation and from 1958 to 1968 was consultant to
the Michigan Department of Mental Health.

A graduate of the Boston University School of
Medicine, Doctor Johnson was affiliated with the
Detroit Consultation Center, the Lapeer State Home
and Training School and the Plymouth State Home
and Training School.

Doctor Johnson was a fellow of the American
Psychiatric Association, and a member of the
Academy of Psychosomatic Medicine, the American
Association for the Advancement of Science, the
Menninger Foundation and the American Associa-
tion of Military Surgeons.

James E. Kermath, MD
Grosse lie

James Edward Kermath, MD, vice chief of staff
at Oakwood Hospital, Dearborn, died Feb. 15 at the
age of 40.

Doctor Kermath was former chief of surgery at
Outer Drive Hospital, Lincoln Park, and was presi-
dent of the Grosse lie Community and Youth Cen-
ter. He was a graduate of the University of Mich-
igan Medical School and was a surgeon.

Frederick E. Kolb, MD
Calumet

Frederick E. Kolb, MD, Calumet generalist, died
Jan. 19 at the age of 62.

Doctor Kolb was affiliated with Calumet Public
Hospital in Laurium and St. Joseph’s Hospital in
Hancock. He was a past president of the Houghton-
Baraga-Keweenaw Medical Society. Doctor Kolb
was a graduate of the Northwestern University
medical school.

400 MICHIGAN MEDICINE APRIL 1972

Thomas H. Miller, MD
Detroit

Thomas H. Miller, MD, emeritus associate pro-
fessor of dermatology at Wayne State University,
died Feb. 22 at the age of 71.

Doctor Miller was a graduate of the University of
Michigan Medical School and was president of the
Detroit Dermatological Society in 1937.

Dayton H. O'Donnell, MD
Bloomfield Township

Dayton H. O’Donnell, MD, a member of the staff
of Southfield’s Providence Hospital, died Feb. 6 at
the age of 69.

Doctor O’Donnell was a graduate of St. Louis
University medical school.

L. G. Rowley, MD
Phoenix

Laurie Guy Rowley, MD, former chief of staff at
Oakland County Hospital, died Jan. 28 at the age
of 77. Doctor Rowley had practiced in Oakland
county for 39 years before retiring in 1969 to
Phoenix, Ariz. He was former medical director of
the county infirmary.

Doctor Rowley was a graduate of Nebraska State
College of Medicine and was also affiliated with
Henry Ford Hospital and Pontiac General Hospital.
He was a generalist.

Isaac S. Schembeck, MD
Detroit

Isaac S. Schembeck, MD, Detroit, long-time oto-
laryngologist with Harper Hospital, died Feb. 23 at
the age of 78.

A native of Nebraska, Doctor Schembeck was a
graduate of the University of Nebraska medical
school. He was a member of the Detroit Ophthal-
mologic Society.

Robert L Schaefer, MD
Detroit

Robert L. Schaefer, MD, leading Midwestern
endocrinologist, died Feb. 17 at the age of 79.
Doctor Schaefer had given most of his medical
service in Detroit, but also practiced in New York
City in 1932 and 1933.

Doctor Schaefer was a graduate of St. Louis
University and received an honorary doctor of sci-
ence degree from the University of Detroit in
1949. He was certified by the American Board of
Internal Medicine in 1937.

Doctor Schaefer was a member of the Endocrine
Society, the American Diabetic Association and the
American Society for Clinical Pharmacology and
Therapeutics.

Walter K. Whitehead, MD
Harper Woods

Walter Kellogg Whitehead, MD, Harper Woods
internist, died Feb. 13 at the age of 69.

Doctor Whitehead was a graduate of the Univer-
sity of Michigan Medical School and was affil-
iated with Harper Hospital, and Cottage Hospital in
Grosse Pointe. He belonged to the American Heart
Association, the Michigan Society of Internal Med-
icine, the American Association for the Advance-
ment of Science, the American Trudeau Society
and the Endocrine Society.

Macomb lists
medical practices
open to new patients

The Macomb County Medical Society has com-
pleted a survey of its members which indicates the
number of local practices still open to new pa-
tients. Questionnaires were mailed to 235 member
physicians, and 119 were returned completed.

The results show 10 pediatric practices open,
none closed; 17 ob-gyn practices open, one closed;
16 general practices open, five closed; 16 internal
medicine practices open, six closed; 13 general
surgery practices open, none closed, and 33 other
specialties open with two closed.

Other results revealed an approximate waiting
time of one week for an appointment with a pedi-
atrician; one week with an obstetrician-gynecol-
ogist; two days for a general practitioner; two
weeks for an internist, a few days for a general
surgeon and a few days to one week for other
specialties.

MICHIGAN MEDICINE APRIL 1972 401

Classified Advertising

$5.00 per insertion of 50 words or less, with an additional 10 cents per word in excess of 50.

PROFESSIONAL INCORPORATION PROGRAMS:
estate planning, income tax reduction, HR- 10 retire-
ment plans, life insurance, disability, income, invest-
ment counsel, and practice management. If you want
the best in financial and practice counseling, phone
or write Phillip Fry and Associates, 14940 Plymouth
Road, Detroit, Michigan 48227. Phone (313) 499-9044.

A FULL TIME CYTOTECHNOLOGIST needed im-
mediately ASCP or eligible. Modern, expanding clini-
cal laboratory, 460 bed general hospital. Excellent
salary, paid vacations, insurance and holidays. Write
or call collect, Personnel Department, Mr. Thornton,
Edward W. Sparrow Hospital, 1215 E. Michigan Ave-
nue, Lansing, Michigan 48912.

IS THERE A DOCTOR in the House? M.D. urgently
needed as an associate in a very active practice in
Cincinnati, Ohio; full partnership within short pe-
riod; General Practice, Internal Medicine, or Family
Practice. Spacious offices, in beautiful medical bldg.,
with all modern facilities, on “Medical Hill,” close
to all hospitals. Financial arrangement negotiable.
Present M.D. wishes to retire soon and is concerned
with his patients’ over-all needs. Would you like to
join him; only those seriously interested in private
practice. Call collect (513) 221-1112, anytime. Med-
ical Recruitment Services, Inc., 400 Oak St., Cin-
cinnati, Ohio 45219, Mrs. Evelyn B. Kruse, Exec-
utive President.

CHILD PSYCHIATRY RESIDENCIES OFFERED:
MICHIGAN— ANN ARBOR, YPSILANTI: “Where
it’s at.” New Child Psychiatry residencies offered in
an innovative, established clinical program. Com-
munity Child Psychiatry, Day Treatment, Out-Patient
and Residential Treatment offer opportunities for a
variety of treatment techniques. Crisis intervention
(“life-space” interview) ; behavioral therapy, pharma-
cotherapy; individual, group and family treatment
methods; dynamic, social and developmental psychi-
atry taught. Learning by independent study, seminars,
supervised experiences. Multi-disciplinary staff in-
cluding: six child psychiatrists, pediatrician, pediatric
neurologist, psychologists, social workers, special edu-
cation teachers, speech therapists, occupational ther-
apist, recreational therapists, etc. Program affiliated
with the University of Michigan and a variety of
clinical settings including: community mental health
centers, guidance clinics, etc. Salaries negotiable. Con-
tact: Elissa P. Benedek, M.D., York Woods Center,
Box A, Ypsilanti, Michigan 48917. Phone (313)
434-3666. An Equal Opportunity Employer.

LOCUM TENENS WANTED for the months of July,
August and September, general practitioner, offices
in hospital, excellent X-ray and laboratory facilities,
summer resort area in southern Michigan. Should be
equipped for emergency service. Contact: B. H.

Growt, M.D., P.O. Box 128, Addison, Michigan
49220.

IM MEDIA! E OPENING for OB-GYN, Internal Medi-
cine, and Orthopedic specialties to establish successful
practice with 14 man multi-specialty group. Excellent
group benefits; pension plan; modern clinic facilities;
progressive community with excellent educational
system including two colleges; city population 35,000;
good recreational facilities; each specialty must be
board eligible or certified; young man with military
obligation completed. Contact: Business Manager,
The Manitowoc Clinic, 601 Reed Avenue, Manito-
woc, Wisconsin 54220.

DOC! OR, are you tired of the urban rat race, traffic
congestion, and the grind of going to two or three
separate hospitals each day? Wouldn’t you rather
live within three minutes of your hospital and 5
minutes of your office, 4 minutes from several large
lakes, and \/2 hour from a major ski area? There is
such a place in North Central Michigan, and there
is an immediate need for a board qualified or eligible
internist, pediatrician, and anesthesiologist. Help in
starting and office space are available. If you would
like further information, please, reply to box #2,
120 West Saginaw Street, East Lansing, Michigan
48823.

MACOMB COUNTY: High quality residential neigh-
borhood. New building. For Dental and Medical
use. Open for inspection. 36380 Garfield, Clinton
Township. Call: Philip F. Pierce (313) 792-0200.

MANAGEMENT POSITION WANTED: Young man
with masters in hospital administration and health
business background seeks position as manager in
small group practice or as assistant in large group.
Reply Box: 3, 120 W. Saginaw St., East Lansing,
Michigan 48823.

PSYCHIATRIST-CHALLENGING OPPORTUNITY
TO practice progressive and innovative treatment
to wide variety of mental disorders; excellent facili-
ties and ancillary staff; comfort of small town living
with nearby city conveniences; excellent school sys-
tem; good climate; regular hours, 30 day vacation,
exc. retirement, life, health ins. plans; can pay
moving expenses; salary range $23,424-$29,848; any
state or DC license required; equal opp. employer.
Write: Chief of Staff, VA Hospital, Salisbury, N.C.
28144.

PHYSICIAN SUMMER PLACEMENT in Beautiful
Upper Peninsula. Hospital sixty (60) miles east of
Mackinac Bridge is seeking a physician with Mich-
igan license to provide partial coverage in Emer-
gency Room during summer months. References re-
quested with terms to be negotiated. Call or write:
Helen Newberry Joy Hospital, Newberry, Michigan.
(906) 293-5181, Jack Vantassel, Administrator.

402 MICHIGAN MEDICINE APRIL 1972

PHYSICIAN’S ASSISTANT AVAILABLE: Male, age
28, married, wife an R.N., has B.S. in biology, 4 years
as Navy Medical Corpsman, total of 9 years in med-
ical fields; for additional details on this or other
dedicated applicants, call collect (513) 221-1112, or
write: Medical Nursing Employment Servcies, Inc.,
400 Oak St., Cincinnati, Ohio 45219, Mrs. E. B.
Kruse— Executive President.

Advertisers in MICHIGAN MEDICINE are
friends of the profession. By accepting their adver-
tising we show confidence in them , their services
and products. They help make the journal a qual-
ity publication. Please familiarize yourself with
their services and products and let them know
that you see their advertising in MICHIGAN
MEDICINE.

W HOSPITAL-MEDICAL^

PROFESSIONAL

F PLANNING, INC. }

PERSONNEL RECRUITMENT

[Alco Universal Building
l East Lansing, Michigan .

FOR

L 48823 J

HOSPITALS CUNICS UNIVERSITIES

517 332-1333 ^

Administrators, Physicians,

Dept. Heads

PHYSICIANS— ALL SPECIALTIES

At no financial obligation, send us your resume
if you would like a fine full-time position with
one of our Clients:

HOSPITALS: Full-time Chiefs of Services, Di-
rectors of Medical Education (General
and Specialty).

MULTI-SPECIALTY CLINICS: General Practice
and all Specialties.

SINGLE-SPECIALTY GROUPS. General Practice
and all Specialties.

MEDICAL SCHOOLS; Teaching and Research
appointments — all Disciplines.

DRUG FIRMS: Basic Science and Clinical Trials
Research

INDUSTRIAL FIRMS: Employee Health Care.
COLLEGES and UNIVERSITIES: Student Health
Care.

In addition to our service to Client organizations, we
assist physicians in considering relative merits of a va-
riety of fine opportunities. No financial obligation at any
time to the candidate. Appointments can be made as
much as a year or more in advance. Send complete
resume plus your professional objectives and geographic
preferences in confidence to Arthur A. Lepinot.

INDEX TO ADVERTISERS

Abbott

Bristol Laboratories

Brown Pharmaceuticals

Burroughs-Wellcome & Co.

Campbell Soup Co

Classified Advertising

Cole Pharmacol Co., Inc

Colgate-Palmolive Co

Geigy Pharmaceuticals

Helen Newberry Joy Hospital

Hospital Planning, Inc

Lilly, Eli and Co

Mead-Johnson

Medical Protective Co

Merck, Sharp & Dohme

Mercywood Hospital

Merrell National

Michigan Medical Service . . .

Pfizer

Pharmacy Mgf. Association . .
Poythress, Wm. P. & Co. . . .

Robins, A. H. & Co

Roche Laboratories

Searle, G. D. & Co

Smith, Kline & French Lab . . .
Stratton, Ben P. Agency . . . .

Stuart Pharmaceuticals

Upjohn

Warner-Chilcoft

Wayne State University

Winthrop Labs

339, 340

361

360

343

335

402, 403

341, 342

3 77, 378, 379, 380

303

398

403

308

348, 349

371

357, 358

389

381, 382

Cover II

374, 375

363, 364, 365

299

395, 396

304, 305, Cover IV

336, 337, 338

306

Cover III

344, 345, 391

354, 355, 356, 384, 385

352, 353

404

392, 393, 394

MICHIGAN MEDICINE APRIL 1972 403

Wednesday, May 10, 1972
Detroit Hilton Hotel
General Theme: Contraception

DR. EDWARD M. SOUTHERN

Upjohn Company

DR. EUGENE C. SANDBERG
Stanford Medical Center

Conferring of Alumni Awards at evening banquet. Advance
banquet registration can be made by writing:

Alumni House
Wayne State University
Detroit, Michigan 48202

There is a charge of $30.00 per couple for doctors and
$15.00 per couple for residents and interns for the banquet.

DR. LUIGI MASTROIANNI, JR.

University of Pennsylvania Hospital

DR. KAMRAN S. MOGHISSI
Wayne State University School of Medicine

Moderator:

DR. TOMMY N. EVANS

Wayne State University School of Medicine

404 MICHIGAN MEDICINE APRIL 1972

^Souqd Off

Many foreign MDs
now coming to U.S.
medicine is better

By John J. Coury, MD
MSMS President-elect

One of my physician friends the other day said
he had compared the names of the doctors who
were listed on the “New Member Page” in Mich-
igan Medicine with the names of the doctors listed
in the “In Memoriam Section.”

If you have done this you would have ample
proof that many, many new physicians and new
MSMS members in Michigan are foreign-trained.

I

There are about 700 of these in Michigan now
on limited license to practice because they are not
citizens. About 300 foreign-trained physicians each
year in recent years obtained full, regular lh
censes. Many of them join their component medical
societies, MSMS and the AMA. We are pleased.

The major reason why many foreign doctors
come to the United States is because of the scien-
tific climate and high standards of medical prac-
tice.

In many countries over-regulated conditions have
served to stymie scientific inquiry. Stimulation is
missing. And without stimulation medical advances
suffer.

Ever since World War II the young foreign physi-
cians have been coming to the United States be-
cause our nation is in the forefront of medicine.
These foreign-trained doctors want both to improve
their education and medical skills and they want
freedom to practice their profession.

How can I prove that medicine is better in the
States? Well, for example, 23 Americans have been
awarded the Nobel Prize in medicine and physi-
ology since World War II. That’s more than were
won by physicians and scientists from all the other
countries of the world combined.

In the same period, well over half of all the
major new drug discoveries were developed in this
country.

And during this period, America has constructed
750 new hospitals while England has built one.

Doctor Coury Doctor Hardwick

The death rate from cancer in America is well
below the rate of Western Europe.

That is true also for tuberculosis, pneumonia,
strokes, and influenza. All of these kill fewer peo-
ple, per capita, than in Western Europe.

When it comes to teaching and applying medical
knowledge, the rest of the medical world looks to
the United States now for leadership.

Needed :

theoretical basis for
national health plans

By C. T. Hardwick, PhD
MSMS Economic Consultant

Nature of Presentation

Americans do not tend to be entranced with
theory or ideological propositions. No, in many in-
stances it is truthfully observed that Americans are
practical people. We want to know — does it work
or will it solve a problem now at hand. We are im-
patient with theory or philosophy which seems to
be reviewed from pragmatic happenings.

In the socio-economic arena dealing with prob-
lems that even have political dimensions, like
health, we seem to have no choice of ignoring the
relationship between theory and practices. The
test is not separating but synthesizing the two di-
mensions.

For example, it does little good to classify
theories or propositions as “liberal” because the
meaning has been changing and often means dif-
ferent things at different times. A short review of
history reveals that those who called themselves

MICHIGAN MEDICINE APRIL 1972 405

SOUND OFF/Continued

liberal during the early part of the century stood
for individualism, independence, and freedom from
government controls. Since the days of the New
Deal and the 1930’s, the liberals have been pro-
posing more and more government take over of
socio-economic plans in the name of humanity.

Even if labels of theories seem to mean less than
desirable, it is not easy to ignore the usefulness
of philosophical guidelines before practice plans
are embraced. In other words when we have sev-
eral choices between socio-economic proposals,
we often have to return to some basics to help us
make the selection.

At the present time, there are some National
Health Plans being proposed in the National Con-
gress as solutions to present health problems. The
sponsors are characterized as liberals, conserva-
tives, radicals, and protectors of current practices.
In this presentation, it is contended that these la-
bels do not help us in our selection process.
Therefore, as an alternative, we will present some
philosophical propositions to help us in our selec-
tion.

Some Guidelines to Judge
National Health Plans

Of course in developing these guidelines, we are
assuming a firm belief in the evolving American
way of life. Our presentation is against a revolution
in health care. It aims at maintaining the strengths
of the American way but still encouraging change
in the areas of weakness.

The suggested guidelines are as follows:

1. Retail responsibility of essential payment for
health services in the private sector for those
able to pay.

2. Let government assume the burden of paying
for those unable to pay the cost of services.

3. Channel the individual and government pay-
ments via the private insurance plans so as
to share the risks.

4. Maintain and encourage the dual system so
that the public and private systems will com-
pete.

5. Establish a professional peer review system
as a motivator toward higher quality health
care.

6. Encourage the experimentation in the plura-
listic delivery system such as solos, partner-
ships, groups, HMOs, and hospital salaried
health services.

7. Develop new linkage between public and pri-
vate practices especially in the neglected
rural and ghetto areas.

It is suggested that interested parties take these
guidelines and check out the following several
national health plans:

1. Kennedy-Griffiths

2. Ameriplan

3. Nixon or Administrative Plan

4. Scott-Percy

5. Burlesur/HIAA

6. Medicredit/AMA

7. Javits Plan
Making the Choice

If you do not like those items listed as guide-
lines, develop your own list and then check the
National Plans against such self determined cri-
teria.

If we first developed the philosophical base, we
should make a more intelligent choice of prefer-
ence— one we are willing to support and make
work.

In keeping with American tradition, all segments
of the society should be heard from, e.g., labor,
poor, management, professional, consumers, rural,
urban, old, young, organized, and unorganized.

Our preference should be made known to our
legislators and backers, and the ultimate compro-
mise should be better than the plan of any one
group not tuned to public wishes.

Any plan involving new experiments in delivery
will upset some people but we must keep search-
ing for new answers to our new problems and new
aspirations in the health field. The new programs
may be no more perfect than old programs, but our
belief in progress and improvement has to include
the health field. Let us work to prove that the cre-
ative American will not copy some other health
program but will work out his own better way.

Michigan needs
to establish
an RVS now

By Mark C. Levine, MD
Flint

“All animals are equal except that some

are more equal than others."

George Orwell: ANIMAL FARM

Prior to the second World War, most Americans
received medical care at the hands of their family
doctor, who, but for the rarest exception, was in-
variably a general practitioner. The few specialists

406 MICHIGAN MEDICINE APRIL 1972

Doctor Levine

around were either found on the faculties of med-
ical schools, or the rare multi-disciplinary clinic
(such as the Mayo Clinic); if in private practice,
their offices were fashionably located (as on Fifth
Avenue in New York City). Under these circum-
stances, there was never a question of the usual
or customary fee for medical care being other than
that charged by the usual family practitioner in his
community.

With World War II came the era of sophisticated
technology, culminating in the nuclear age. The
march of technology did not spare the field of
medicine; as the art of medicine rapidly gave way
to the science of medicine, as the revered image
of the gentle family practitioner was replaced with
the more authoritarian, impersonal and precise ap-
proach of the specialist, so began the changes in
the relationship of the medical profession to so-
ciety in general.

In recent years, the increasing intervention of
third parties, including governmental agencies at
all levels, and also private insurance companies (to
say nothing of the peculiar status of Blue Cross-
Blue Shield) in all phases of medical care, has
placed all these problems on public display. When
it became apparent to third parties, and particular-
ly to the federal government, that medical care for
the elderly and indigent was expensive, there be-
gan the rush to secure a fee schedule which could
be applied by all third parties to all physicians.

Traditions in medicine die hard, and therefore
while most physicians trained in medical or sur-
gical specialties have tended to establish fee
schedules for procedures limited to their own area,
no one has really challenged the traditional con-
cept that where procedures are done by more than
one kind of physician (general practitioner, special-
ists of one or more disciplines), the fee paid by
the third party should be the same.

Many specialists circumvented the issue by sim-
ply charging what they felt was the value of their
services for a particular procedure, and really did
not concern themselves too much with the amount
paid by the third party even if it was no more than
the fee allowed another physician without special
training. Perhaps specialists have not pushed the
issue to avoid offending their referral sources, (in
many cases general practitioners), even though
they did feel that the additional time and expense
of post-graduate training, and the presumed addi-
tional skills acquired thereby, seemed to justify
high remuneration.

But now that third parties are demanding that
whatever benefit is allowed be accepted as full
payment for the service rendered, the question of
equal fee for equal service must now be faced by
all physicians irrespective of their training or meth-
od of practice. While the concept has been upheld
by local, state, and national medical societies in
the past, it has now been challenged openly by the
Michigan Society of Internal Medicine, and all spe-
cialists must face the issue in open debate.

There are few precedents throughout the world
upon which to base a position. In Quebec, the So-
ciety of Medical Specialists argued successfully
that such a concept was invalid, and now there is
a differential fee schedule in the Provincial Medi-
care Act. Under government health schemes
throughout the world, the specialist occupies a
very different position in that he is a salaried,
hospital-based physician as opposed to the gen-
eral practitioner, who usually does not have hos-
pital privileges and is paid on a capitation basis or
according to a rigid fee schedule. It is interesting
that in England, where the National Health Service
does permit physicians to “opt out” and accept
private patients at whatever fee they want to
charge, many specialists have found an increasing
demand for private medical care.

It could be argued that the fairest way of han-
dling relative values in terms of fees would be to
place an hourly rate on the work of all physicians.
This would take care of most of the problems of
specialists who invariably spend more time with
each patient than do physicians who see 50 to 100
patients per day in their offices. Opponents might
claim that if a physician worked at a fixed hourly
rate, there might be foot-dragging to pad bills, but
the strong incentive of most physicians to finish
their work to permit a little leisure time, would eas-
ily negate such accusations.

The most important criterion of qualification to-
day is board certification, and any differential fee
schedule would have to be based on certification
by a national specialty board. Of course, it would
be unfair to expect some individuals who had never
got around to taking their board examinations to
settle for a lower fee scale after many years in
practice. However, while some sort of “grandfather
clause” might have to be worked out, it must be
kept in mind that many specialists who submitted
to the ordeal of certification examinations were at
least partly motivated by the realization that this
situation eventually might come to pass.

MICHIGAN MEDICINE APRIL 1972 407

SOUND OFF/Continued

Mrs. Schoff

The auxiliary
is there

to help you. Doctor

By Mrs. Charles Schoff
President, MSMS Auxiliary

Doctor, do you have a problem life?

A problem wife?

Let the woman’s auxiliary come to your aid. Our
avowed purpose is to help you, singly and collec-
tively.

County auxiliaries plan parties, to add a little
spice and recreation to your life.

Members help you conduct clinics; collect med-
icines you can’t use and haul them to centers so
they can be send around the world; set up drug
abuse programs; pinch-hit for you when you’re too
busy to man a careers booth . . . some even ar-
range entire career days to encourage young peo-
ple into the medical field; see that your patient
gets hot meals at home once a day; write letters
for you to your legislator; work hard to educate
people about preventative medicine and, if all this
isn’t enough, they gladly take on any task your
medical society suggests.

How does this help you, if you have a problem
wife?

Obviously, it keeps her busy.

And if your problem is that she’s too busy to
stay home, the auxiliary has a solution to that, too.
She can sit and sew for your AMA-ERF. Some of
the women make beautiful ties which are sold and
the money all goes into the AMA-ERF fund. They
make other things, too. And they can buy beau-
tiful gift items for you from their project chairmen,
adding even more to the fund.

You really can’t afford NOT to have your wife
join the county auxiliary, Doctor. It’s the only place
she’ll find where the other girls have the same
trouble serving meals on time or answering the
telephone and can compare notes on living with a
lovable perfectionist.

DR. LEVINE/Continued

While board eligibility can never be equivalent
to board certification, we must consider those indi-
viduals who oppose any form of examination and
who maintain that having completed their training
and/or practice requirements, they must be equal
in competence to those who have added a paper
certificate by demonstrating this competence by a
written and/or oral exam. There are also fine gen-
eral practitioners who are upset with the whole
concept of a specialty board of family practice and
who argue that if they wanted to be specialists
they would have taken such training in the first
place. But this is a world where pragmatism must
prevail, where accommodations and compromises
are necessary, and where a decision must be made
now on producing a fee schedule of some sort for
the third parties who pay the vast majority of the
bills for personal medical care in the United States.

Thus, the following is proposed:

All specialty groups, preferably at a state level,
must evaluate the absolute and relative values of
their services in clearly defined manner. It is a
foolish sentimentality, an anachronism of the nu-
clear and computer age, to insist that all physi-
cians can deliver all forms of medical care in an
equal manner irrespective of training. Today’s spe-
cialists, who now outnumber general or family
practitioners by almost two to one at a national
level, will not accept “equal fee for equal service”
after spending several years in post-graduate study
and then sitting board examinations.

We cannot accept the precept that eligibility is
equivalent to certification in a specialty, until the
specialty societies abolish certification examina-
tions in favor of a comprehensive in-training exam-
ination to insure that no one is allowed to com-
plete his or her post-graduate study until a certain
level of competence has been achieved. It is likely
that the value of services per hour would be
roughly equivalent for most board certified physi-
cians; very few would object to the concept that a
physician certified in Family Practice is worth less
per hour than one certified in one of the more
traditional specialties. Of course, the inclusion of
surgeons, radiologists, or pathologists into an hour-
ly rate might be a little controversial, but none-
theless does have merit.

State or national medical societies are asking
for trouble if they expect to impose a relative value
scale applicable to the fees of every physician,
while retaining the concept of “equal fee for equal
service.” Compromises will have to be made be-
tween different groups of individuals who perform
similar or identical services, so that some degree
of uniformity is achieved. But the time for a Mich-
igan Relative Value Scale has come, and it must be
established in the least divisive manner as soon as
possible.

(Doctor Levine's article is a condensation of his
editorial printed in the January issue of the Gen-
esee County Medical Society Bulletin. It is re-
printed here with permission.)

408 MICHIGAN MEDICINE APRIL 1972

EDIGRAMS

.,ru-c Shii l-RANCISCO

MEDICAL CENTER LIBRARY

VTE NEWS FROM THE MICHIGAN STATE MEDICAL SOCIE

1 1972

April 20, 1972, Volume 71, Number 12
Michigan State Medical Society
Reading Time: 2 Minutes, 25 Seconds

OST YOUR SIGN, DOCTOR . . . Internal Revenue Service is conducting a
pot-check of physician offices in Michigan and throughout the nation to

Ietermine that physicians are complying with Economic Phase II regulation
ailing for (1) a sign stating that a list of the physician's fees is
vailable on request, and (2) that the list is actually available for
nspection. A number of doctors in Michigan have indicated IRS has visited
hem, and have warned that such visits tend to create fear among the office
taff, disrupt the office practice, and encroach on the physician's right
:o practice medicine. AMA Legal Counsel has been consulted, and advises
:hat the regulation provides that "the public" may ask at any time to
review the doctor's fees. AMA says the term, "the public" is ill-defined,
>ut should be considered to mean (1) the IRS, (2) those people who have
Established a patient relationship with the physician, and (3) those people
/ho are legitimate prospective patients. AMA advises a hard line showing
:he fee list to anyone who does not fit these three categories. MSMS is
interested in how many such requests doctors are receiving. Please advise
3ruce Ambrose, manager, MSMS Dept, of Government Relations, when and if
^ou receive such requests from IRS or others. A copy of the suggested
sign to post was printed by MSMS in the February issue of Michigan Medicine
on page 184.

APRIL 28 IS THE DEADLINE for MSMS members to return the AMA membership
opinion poll sent by the AMA on April 1. This is an unprecedented move to
seek the opinion of members on questions to help guide the AMA Board of
Trustees and House of Delegates. Please fill in your questionnaire, and
share your views with the MSMS delegates and alternates to the AMA. (See
Doctor Master's message in "Sound Off" feature in May Michigan Medicine.)

MSMS COMMITTEE on Planning and Priorities met April 19 in two work groups
to study the Phase II Report of MSMS member opinions, as completed by the
Alexander Grant Company in March. The MSMS House of Delegates March 20-21
referred the report to the Planning and Priorities Committee for evaluation.
Study Group A, led by Ralph S. Green, MD, chairman, met to study physician
opinions about MSMS member services and the Report recommendations. Study
Group B, led by John J. Coury, MD , chairman, discussed member views about
MSMS organization and committee structure.

INTERIM GUIDELINES and procedures have been sent by MSMS to component
society presidents about handling possible requests that the National
Health Services Corps assign physicians where there are critical short-
ages of health personnel. The presidents have been asked to send their
evaluation of the procedures back to MSMS by April 20 for consideration
April 26 by The Council. MSMS will not review applications until the
component society has first determined the need and justification for
requesting physician manpower.

PLEASE WATCH your mail for the 1972 Overhead Cost Survey which will be
mailed in April to all members by the MSMS Bureau of Economic Information.

The results will be compared to the results of the 1971 Survey and give
MSMS solid figures showing trends, etc. "Respond, Respond" was the appeal
voiced by Co-Editor Edward Tallant, MD , in a recent Detroit Medical News
editorial.

MICHIGAN PHYSICIANS have a real opportunity to provide help for medical
students who are seeking summer employment. In the SAMA-MECO (Student
American Medical Association - Medical Education and Community Orientation)
Program, MSMS has assisted in placing 89 students in Michigan hospitals
for the summer of 1972. Forty students still would like to be placed or
be offered summer employment related to medicine. If you can help arrange
for additional SAMA-MECO places or suggest summer employment opportunities,
please contact the MSMS Communications Department immediately.

ONLY BNDD OFFICIAL ORDER FORMS are valid effective May 1, 1972 for trans-
actions involving Schedule I and II controlled substances. Practitioners
can obtain new forms by forwarding old type IRS requisition (IRS Form 679.]
to BNDD Registration Branch, P.0. Box 28083, Central Station, Washington,
D.C. 20005. Registrant's complete, nine-character BNDD number must be
shown to be processed. Registrants who do not have an IRS requisition,
and who desire the new order form, are required to complete Form BND 222D
which can be obtained by writing to: Bureau of Narcotics and Dangerous

Drugs, 357 Federal Bldg., 231 W. Lafayette, Detroit 48226.

SOME QUESTIONS have been directed to MSMS about the acceptance by component
societies of federal funds. In September, 1968, the MSMS approved AMA
guidelines subject to five conditions. One of the guidelines permits that
a state or local medical society "may enter into agreements with government
agencies to administer health care programs and to have the administrative
costs of such programs financed from governmental funds." Other require-
ments involve "ethical precepts in the continuance of its (medical) role of
responsible leadership." The MSMS Council added a proviso "that all pro-
grams involving direct use of government funds by component societies be
presented to The Council for evaluation." A full text of the guidelines
is available by writing MSMS Department of Government Relations.

FOUR PUBLIC FORUMS on Diabetes will be co-sponsored by the Michigan Diabet
Association, MSMS, Wayne County Medical Society, and Oakland County Medica
Society. The meetings will be at Oak Park High, 7:30, May 2; Ford World
Headquarters, 7:30, May 4; Regina High School, Harper Woods, 7:30, May 10,
and Temple Beth El on Woodward, 7:30, May 11. Medical society participatiij
has been coordinated by the MSMS Department of Communications.

KEYNOTE ADDRESS at the annual state Woman's Auxiliary Legislative Day in
Lansing April 19 was delivered by MSMS President-Elect John J. Coury , MD.

The program also featured Louis R. Zako, MD, MDPAC chairman. The fifth
annual legislative day covered current medical legislation and included a
luncheon with legislators.

April 20, 1972 Vol. 71, No. 12

MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

EDITOR: HERBERT A. AUER

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

UMIVERS [ T Y OF CAL
LIBRARY SCH OF MED
THIRD £ PARNASSUS AVE
SAN FRANCISCO CAL 94122

IEDIGRAMS

U. U rnrtlNl.liuU

MEDICAL CENTER LIBRARY

ATE NEWS FROM THE MICHIGAN STATE IV^&bAtioClfeTY

April 28, 1972, Volume 71, Number 13
Michigan State Medical Society
Reading Time: 2 Minutes, 45 Seconds

Y A VOTE OF 96 to 6, the Michigan House of Representatives has passed
ouse Bill 5883 to repeal the Basic Science Act. The bill now is before
he Senate Committee on Health, Social Services & Retirement (Sen. Alvin

eGrow, chairman) for further consideration.

MS MS COUNCIL DREW a fine line April 26 between services provided to minors
without parental consent in adopting legislative positions on two bills.

HB 5084, now before the Senate, would permit rendering of birth control
services to minors without parental consent; HB 6106, in the House, would
permit rendering of any service to minors without parental consent. Council
accepted a Legal Affairs Committee recommendation that, "There are specific
instances where physician services to minors without parental consent may
be advisable (e.g., birth control, venereal disease, drug and alcohol de-
pendence) ; but that general health matters are properly the concern of the
parents." MSMS thus supports HB 5084, opposes HB 6106. Current statutes
provide for allowing physician services without parental consent in cases
of suspected venereal disease and drug dependence.

-JAYS TO INCREASE political activities were planned by the MDPAC Board of
directors, April 26. Appointed to the Board were Thomas C. Payne, MD,
Lansing, and Charles H. Willison, MD, Midland, as directors at-large.

Serving as new directors for congressional districts are Joshua S. Williams,
JD, Detroit, from the 1st congressional district; Aaron K. Warren, MD,
Cassopolis, 4th district; Marshall J. Blondy, MD, Detroit, 17th district,
and Robert D. Allaben, MD , Farmington, 19th district. The Board also con-
sidered ways to further increase membership.

AN AD HOC TASK FORCE to work with the AMA on educational projects re natiom
health insurance will soon be appointed by the MSMS Council chairman. Author
ization for the committee was voted by the MSMS Council 4/26.

AFTER REVIEWING a position statement from the Michigan Psychiatric Associ-
ation, the MSMS Council 4/26 approved a statement that "any system of national
health insurance should provide coverage for mental and emotional disorders
to the same degree and extent as for any other illness."

A MSMS POSITION WAS approved by the MSMS Council 4/26 on who could dispense
medications under certain circumstances, reading: "The State of Michigan

Board of Pharmacy provisions be amended to allow registered nurses, on
written policies and procedures adopted by the hospital pharmacy and/or
therapeutics committee, to dispense medications ordered by a qualified
physician in the absence of a registered pharmacist."

THE COUNCIL 4/26 authorized a letter to the Michigan Department of Health
offering suggestions for consideration in their development of proposed
"Guidelines for Development of Health Care Delivery Organizations." The
Health Department has been ordered by legislation to develop such guidelines .

THE APPOINTMENT of an ad hoc membership committee by MSMS Council Chairman
Brooker L. Masters, MD, was approved by the MSMS Council 4/26. Doctor
Masters expressed his concerns for better membership recruitment activity
in his message to the Spring meeting of the House of Delegates. The com-
mittee will be charged to develop guidelines and recommendations for the
midsummer meeting of The Council.

MICHIGAN MEDICAL STUDENTS soon will begin receiving this MSMS Medigram
newsletter twice each month, in another effort to tell students about the
work of the state medical society. The MSMS House of Delegates in spring
suggested such a project and The Council explored the financial aspects
and voted approval.

A MAILING will be developed soon to all members offering them the oppor-
tunity of leasing automobiles through a MSMS-approved leasing company.

This new membership service was approved by the MSMS Council 4/26 after
examination of proposals from three leasing firms.

THE AMA COUNCIL on Medical Services has recommended the nomination of
Donald N. Sweeny, MD , Detroit, to a seat on the Council, to succeed George
W. Slagle, MD, Battle Creek, who is not eligible for another term. A
letter supporting Doctor Sweeny, who is chairman of the MSMS delegation
to the AMA, has been sent to the AMA by MSMS. The MSMS delegates met 4/26
to move along a campaign to support Doctor Sweeny at the AMA Convention in
June in San Francisco.

THE NUMBER of registered physicians in Michigan totaled 9,090 doctors of
medicine, 213 more than the previous year.

IF YOU HAVE NOT posted sign required under Phase II Economic Guidelines, yoi ,
are urged to do so. Sign advising patients that a list of base prices for
principal services is available for examination must be posted in a prominei
place. "Principal services" that MDs must list in their schedule of base
fees have finally been defined by Price Commission. It said principal ser-
vices "are those which comprise 90% of the annual revenues." It is not
necessary, however, to list any service for which the charge is $5 or less.
Any change from the base fee must be noted in the fee schedule. In clinics,
professional corporations and any other office with more than one physician,
each doctor must post his own sign.

PLEASE RETURN your 1972 Physician Overhead Cost Survey. The information
is vitally needed by the MSMS Bureau of Economic Information.

April 28, 1972 Vol. 71, No. 13

n@y§0OD

fitelfcosod!

MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

UNIVERSITY OF CAL
LIBRARY SCH OF MED
THIRD & PARNASSUS
SAN FRANCISCO CAL

AVE

94122

EDITOR: HERBERT A. AUER

V

1972 MSMS Annual Session • Detroit • Oct. 1-5

(^Michigan. <$) Wediciqe

OFFICIAL JOURNAL OF THE MICHIGAN STATE MEDICAL SOCIETY . VOLUME 71, NUMBER 14 • MAY, 1972

MEDICAL CEMirR LIBRARY

MAY 26 1972

During this lovely month, our state,
already studded with Michigan Week ob-
servances May 20-27, flashes another jewel:
the new Wayne State University Gordon
H. Scott Hall of Basic Medical Sciences,
officially dedicated May 8.

The emphasis is on Michigan through-
out this issue, with articles on physician
placement opportunities, SW Michigan
EKG telephone analysis, plans and hopes
of the deans of Michigan’s three medical
schools, and an analysis of ZPG implica-
tions for Michigan.

The negative power of undue anxie
in congestive heart failure...

This man thinks he can no longer
take breathing- for granted.

Typical of many patients with congestive
heart failure, he also suffers from severe
anxiety a psychic factor that may influence the character
and degree of his symptoms, such as dyspnea.

His apprehension may also deprive him of the
emotional calm so important in maintenance therapy

Aid in rehabilitation

Specific medical and environmental meas-
ures are often enhanced by the antianxiety
action of adjunctive Libritabs (chlordiaz-
epoxide) . Libritabs can also facilitate treat-
ment of the tense convalescent patient until
antianxiety therapy is no longer required.
Whereas in geriatrics the usual daily dosage
is 5 mg two to four times daily, the initial
dosage in elderly and debilitated patients
should be limited to 10 mg or less per day,
adjusting as needed and tolerated.

Concomitant use with primary agents
Libritabs is used concomitantly with certain
specific medications of other classes of
drugs, such as cardiac glycosides, diuretics,
antihypertensives, vasodilators and oral
anticoagulants, whenever excessive anxiety
or emotional tension adversely affects the
clinical condition or response to therapy.
Although clinical studies have not estab-
lished a cause and effect relationship, phy-
sicians should be aware that variable effects
on blood coagulation have been reported
very rarely in patients receiving oral anti-
coagulants and chlordiazepoxide HC1.

The positive power of

Libritabs1

(chlordiazepoxide)

5-mg, 10-mg,25-mg tablets

t.i.d/q.i.d.

up to 100 mg daily

for severe anxiety
accompanying
congestive heart failure

Before prescribing, please consult complete product
information, a summary of which follows:

Indications: Indicated when anxiety, tension and apprehension
are significant components of the clinical profile.

Contraindications: Patients with known hypersensitivity to the
drug.

Warnings: Caution patients about possible combined effects
with alcohol and other CNS depressants. As with all CNS-acting
drugs, caution patients against hazardous occupations requiring
complete mental alertness ( e.g operating machinery, driving).
Though physical and psychological dependence have rarely been
reported on recommended doses, use caution in administering to
addiction-prone individuals or those who might increase dosage;
withdrawal symptoms (including convulsions), following discon-
tinuation of the drug and similar to those seen with barbiturates,
have been reported. Use of any drug in pregnancy, lactation, or in
women of childbearing age requires that its potential benefits be
weighed against its possible hazards.

Precautions: In the elderly and debilitated, and in children over
six, limit to smallest effective dosage (initially 10 mg or less per
day) to preclude ataxia or oversedation, increasing gradually as
needed and tolerated. Not recommended in children under six.
Though generally not recommended, if combination therapy with
other psychotropics seems indicated, carefully consider individual
pharmacologic effects, particularly in use of potentiating drugs
such as MAO inhibitors and phenothiazines. Observe usual pre-
cautions in presence of impaired renal or hepatic function. Para-
doxical reactions (e.g., excitement, stimulation and acute rage)
have been reported in psychiatric patients and hyperactive
aggressive children. Employ usual precautions in treatment of
anxiety states with evidence of impending depression; suicidal
tendencies may be present and protective measures necessary.
Variable effects on blood coagulation have been reported very
rarely in patients receiving the drug and oral anticoagulants;
causal relationship has not been established clinically.

Adverse Reactions : Drowsiness, ataxia and confusion may occur,
especially in the elderly and debilitated. These are reversible in
most instances by proper dosage adjustment, but are also occa-
sionally observed at the lower dosage ranges. In a few instances
syncope has been reported. Also encountered are isolated instances
of skin eruptions, edema, minor menstrual irregularities, nausea
and constipation, extrapyramidal symptoms, increased and de-
creased libido— all infrequent and generally controlled with dosage
reduction; changes in EEG patterns (low-voltage fast activity)
may appear during and after treatment; blood dyscrasias (includ-
ing agranulocytosis), jaundice and hepatic dysfunction have been
reported occasionally, making periodic blood counts and liver
function tests advisable during protracted therapy.

Supplied : Tablets containing S mg, 10 mg or 25 mg chlordiazepoxide.

r \ Roche Laboratories

ROCHE / Division of Hoffmann-La Roche Inc.

, / Nutley, N.J. 07110

Our* leaders

MSMS Officers and Councilors

PRESIDENT

PRESIDENT-ELECT

SECRETARY

TREASURER

ASS T SECRETARY

ASS T TREASURER

SPEAKER

VICE SPEAKER

PAST PRESIDENT

AMA DELEGATION CHAIRMAN

COUNCIL CHAIRMAN

COUNCIL VICE CHAIRMAN . . .

Sidney Adler, MD Detroit

John J. Coury, MD Port Huron

Kenneth H. Johnson, MD Lansing

John R. Ylvisaker, MD Pontiac

Ross V. Taylor, MD Jackson

Ernest P. Griffin, MD Flint

Vernon V. Bass, MD Saginaw

James D. Fryfogle, MD Detroit

Harold H. Hiscock, MD Flint

Donald N. Sweeny, Jr., MD Detroit

Brooker L. Masters, MD Fremont

Robert M. Leitch, MD Battle Creek

„ — COUNCILOR

First District Councilors: (V’ayne County) DISTRICT MAP

Edward J. Tallant, MD, Detroit
Ralph R. Cooper, MD, Detroit
Frank G. Bicknell, MD, Detroit
Brock E. Brush, MD, Detroit
Louis R. Zako, MD, Allen Park
Second District Councilor: Ross V. Taylor, MD, Jackson
Counties: Clinton, Eaton, Hillsdale, Ingham, Jackson
Third District Councilor: Robert M. Leitch, MD, Battle Creek
Counties: Branch, Calhoun, St. Joseph
Fourth District Councilor: W. Kaye Locklin, MD, Kalamazoo
Counties: Allegan, Berrien, Cass, Kalamazoo, Van Buren
Fifth District Councilor: Noyes L. Avery, MD, Grand Rapids
Counties: Barry, Ionia-Montcalm, Kent, Ottawa
Sixth District Councilor: Ernest P. Griffin, Jr., MD, Flint
Counties: Genesee, Shiawassee

Seventh District Councilor: James H. Tisdel, MD, Port Huron
Counties: Huron, Sanilac, Lapeer, St. Clair
Eighth District Councilor: William A. DeYoung, MD, Saginaw
Counties: Gratiot-Isabella-Clare, Midland, Saginaw, Tuscola
Ninth District Councilor: Adam C. McClay, MD, Traverse City

Counties: Grand Traverse-Leelanau-Benzie, Manistee, Northern Michigan (Antrim, Charlevoix,
Cheboygan and Emmet combined), Wexford-Missaukee
Tenth District Councilor: Robert C. Prophater, MD, Bay City

Counties: Alpena-Alcona-Presque Isle, Bay-Arenac-Iosco, North Central Counties, (Otsego, Mont-
morency, Crawford, Oscoda, Roscommon, Ogemaw, Gladwin and Kalkaska, combined)

Eleventh District Councilor: Brooker L. Masters, MD, Fremont

Counties: Mason, Mecosta-Osceola-Lake, Muskegon, Newaygo, Oceana
Twelfth District Councilor: Raymond Hockstad, MD, Escanaba

Counties: Chippewa-Mackinac, Delta-Schoolcraft, Luce, Marquette-Alger
Thirteenth District Councilor: Donald T. Anderson, MD, Wakefield

Counties: Dickinson-Iron, Gogebic, Houghton-Baraga-Keweenaw, Menominee, Ontonagon
Fourteenth District Councilor: Donato F. Sarapo, MD, Adrian
Counties: Lenawee, Livingston, Monroe, Washtenaw
Fifteenth District Councilor: Sydney Scher, MD, Mount Clemens
Counties: Macomb, Oakland

DIRECTOR

GENERAL COUNSEL

LEGAL COUNSEL

ECONOMIC CONSULTANT
SCIENTIFIC EDITOR

Warren F. Tryloff East Lansing

Lester P. Dodd Detroit

A. Stewart Kerr Detroit

Clyde T. Hardwick, PhD Houghton

John W. Moses, MD Detroit

410 MICHIGAN MEDICINE MAY 1972

cpresideqt’s page

This is the year of the national presidential elec-
tion. The candidates are using the professional
lexicographer to expound their double meanings.
The theme seems to be “let’s talk awhile before we
say anything.” The issues and problems confront-
ing our nation seem to be secondary.

Medicine apparently has many of the same diffi-
culties of the politician. We talk about primary and
secondary physicians, providers, peer review,
PSROs (Professional Standards Review Organiza-
tions), HMOs (Health Maintenance Organizations),
and foundations for medical care without really
knowing the meaning of the catch phrases. But the
issue still remains; namely, the distribution and de-
livery of health care to all segments of our popula-
tion and the highest standard of care. The iden-
tification of costs must first concern itself with the
needs.

We are just beginning to lay the keel of our state
foundation as a separate corporation outside the
state society. Physicians have various and sundry
ideas of what constitutes the foundation. Perhaps a
rather brief analysis of “foundation” nationwide,
would help clarify our thoughts.

Because of variations among foundations, gen-
eralizations tend to be inaccurate.

Foundations for medical care are autonomous
corporations, sponsored by local (state or county)
medical societies, concerned with quality (high
standards) and cost of medical care. Some are
within county and state medical societies, others
are separate corporations, some in conjunction
with osteopaths.

Common to all foundations: — 1. Doctors must
retain responsibility and leadership in the design,
administration and delivery of medical services (in
hospitals, office, clinic, home). 2. Medical care must
be provided at a just and equitable cost to both
patient and physician. 3. Peer review is conducted
by medical society members to encourage high
standards and control costs.

The primary function of most foundations is pre-
serving traditional modes of rendering care: (solo,
fee-for-service practice, patient-physician relation-
ship and freedom of choice.) Over half the state
medical societies do not have statewide founda-
tions.

California Foundations: — In California, local
county foundations started in the 1950s. In 12 years
with Medicare and Medicaid and rising medical
costs, county and state medical societies began to
implement the foundation philosophy on a broad
scale. Some of the increasing interest was to pro-
tect the solo practice of medicine.

In California, all foundations are on a county
level. There is no California Medical Association

Sidney Adler, MD
MSMS president

foundation. In California, they advocate minimum
benefits and will not contract with a carrier that
does not underwrite them. Peer review is on a local
level and is completed prior to reimbursement. It
is controlled and conducted by physicians to as-
sure quality of care and proper utilization of fa-
cilities.

Some of these foundations process the physi-
cians’ claims to all their commercial insurance car-
rier contracts. (See guidelines of the California
Relative Value Study of the CMA with its own con-
version factor. Committees determine criteria of
care — length of stay, frequency of home and office
visits, injections, labs, etc.)

Health Care Evaluation in Hennepin County
Minnesota: — “The local medical profession as-
sures availability of high quality health services to
all residents of the area at reasonable cost.” The
twin cities, Minneapolis and St. Paul, participate in
influencing health care planning, designing and
monitoring services and evaluating the existing
health care arrangements. This is an attempt to
provide adequate health care to the needy. They
do not insist on a minimum scope of benefits. They
do not process claims and the guidelines are the
usual and customary fees. They decide on the ap-
propriateness and duration of stay in hospitals.

Missouri State Medical Society Model: It does
not sponsor commercial prepaid health insurance
programs. It does not set minimum benefits to the
insurance carrier or set fee schedules. It is pri-
marily a peer review mechanism for government
programs. It attempts to identify patterns of health
care delivery and areas of weakness in the prac-
tice of medicine.

Initially, participation by all physicians was on a
quasi-mandatory basis. This led to many difficulties
among physicians. The pattern of care by doctors
of osteopathy and medical doctors conformed to
the same standard of analysis. The final appeal is
through Judicial Commission of the state.

Thus, it is obvious that there is growing concern
that the solo fee-for-service type of medicine is be-
ing threatened. There is apprehension and fear of
greater governmental involvement. Proof of this is
the HR I (Bennett Amendment) before Congress,
particularly in the PSRO which will probably in-
volve consumer representation in the foundation.
Foundations are thought to be the answer to the
(Continued on Page 420)

MICHIGAN MEDICINE MAY 1972 411

Loqteqts

SCIENTIFIC ARTICLES

423 The Michigan Blue Cross Hemodialysis Pilot Project:
Results of a 30-month pilot study; William G. Bunto,
MD, Harold L. Tremain, MD, Neel M. Kibe, MA, MBA

429 Value of the neurological examination, electromyog-
raphy and myelography in herniated lumbar disc; Har-
old D. Portnoy, MD, Manzoor Ahmad, MD

435 Zero population growth: An analysis of its implications
for Michigan; Kurt Gorwitz, ScD, Ch. Muhammad Sid-
dique

441 A new look at the turtle problem; Edwin M. Knights,
Jr., MD; Dennis Swieczkowski, MSc

FEATURE ARTICLES

417 County in the spotlight: the Kalamazoo Academy,
Judith Marr

445 The deans of Michigan’s three medical schools reveal
hopes and plans; John A. Gronvall, MD, Robert D.
Coye, MD, Andrew D. Hunt, Jr., MD

464 Multiphasic screening referral guidelines explained;
Donald N. Sweeny, Jr., MD

472 MSMS reveals physicians’ fees by region and procedure

474

Report on Michigan’s only
service; John H. Carter, MD

EKG

telephone analysis

496

203 Michigan communities
other specialists

seek

family doctors and

OTHER FEATURES

410

Our leaders

460

MSMS Council

411

President’s page

highlights

440

Monthly surveillance report

470

MSMS in action

443

Perinatal tips

489

Your opinion please

444

Michigan authors

500

In memoriam

457

Michigan mediscene

505

Sound off

On

Our Cover

Scott Hall is the new nucleus of the WSU School of
Medicine. It is named for the late Gordon H. Scott, PhD,
former chairman of the WSU Department of Anatomy, dean
of the medical school and vice president for medical school
development from 1961 to 1968. Scott Hall, in the Detroit
Medical Center, is the largest college building in Michigan.
Its size, coupled with faculty expansion, will allow the
university medical school to become one of the largest in
the U.S.

Publication of Michigan Medicine is under the direction
of the Publication Committee, Michigan State Medical So-
ciety. The scientific editor is responsible for the scientific
content. The managing editor is responsible for the pro-
duction, correspondence and contents of the journal. He
and the executive editor share final responsibility of the
entire publication.

Neither the editors nor the state medical society will
accept responsibility for statements made or opinions ex-
pressed by any contributor in any article or feature pub-
lished in the pages of the journal. In editorials, the views
expressed are those of the writer and not necessarily offi-
cial positions of the society.

SCIENTIFIC EDITOR

John W. Moses, MD

EXECUTIVE EDITOR

Herbert A. Auer

MANAGING EDITOR

Judith Marr

PUBLICATION COMMITTEE

Edward J. Tallant, MD
Detroit
Chairman

Robert M. Leitch, MD
Battle Creek
Donato F. Sarapo, MD
Adrian

(fMichigari (^Mediciqe

Devoted to the interests of the medical profession and
public health in Michigan.

INFORMATION FOR CONTRIBUTORS

1. Address scientific manuscripts to the Publication Com-
mittee, Michigan State Medical Society, 120 West Saginaw
Street, East Lansing, Michigan 48823. Submit original, double-
spaced typewritten copy and two carbon copies or photo copies
on letter size (8^2 x 11 inch) paper. On page one, include
title, authors, degrees, academic titles, and any institutional or
other credits.

2. Authors are responsible for all statements, methods, and
conclusions. These may or may not be in harmony with the
views of the Editorial Staff. It is hoped that authors may have
as wide a latitude as space available and general policy will
permit. The Publication Committee expressly reserves the right
to alter or reject any manuscript, or any contribution, whether
solicited or not.

3. Illustrations should be submitted in the form of glossy
prints or original sketches from which reproductions will be
made by Michigan Medicine.

4. Articles should ordinarily be less than four printed pages
in length (3000 words).

5. References should conform to Cumulative Index Medicus ,
including, in order: Author, title, journal, volume number,
page, and year. Book references should include editors, edition,
publisher, and place of publication, as well.

6. The editors welcome, and will consider for publication,
letters containing information of interest to Michigan physi-
cians, or presenting constructive comment on current contro-
versial issues. News items and notes are welcome.

7. It is understood that material is submitted for exclusive
publication in Michigan Medicine.

MICHIGAN MEDICINE is the official organ of the Michigan
State Medical Society, published under the direction of the
Publication Committee. Published Semi-Monthly, Trimonthly
in January and December; 26 issues, by the Michigan State
Medical Society as its official journal. Second class postage
paid at East Lansing, Mich, and at additional mailing offices.
Yearly subscription rate, $9.00; single copies, 80 cents. Addi-
tional postage: Canada, $1.00 per year; Pan-American Union,
$2.50 per year; Foreign, $2.50 per year. Printed in USA. All
communications relative to manuscripts, advertising, news,
exchanges, etc., should be addressed to Judith Marr, Mich-
igan State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. Phone Area Code 517, 337-1351.
© 1972 Michigan State Medical Society.

412 MICHIGAN MEDICINE MAY 1972

rheumatoid arthritic blowup...

Tandearil Geigy

oxyphenbutazone nf tablets of 100 mg.

Important Note: This drug is not a simple analgesic.

Do not administer casually. Carefully evaluate patients
before starting treatment and keep them under close
supervision. Obtain a detailed history, and complete
physical and laboratory examination (complete
hemogram, urinalysis, etc.) before prescribing and at
frequent intervals thereafter. Carefully select patients,
avoiding those responsive to routine measures, con-
traindicated patients or those who cannot be observed
frequently. Warn patients not to exceed recommended
dosage. Short-term relief of severe symptoms with
the smallest possible dosage is the goal of therapy.
Dosage should be taken with meals or a full glass of
milk. Patients should discontinue the drug and report
immediately any sign of: fever, sore throat, oral
lesions (symptoms of blood dyscrasia); dyspepsia,
epigastric pain, symptoms of anemia, black or tarry
stools or other evidence of intestinal ulceration or
hemorrhage, skin reactions, significant weight gain or
edema. A one-week trial period is adequate. Discon-
tinue in the absence of a favorable response. Restrict
treatment periods to one week in patients over sixty.
Indications: Acute gouty arthritis, rheumatoid arthritis,
rheumatoid spondylitis.

Contraindications: Children 14 years or less; senile
patients; history or symptoms of G.l. inflammation or
ulceration including severe, recurrent or persistent
dyspepsia; history or presence of drug allergy; blood
dyscrasias; renal, hepatic or cardiac dysfunction;
hypertension; thyroid disease; systemic edema;
stomatitis and salivary gland enlargement due to the
drug; polymyalgia rheumatica and temporal arteritis;
patients receiving other potent chemotherapeutic
agents, or long-term anticoagulant therapy.

Warnings: Age, weight, dosage, duration of therapy,
existence of concomitant diseases, and concurrent
potent chemotherapy affect incidence of toxic reac-
tions. Carefully instruct and observe the individual
patient, especially the aging (forty years and over)
who have increased susceptibility to the toxicity of the
drug. Use lowest effective dosage. Weigh initially
unpredictable benefits against potential risk of severe,
even fatal, reactions. The disease condition itself is

unaltered by the drug. Use with caution in first trimes-
ter of pregnancy and in nursing mothers. Drug may
appear in cord blood and breast milk. Serious, even
fatal, blood dyscrasias, including aplastic anemia,
may occur suddenly despite regular hemograms, and
may become manifest days or weeks after cessation
of drug. Any significant change in total white count,
relative decrease in granulocytes, appearance of
immature forms, or fall in hematocrit should signal
immediate cessation of therapy and complete hema-
tologic investigation. Unexplained bleeding involving
CNS, adrenals, and G.l. tract has occurred. The drug
may potentiate action of insulin, sulfonylurea, and
sulfonamide-type agents. Carefully observe patients
taking these agents. Nontoxic and toxic goiters and
myxedema have been reported (the drug reduces
iodine uptake by the thyroid). Blurred vision can be
a significant toxic symptom worthy of a complete
ophthalmological examination. Swelling of ankles or
face in patients under sixty may be prevented by
reducing dosage. If edema occurs in patients over
sixty, discontinue drug.

Precautions: The following should be accomplished at
regular intervals: Careful detailed history for disease
being treated and detection of earliest signs of
adverse reactions; complete physical examination
including check of patient's weight; complete weekly
(especially for the aging) or an every two week blood
check; pertinent laboratory studies. Caution patients
about participating in activity requiring alertness and
coordination, as driving a car, etc. Cases of leukemia
have been reported in patients with a history of short-
and long-term therapy. The majority of these patients
were over forty. Remember that arthritic-type pains
can be the presenting symptom of leukemia.

Adverse Reactions: This is a potent drug; its misuse
can lead to serious results. Review detailed informa-
tion before beginning therapy. Ulcerative esophagitis,
acute and reactivated gastric and duodenal ulcer
with perforation and hemorrhage, ulceration and per-
foration of large bowel, occult G.l. bleeding with
anemia, gastritis, epigastric pain, hematemesis, dys-
pepsia, nausea, vomiting and diarrhea, abdominal

distention, agranulocytosis, aplastic anemia, hemo-
lytic anemia, anemia due to blood loss including
occult G.l. bleeding, thrombocytopenia, pancytopenia,
leukemia, leukopenia, bone marrow depression, so-
dium and chloride retention, water retention and edema,
plasma dilution, respiratory alkalosis, metabolic
acidosis, fatal and nonfatal hepatitis (cholestasis may
or may not be prominent), petechiae, purpura without
thrombocytopenia, toxic pruritus, erythema nodosum,
erythema multiforme, Stevens-Johnson syndrome,
Lyell’s syndrome (toxic necrotizing epidermolysis),
exfoliative dermatitis, serum sickness, hypersensitivity
angiitis (polyarteritis), anaphylactic shock, urticaria,
arthralgia, fever, rashes (all allergic reactions require
prompt and permanent withdrawal of the drug), pro-
teinuria, hematuria, oliguria, anuria, renal failure with
azotemia, glomerulonephritis, acute tubular necrosis,
nephrotic syndrome, bilateral renal cortical necrosis,
renal stones, ureteral obstruction with uric acid crys-
tals due to uricosuric action of drug, impaired renal
function, cardiac decompensation, hypertension,
pericarditis, diffuse interstitial myocarditis with mus-
cle necrosis, perivascular granulomata, aggravation of
temporal arteritis in patients with polymyalgia rheu-
matica, optic neuritis, blurred vision, retinal hemor-
rhage, toxic amblyopia, retinal detachment, hearing
loss, hyperglycemia, thyroid hyperplasia, toxic goiter
association of hyperthyroidism and hypothyroidism
(causal relationship not established), agitation, con-
fusional states, lethargy; CNS reactions associated
with overdosage, including convulsions, euphoria,
psychosis, depression, headaches, hallucinations,
giddiness; vertigo, coma, hyperventilation, insomnia;
ulcerative stomatitis, salivary gland enlargement.

(B) 98-146-800-E

For complete details, including dosage, please see
full prescribing information.

GEIGY Pharmaceuticals

Division of CIBA-GEIGY Corporation

Ardsley, New York 10502

TA. 8356 -9

/

■nitwi mini.—

Though Talwin® can be compared
to codeine in analgesic efficacy, it is not
a narcotic. So patients receiving Talwin
for prolonged periods face fewer of
the consequences you’ve come to expect
with narcotic analgesics. And that, in
the long run, can mean a better outlook
for your chronic-pain patient.

Talwin Tablets are:

• Comparable to codeine in analgesic efficacy:
one 50 mg. Talwin Tablet appears equivalent in analgesic
effect to 60 mg. (1 gr.) of codeine. Onset of significant anal-
gesia usually occurs within 15 to 30 minutes. Analgesia

is usually maintained for 3 hours or longer.

• Tolerance not a problem: tolerance to the analgesic
effect of Talwin Tablets has not been reported, and no
significant changes in clinical laboratory parameters
attributable to the drug have been reported.

• Dependence rarely a problem: during three years of
wide clinical use, only a few cases of dependence have
been reported. In prescribing Talwin for chronic use, the
physician should take precautions to avoid increases in
dose by the patient and to prevent the use of the drug in
anticipation of pain rather than for the relief of pain.

• Not subject to narcotic controls: convenient to
prescribe — day or night — even by phone.

• Generally well tolerated by most patients: infre-
quently cause decrease in blood pressure or tachycardia;
rarely cause respiratory depression or urinary retention;
seldom cause diarrhea or constipation. If dizziness, light-
headedness, nausea or vomiting are encountered, these
effects tend to be self-limiting and to decrease after the
first few doses. (See last page of this advertisement for

a complete discussion of adverse reactions and a brief
discussion of other Prescribing Information. )

- \

w.-w-

a new outlook in

Contraindications: Talwin, brand of pentazocine (as hydrochloride),
should not be administered to patients who are hypersensitive to it.
Warnings: Head Injury and Increased Intracranial Pressure. The
respiratory depressant effects of Talwin and its potential for ele-
vating cerebrospinal fluid pressure may be markedly exaggerated in
the presence of head injury, other intracranial lesions, or a pre-
existing increase in intracranial pressure. Furthermore, Talwin can
produce effects which may obscure the clinical course of patients
with head injuries. In such patients, Talwin must be used with ex-
treme caution and only if its use is deemed essential.

Usage in Pregnancy. Safe use of Talwin during pregnancy (other
than labor) has not been established. Animal reproduction studies
have not demonstrated teratogenic or embryotoxic effects. How-
ever, Talwin should be administered to pregnant patients (other
than labor) only when, in the judgment of the physician, the po-
tential benefits outweigh the possible hazards. Patients receiving
Talwin during labor have experienced no adverse effects other than
those that occur with commonly used analgesics. Talwin should be
used:with caution in women delivering premature infants.

Drug Dependence. There have been instances of psychological and
physical dependence on parenteral Talwin in patients with a history
of drug abuse and, rarely, in patients without such a history. Abrupt
discontinuance following the extended use of parenteral Talwin has
resulted in withdrawal symptoms. There have been a few reports of
dependence and of withdrawal symptoms with orally administered
Talwin. Patients with a history of drug dependence should be under
close supervision while receiving Talwin orally.

In prescribing Talwin for chronic use, the physician should take pre-
cautions to avoid increases in dose by the patient and to prevent the
use of the drug in anticipation of pain rather than for the relief of
pain.

Acute CNS Manifestations. Patients receiving therapeutic doses of
Talwin have experienced, in rare instances, hallucinations (usually
visual), disorientation, and confusion which have cleared spontane-
ously within a period of hours. The mechanism of this reaction is
not known. Such patients should be very closely observed and vital
signs checked. If the drug is reinstituted it should be done with cau-
tion since the acute CNS manifestations may recur.

Usage in Children. Because clinical experience in children under 12
years of age is limited, administration of Talwin in this age group is
not recommended.

Ambulatory Patients. Since sedation, dizziness, and occasional eu-
phoria have been noted, ambulatory patients should be warned not
to operate machinery, drive cars, or unnecessarily expose them-
selves to hazards.

chronic

pain

M. of moderate to severe intensity

of Talwin on the sphincter of Oddi, the drug should be used with
caution in patients about to undergo surgery of the biliary tract.
Patients Receiving Narcotics. Talwin is a mild narcotic antagonist.
Some patients previously receiving narcotics have experienced mild
withdrawal symptoms after receiving Talwin.

CNS Effect. Caution should be used when Talwin is administered
to patients prone to seizures; seizures have occurred in a few such
patients in association with the use of Talwin although no cause and
effect relationship has been established.

Adverse Reactions : Reactions reported after oral administration
of Talwin include gastrointestinal : nausea, vomiting; infrequently
constipation; and rarely abdominal distress, anorexia, diarrhea.
CNS effects: dizziness, lightheadedness, sedation, euphoria, head-
ache; infrequently weakness, disturbed dreams, insomnia, syncope,
visual blurring and focusing difficulty, hallucinations (see Acute
CNS Manifestations under WARNINGS) ; and rarely tremor, irri-
tability, excitement, tinnitus. Autonomic: sweating; infrequently
flushing; and rarely chills. Allergic: infrequently rash; and rarely
urticaria, edema of the face. Cardiovascular : infrequently decrease
in blood pressure, tachycardia. Other: rarely respiratory depression,
urinary retention.

Dosage and Administration: Adults. The usual initial adult dose is
1 tablet (50 mg.) every three or four hours. This may be increased
to 2 tablets (100 mg.) when needed. Total daily dosage should not
exceed 000 mg.

When antiinflammatory or antipyretic effects are desired in addi-
tion to analgesia, aspirin can be administered concomitantly with
Talwin.

Children Under 12 Years of Age. Since clinical experience in chil-
dren under 12 years of age is limited, administration of Talwin in
this age group is not recommended.

Duration of Therapy. Patients with chronic pain who have received
Talwin orally for prolonged periods have not experienced with-
drawal symptoms even when administration was abruptly discon-
tinued (see WARNINGS). No tolerance to the analgesic effect has
been observed. Laboratory tests of blood and urine and of liver and
kidney function have revealed no significant abnormalities after
prolonged administration of Talwin.

Overdosage: Manifestations . Clinical experience with Talwin over-
dosage has been insufficient to define the signs of this condition.
Treatment. Oxygen, intravenous fluids, vasopressors, and other
supportive measures should be employed as indicated. Assisted or
controlled ventilation should also be considered. Although nalor-
phine and levallorphan are not effective antidotes for respiratory
depression due to overdosage or unusual sensitivity to Talwin, par-
enteral naloxone (Narcan®, available through Endo Laboratories) is
a specific and effective antagonist. If naloxone is not available, par-
enteral administration of the analeptic, methylphenidate (Ritalin®),
may be of value if respiratory depression occurs.

Talwin is not subject to narcotic controls.

How Supplied : Tablets, peach color, scored. Each tablet contains
Talwin (brand of pentazocine) as hydrochloride equivalent to 50 mg.
base. Bottles of 100.

Precautions: Certain Respiratory Conditions. Although respiratory
depression has rarely been reported after oral administration of
Talwin, the drug should be administered with caution to patients
with respiratory depression from any cause, severe bronchial asth-
ma and other obstructive respiratory conditions, or cyanosis.
Impaired Renal or Hepatic Function. Decreased metabolism of the
drug by the liver in extensive liver disease may predispose to ac-
centuation of side effects. Although laboratory tests have not indi-
cated that Talwin causes or increases renal or hepatic impairment,
the drug should be administered with caution to patients with such
impairment.

Myocardial Infarction. As with all drugs, Talwin should be used
with caution in patients with myocardial infarction who have nau-
sea or vomiting.

Biliary Surgery. Until further experience is gained with the effects

lA/zn/hrop ) Winthrop Laboratories, New York, N. Y. 10016 (1583)

50 mg. Tablets

Talwin

brand of •

pentazocine

the long-range analgesic

(as hydrochloride)

Leading persons in the establishment of the
new Kalamazoo Family Health Center, Inc.,
are, from left, Betty OfFet, president, board

of directors; John Vogt, administrator; Robert
Cain, architect, and Lenard Fouche, MD,
medical director. The specially-designed cen-
ter is shown in the back prior to installation.

County in the spotlight

Kalamazoo doctors’ enthused support
Keys neighborhood health center

By Judith Marr
Managing Editor

On the north side of Kalamazoo, described by
health leaders as “a pocket of poverty, physical
deterioration and medical resource scarcity,” there
is a shining example of community cooperation.

The shining example is the Kalamazoo Family
Health Center, Inc., which, on March 8, began to
provide medical services from a mobile unit spe-
cifically designed as a temporary health facility. It
serves the medically indigent in the county and
any resident of north Kalamazoo.

The mobile unit is the first result of dreams and
plans of the community’s medical leaders, among
them the Kalamazoo Academy of Medicine. The
academy’s cooperation in the unit’s creation is a
fine example of the leadership that a county med-
ical society can provide to its community.

The mobile unit is designed to meet the needs
of those Kalamazoo area residents who ‘‘have just
given up medically — who have no doctor,” says
Frederick J. Margolis, MD, acting county health
director and a member of the health center’s board
of directors.

The unit will fill in until a permanent Family
Health Center is completed. Construction should
begin in the fall, estimates Doctor Margolis, who is
greatly enthused about the entire project.

“We are trying to duplicate the service of private
practices as much as possible. The patients are
followed by their own doctors; if they are sick they
are sent right to a hospital, and referred to spe-
cialists if necessary,” he says.

New patients entering the mobile unit are met
by trained personnel who sit with them and explain
the project, according to Doctor Margolis.

There are now six full-time employes of the
health center’s mobile unit — among them an LPN,
a nurse’s aide, clerical personnel and full-time Ad-
ministrator John Vogt. Medical Administrator Len-
ard Fouche, MD, a board-certified surgeon, just
joined the staff on a part-time basis after four years
residency at St. Louis Hospital.

The mobile unit itself looks more like a house,
says Doctor Margolis. It contains an offce, large
waiting room divided into two sections for adults
and children, three examination rooms and an
X-ray room. It was designed by an architect and
built to the health center corporation’s specifica-
tions.

And much of the credit for its being belongs to
the Kalamazoo Academy of Medicine. “The guys
have been great about it,” says Doctor Margolis.

In March 1971, the Academy passed a resolution
“enthusiastically supporting the establishment of a
family health center on the north side of Kalama-
zoo.”

The resolution followed a study made by the
Academy’s Ad Hoc Committee on Community
Health Care which declared that the prime health
need of Kalamazoo was to provide preventive
health care and high quality medical treatment
services for all economic levels in the community.

The Ad Hoc Committee’s findings agreed with an
earlier report made by the Community Services
Council of Kalamazoo County, which classified
(Continued on Page 420)

MICHIGAN MEDICINE MAY 1972 417

In acute gonorrhea

(urethritis, cervicitis, proctitis when due
to susceptible strains of N. gonorrhoeae)

Sterile Trobicin®

(spectinomycin dihydrochloride pentahydrate)— For Intramuscu-
lar injections, 2 gm vials containing 5 ml when reconstituted
with diluent. 4 gm vials containing 10 ml when reconstituted with
diluent.

An aminocyclitoi antibiotic active in vitro against most strains of
Neisseria gonorrhoeae (MIC 7.5 to 20 mcg/ml). Definitive in vitro
studies have shown no cross resistance of N. gonorrhoeae be-
tween Trobicin and penicillin.

Indications: Acute gonorrheal urethritis and proctitis in the male
and acute gonorrheal cervicitis and proctitis in the female when
due to susceptible strains of N. gonorrhoeae.

Contraindications: Contraindicated in patients previously
found hypersensitive to Trobicin. Not indicated for the treatment

of Syphilis. ®I972 The Upjohn Company

Warnings: Antibiotics used to treat gonorrhea may mask or
delay the symptoms of incubating syphilis. Patients should be
carefully examined and monthly serological follow-up for at
least 3 months should be instituted if the diagnosis of syphilis is
suspected.

Safety for use in infants, children and pregnant women has not
been established.

Precautions: The usual precautions should be observed with
atopic individuals. Clinical effectiveness should be monitored to
detect evidence of development of resistance of N. gonorrhoeae.

Adverse reactions: The following reactions were observed
during the single-dose clinical trials: soreness at the injection site,
urticaria, dizziness, nausea, chills, fever and insomnia.

During multiple-dose subchronic tolerance studies in normal
human volunteers, the following were noted: a decrease in hemo-

418 MICHIGAN MEDICINE MAY 1972

Trobicin

sterile spectinomycin dihydrochloride
penta hydrate, Upjohn

/

High cure rate:* 96% of 571 males, 95% of 294 females

(Dosages, sites of infection, and criteria for diagnosis and cure are defined below.)**

Assurance of a single-dose, physician-controlled treatment schedule

No allergic reactions occurred in patients with an alleged history of penicillin sensitivity
when treated with Trobicin, although penicillin antibody studies were not performed

Active against most strains of Neisseria gonorrhoeae in vitro (M I C 75 20 mcg/ml)

A single two-gram injection produces peak serum concentrations averaging about
100 mcg/ml in one hour (average serum concentrations of 15 mcg/ml present 8 hours after dosing)

Note: Antibiotics used in high doses for short periods of time to treat gonorrhea may mask or delay the
symptoms of incubating syphilis. Since the treatment of syphilis demands prolonged therapy with any
effective antibiotic, and since Trobicin is not indicated in the treatment of syphilis, patients being treated for
gonorrhea should be closely observed clinically. Monthly serological follow-up for at least 3 months should
be instituted if the diagnosis of syphilis is suspected. Trobicin is contraindicated in patients previously found
hypersensitive to it.

'"Data compiled from reports of 14 investigators. ^Diagnosis was confirmed by cultural identitication of N. gonorrhoeae on Thayer-
Martin media in all patients. Criteria for cure: negative culture after at least 2 days post-treatment in males and at least 7 days post-
treatment in females. Any positive culture obtained post-treatment was considered evidence of treatment failure even though the
follow-up period might have been less than the periods cited above under "criteria for cure" except when the investigator determined
that reinfection through additional sexual contacts was likely. Such cases were judged to be reinfections rather than relapses or
failures. These cases were regarded as non-evaluatable and were not included.

globin, hematocrit and creatinine clearance,- elevation of alka-
line phosphatase, BUN and SGPT. In single and multiple-dose
studies in normal volunteers, a reduction in urine output was
noted. Extensive renal function studies demonstrated no con-
sistent changes indicative of renal toxicity.

Dosage and administration: Keep at 25°C and use within
24 hours after reconstitution with diluent.

Male — single 2 gram dose (5 ml) intramuscularly. Patients with
gonorrheal proctitis and patients being re-treated after failure
of previous antibiotic therapy should receive 4 grams (10 ml). In
geographic areas where antibiotic resistance is known to be pre-
valent, initial treatment with 4 grams (10 ml) intramuscularly is
preferred.

Female — single 4 gram dose (10 ml) intramuscularly.

How supplied: Vial s, 2 and 4 grams — with ampoule of Bacterio-

satic Water for Injection with Benzyl Alcohol 0.9% w/v. Recon-
stitution yields 5 and 10 ml respectively with a concentration of
spectinomycin dihydrochloride pentahydrate equivalent to 400
mg spectinomycin per ml. For intramuscular use only.
Susceptibility Powder— for testing in vitro susceptibility of N.
gonorrhoeae.

Human pharmacology: Rapidly absorbed after intramuscular
injection. A two-gram injection produces peak serum concentra-
tions averaging about 100 mcg/ml at one hour with 15 mcg/ml
at 8 hours. A four-gram injection produces peak serum concen-
trations averaging 160 mcg/ml at two hours with 31 mcg/ml at
8 hours.

For additional product information, see your Upjohn representa-
tive or consult the package insert. med-b-i-s (lwb)

Upjohn

The Upjohn Company, Kalamazoo, Michigan 49001

MICHIGAN MEDICINE MAY 1972 419

KALAMAZOO DOCTORS/Continued

medical care second in importance to the com-
munity and third in priority for community attention.

The Academy devoted an entire meeting to the
proposed neighborhood center and heard Albert L.
Pisani, MD, director, describe his highly successful
health care center in the Chicago inner city.

The Academy was vitally involved in the plan-
ning of the center, and early appointed two mem-
bers, Tom Riegle, MD, and Donald May, MD, now
Academy president, to its board.

The Academy donated $1,500 to help get the
center started, while virtually every other major
health organization in the community, including
Kalamazoo’s two general hospitals and the Kalama-
zoo County Health Department, formally endorsed
the center.

Now there are 30 Kalamazoo physicians verbally
committed to support of the center, and nine of
them work on the staff on an hourly basis. A full-
time pediatrician, a woman doctor, is expected to
join the staff this month, after completing Michigan
licensing requirements.

The Academy representative is now David K.
Hickok, MD, who is one of seven professionals on
the 21-member board.

The center has a sliding fee schedule, charging
its patients according to size of family and ability
to pay. Thus the center is self-supporting. And “we
believe the staff doctors should be paid,” says Doc-
tor Margolis.

When the staff moves into its $1 million perma-
nent building, says Doctor Margolis, “we will de-
vote half our energies to preventative medicine.”

Through an Upjohn grant, the center will be hir-
ing health education and Outreach personnel to go
out into the neighborhood and into the homes.

“Oh, we’ll have the kind of setup you wish you
had in your own office,” predicts Doctor Margolis.
The clinic will offer family planning, nutrition infor-
mation, venereal disease advice and team coun-
seling for emotionally troubled youth. Psychiatric
workers from Kalamazoo State Hospital and Kala-
mazoo Child Guidance Clinic will work through the
clinic and a large room will be available for neigh-
borhood meetings.

Most recently, the Family Health Center, Inc., has
become one of three Michigan organizations to re-
quest Michigan State Medical Society endorsement
of its application for placement of two physicians
from the National Health Service Corps.

“We feel that we should get new medical per-
sonnel in the community rather than dilute the
present physician force,” explains Doctor Margolis.

On March 28, MSMS endorsed the center’s re-
quest for the health service corps physicians, and
approval from the federal government is awaited.

“Things are going nicely,” Doctor Margolis re-
ports. “This is the kind of thing that is going to
build. It’s been well planned and thought out. And
people are keeping their appointments.”

UPMS

sets annual meeting
June 23 - 24 in Marquette

Plans are taking shape for the 77th Annual Meet-
ing of the Upper Peninsula Medical Society, sched-
uled June 23-24 at the Holiday Inn in Marquette.

Morning sessions both days will present panel
discussions of the problems of family practitioners
in small-town office practices. Chairman is Eric T.
Lincke, MD, Marquette; whose committee is com-
posed of William Hopkins, MD, R. L. Carefoot, MD,
and Carl F. Hammerstrom, MD, all of Marquette.

Louis Rosenbaum, MD, Ishpeming, is chairman
of the Friday afternoon session which will take up
socio-economic problems as related to third party
systems. On the panel will be Robert L. Hamburg,
MD, president of the board, Michigan Medical Serv-
ice; Richard Campau, manager, MSMS Department
of Operations and Economics; Donald T. Anderson,
MD, Kingsford, and Raymond L. Hockstad, MD, Es-
canaba, MSMS Councilors, and Larry Sell, MD,
Manistique.

DOCTOR ADLER/Continued

complex requirement under the Bennett Amend-
ment which has not as yet passed Congress.

The social planners and congressional leaders
and those who advise them tend to overlook the
fact that medicine is not an exact science as yet
and that there are personal human factors that in-
fluence physicians and patients. Is medicine a
commodity that can be bought and sold like any
other commodity on the open market?

The teaching of the physician and the public as
to the problems involved are essential to the suc-
cess of any foundation. Government supervision
and control may, in the long run, be self-defeating.

We must have a pluralistic approach to any type
of delivery and distribution of health care. Care-
fully controlled experimentation in the delivery and
distribution of health care is essential for meaning-
ful changes if we are to identify the rising costs.

Let us all clearly understand what we are talking
about and doing in altering the practice of med-
icine.

There is danger in the verbal pollution of the
medical atmosphere by government and medical
politicians. If we are not crystal clear in our aims
and goals in our practice of medicine, we will wind
up shoveling fog.

420 MICHIGAN MEDICINE MAY 1972

The crucial experiment: conve rsion
of 6-aminopenicillanic acid
(6-APA) into benzylpenicillin by
treatment with phenylacetyl
chloride. We’ve come a long way
since 1957. Over the past 14 years
more than 3000 different semi-
synthetic penicillins have been
synthesized and evaluated by our
staff. The fruits of their work are
in your hands today.

Totacillirf

Pyoperi disodium carbenicillin
Bactociir sodium oxacillin

and more to come

Beecham-Massengill
Pharmaceuticals SEE!

Need we say more?

Div. of Beecham Inc., Bristol,Tennessee 37620

□Totacillin (ampicillin trihydrate) capsules equivalent to 250 mg. and 500 mg. ampicillin, for oral suspension
equivalent to 125 mg./5 cc. and 250 mg./5 cc. ampicillin. DPyopen (disodium carbenicillin) vials for
injection equivalent to 1 gm. and 5 gm. of carbenicillin. DBactocill (sodium oxacillin) capsules equivalent to
250 mg. and 500 mg. oxacillin and vials for injection equivalent to 500 mg. and 1 gm. oxacillin.

One of
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4 meg-

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Additional information
available to the
profession on request.

422 MICHIGAN MEDICINE MAY 1972

Scieqtjfic paper's

THE MICHIGAN BLUE CROSS
Hemodialysis Pilot Project

Results of a 30 month pilot

By William G. Bunto, MD
Harold L. Tremain, MD, ACOG
Neel M. Kibe, MA, MBA
Detroit

The development of the teflon-silastic cannula
in 1960 by Quinton, Dillard and Scribner1 made
repetitive hemodialysis for chronic renal failure
feasible for large numbers of patients. Before,
hemodialysis had been used primarily for short-
term treatment of reversible kidney disease, acute
poisonings, and the like. Repetitive hemodialysis
has now become an accepted clinical procedure,
no longer considered research or experimental
therapy. Approximately 5,000 patients in the
United States are receiving hemodialysis today,
either at home or in centers especially equipped
and staffed for this purpose.2 Yet there are prob-
ably twice this many persons in the United States
who could benefit from treatment, but are not re-
ceiving it mainly because of lack of facilities, and
the extremely high costs involved.

Having already recognized short-term inpatient
hemodialysis as a hospital benefit, Michigan Blue
Cross in 1963 allowed payment for the same pro-
cedure on a repetitive basis for chronic renal dis-
ease. In the four years extending from 1963 to
1967, payments totalling $570,000 were made on
behalf of 57 Michigan Blue Cross members in 12
different hospitals, averaging $12,000 per patient
year, or $33 per patient day.

Home hemfodialysis was seen as a partial answer
to the prohibitive costs of the procedure as early
as 1964.3 By 1968, it was clear home hemodialysis
had developed into an accepted, feasible practice
for selected patients, at an annual cost (disregard-
ing initial equipment costs) far below that of hos-

Doctor Bunto is medical case consultant and
Doctor Tremain is vice president for medical af-
fairs with the Medical Affairs Division of Mich-
igan Hospital Service. Mr. Kibe is research
analyst with the Research Services Department.

study

pital center dialysis.4 With this background, then,
Michigan Blue Cross embarked on a pilot project
whose intent was to cover the major costs of the
procedure both in the hospital outpatient depart-
ment and at home. For the former, this project
represented an extension of existing outpatient
benefits; for the latter, an extension of the exist-
ing Michigan Blue Cross Coordinated Home Care
Program.

There were several objectives of the pilot study:
1) to develop statistical data pertaining to cost
and utilization, for informational and actuarial
uses, 2) to encourage the coordinated, planned
development of hemodialysis programs in the
State, and similarly to discourage unnecessary
duplication of facilities, 3) to provide financial
support for the relatively small numbers of pa-
tients in whom chronic renal disease is econom-
ically catastrophic, and 4) to discover and correct
administrative problems before proposing hemo-
dialysis as a Michigan Blue Cross contract benefit.

Covered Services and Supplies

The pilot project began September 1, 1968, and
ended March 31, 1971. During this time, Michigan
Blue Cross covered the costs of the following for
hemodialysis outpatients: disposable supplies, such
as the dialysis membrane, tubing, dressings, dialysis
solution, drugs, and related laboratory tests. Other
expenses, such as nursing supervision, use of the
equipment and facilities, and instruction were
generally included as a “room charge” and re-
imbursed as such. Special procedures, such as
blood transfusion, minor surgery (e.g., catheter
insertion) were not included as a pilot project
expense, since these are generally paid as a con-
tractual outpatient benefit. The cost of blood it-
self was excluded as a pilot project benefit, as
well as by contract.

For home dialysis patients, the costs of sup-
plies, drugs, and laboratory tests were covered as
for the outpatient. “Room charges,” of course,
were not applicable. Nursing services provided by

MICHIGAN MEDICINE MAY 1972 423

BLUE CROSS HEMODIALYSIS/ Continued

the home care agency were covered, home care
agency participation being a prerequisite to pay-
ment for home dialysis.

No payment (aside from reimbursement for ad-
ministrative supervision) was made to the physi-
cian by Michigan Blue Cross. The physician was
reimbursed by Michigan Blue Shield, but these
expenditures were omitted from this report. Costs
of the kidney machine itself were excluded. No
payment was made to family members or friends
for their training in conjunction with the training
of the home dialysis patient. No payment was
made for take-home drugs except those actually
used in the dialysis procedure.

Sources of Data

There were 10 hospitals and seven home care
agencies participating in this pilot project. Data
were obtained from three sources: (1) hospital

bills and “Start of Care Report” forms completed
by hospital personnel; (2) home care agency bills,
and (3) replies to a questionnaire sent to the at-
tending physicians. The patients represented in
this pilot study were regular Michigan Blue Cross
subscribers. The study did not include Medicare
or Medicaid patients, or patients whose hospital-
ization coverage came under a national Blue Cross
account, such as Federal employees.

During the 30 months of the pilot project, a
total of 161 patients were available for inclusion
in the study. Of these, 23 patients had to be ex-
cluded for lack of any data. For expository pur-
poses, the pilot study patients were classified into
two basic categories: “Chronic Outpatient” and
“Home Hemodialysis.” Chronic outpatients re-
ceived all of their dialyses at the outpatient fa-
cility of a hospital either (a) because the hospital
in question offered only hospital-based chronic
dialysis, (b) the hospital did not participate in
the Michigan Blue Cross Coordinated Home Care
Program, (c) the patients were unsuitable for
home hemodialysis for one reason or another, or
(d) for all reasons mentioned above. Home hemo-
dialysis patients, except for health complications
or equipment malfunction or both, dialyzed them-
selves at home with routine supervision from the
Home Care agencies. The home hemodialysis pa-
tient category comprised not only those patients
who were dialyzing themselves at home but also
those recently admitted patients who were being
trained for home hemodialysis. Of 138 patients in-
cluded in the study, 49 were outpatients and 89
on home hemodialysis.

Data on basic patient characteristics such as the
age and sex were extracted from “Start of Care
Reports” provided by Michigan Blue Cross and
completed by either the hospital personnel or so-
cial workers attending the patients. Financial data
on such items as hemodialysis treatment room, sup-

plies, drugs and laboratory tests were provided on
standard Michigan Blue Cross billing forms.

Of the 10 hospitals, eight provided home dial-
ysis training, and four of these also performed out-
patient dialysis on patients who, for one reason or
another, were deemed unsuitable for home dialysis
training. A ninth hospital performed outpatient
dialysis, but did not train patients for home dial-
ysis, and the tenth hospital performed dialysis only
as an interim measure while the patient awaited
renal transplant.

Findings

Hospital and Home Care Agency Data

Table I shows the dialysis charges paid for out-
patient dialysis in five hospitals. The average
charges paid were about $18,900 per year, ranging

Dialysis Charges

TABLE 1

Paid for Chronic

Outpatients

Charges Paid Per

Annual

Hospital

Dialysis

Charges

Hospital B

$148.00

$17,600

Hospital D

248.00

29,500

Hospital E

131.00

15,600

Hospital H

147.00

17,500

Hospital J

119.00

14,200

Overall Average Per Dialysis $159.00

Overall Average Per Man-Year* $18,900

*A man-year is defined as one patient undergoing dialysis
for one year.

from $14,200 to $29,500. Higher overall costs of
running the dialysis program seems to be the rea-
son for significantly higher annual dialysis charges
at hospital D. The overall average charges paid in
these five hospitals for a single outpatient hemo-
dialysis were $159, ranging from $119 to $248. The
overall average number of dialysis treatments per
year was 119, ranging from 109 to 132.

TABLE II

Home Hemodialysis Training Costs

Training Period Charges

Hospital in Weeks Paid

Hospital A

12

$14,500

Hospital B

16

4,800

Hospital E

12

2,800

Hospital F

12

5,000

Hospital G

8

4,900

Hospital H

12

4,600

Hospital 1

8

3,800

Hospital J

10

3,700

Average Training Period 11

Overall Average Training Charges $ 5,400

424 MICHIGAN MEDICINE MAY 1972

Table II shows the training periods and charges
for patients being prepared for home dialysis. The
average charges paid for training patients for
home hemodialysis at eight hospitals were $5,400.
The average length of training was 11 weeks, dur-
ing which 28 dialyses were performed. Charges
ranged from $2,800 to $14,500, the latter figure
occurring in one hospital whose dialysis training
program had just been started, with high “set-up”
costs to be offset. The average cost of one dialysis
during training for home dialysis was $194.

Table III shows the average charges per dialysis
for patients dialyzing themselves at home. The

TABLE III

Average Charges Paid per Home Hemodialysis

Average

Hospital Charges Paid

Dialysis

cedures were not sufficiently uniform to derive
statistically meaningful data. Costs of visiting nurse
supervision of home dialysis patients represented
only one to three percent of the costs of home
dialysis.

Ninety-five of the 138 patients were male (68.3
percent) . The average age for males was 39, and
for females 41, over 90 percent of both being be-
tween the ages of 15 to 54. During the 30 month
period of the pilot study, there were 20 deaths.

One of the objectives of the pilot study was to
enable Blue Cross to know the probable case-load
of patients and resulting financial obligations for
the immediate future. With this in mind, projec-
tions were made for the years 1973 and 1975 using
the Delphi Method5 (Table V). As a useful non-
mathematical technique, the Delphi Method was

TABLE V

Hospital E $34.00

Hospital F 48.00

Hospital G 32.00

Hospital H 16.00

Hospital I 36.00

Hospital J 28.00

Overall Average $32.00

overall charges paid for dialysis in patients’ homes
excluding the cost of the artificial kidney machine
and its installation were $32.00, ranging from
$16.00 to $48.00. The annual cost approached
$7,400 per year, including two cannulations cost-
ing $250 each.

A comparison of the costs of outpatient and
home hemodialysis is presented in Table IV.

One hospital not represented in the tables of-
fered only a pre-transplant dialysis program, and

TABLE IV

Outpatient and Home Hemodialysis:
Comparison of Man-Year Charges

Charges Per

Category Man-Year

Outpatient $18,900

Home Hemodialysis

a) First year 16,184

b) Subsequent years 7,372

therefore its charges were calculated separately
from the other hospitals. The average dialysis costs
for a patient awaiting a kidney transplant at this
hospital were approximately $12,500, based on
charges for 1 1 patients.

Although each hospital divided its charges into
room, supplies, laboratory and drugs, billing pro

Hemodialysis Case Load Projections

Cases

1973

1975

Home Hemodialysis . .

, . . 472

719

Outpatient

166

180

Financial Obligations

Home Hemodialysis . ,

...$3,598,000

$5,438,000

Outpatient

. .. 2,636,000

3,002,000

Total

. .. 6,234,000

8,440,000

developed by Dr. Olaf Helmer of the Rand Cor-
poration to “obtain systematic combination of in-
dividual judgments to obtain a reasoned con-
sensus.” Probable financial obligations to Michigan
Blue Cross were computed with the help of the
following assumptions:

1. The new cases occurring each year will be
evenly distributed throughout the state.

2. Since Michigan’s 1970 resident population is
about 4.4 percent of the total United States
population, it will remain approximately at
4.4 percent through 1975.

3. The proportion of home to chronic outpa-
tient hemodialysis patients will increase from
65 percent in 1970 to 80 percent by 1975.

4. Of all kidney transplants which will be per-
formed in the United States each year, 4.4
percent will occur in Michigan and the
Michigan Blue Cross share of them will be
in proportion to its enrollment share of the
state population each year.

5. Fifty percent of kidney transplants on pa-
tients performed during a year will be suc-
cessful. Of the remaining 50 percent, half of
the patients will have a second transplant
the following year and the other half will
return to hemodialysis.

MICHIGAN MEDICINE MAY 1972 425

BLUE CROSS HEMODIALYSIS/ Continued

6. Mortality rates for hemodialysis patients will
be 14 percent for the first year and 10 per-
cent in subsequent years.

7. In estimating financial obligations, no “in-
flation factor was used because it is very
probable that charges incurred and paid for
eligible subscribers will be more than offset
by (a) larger percentage of patients being
maintained on home hemodialysis and (b)
less expensive machines being used. Hence,
charges per man-year for both outpatient and
home hemodialysis have been assumed to re-
main constant through 1975. Projections for
1973 and 1975 are presented in Table V,
using cost models shown in Figures 1 and 2.

Physician Questionnaire Data

A questionnaire was sent to each physician for
each patient included in the pilot project. The
following data is derived from 103 completed
questionnaires.

As Table VI shows, the most frequent primary
diagnosis was chronic glomerulonephritis. Second-

TABLE VI

Frequency of Diagnosis (Primary)

Number of

Diagnoses Times Reported

Chronic glomerulonephritis 47

Polycystic kidneys 15

Chronic pyelonephritis 9

Chronic renal failure, etiology

not specified or unknown 8

Malignant hypertension

(nephrosclerosis) 4

Diabetic nephropathy 3

Chronic interstitial nephritis 2

Goodpasture’s disease 2

Lupus erythematosus 2

Hydronephrosis ’ ' 2

Alport’s syndrome 1

Carcinoma of colon ”

“Congenital” nephritis 1

Radiation nephritis j 1

Retroperitoneal fibrosis 1

Diagnosis omitted 4

Total ^103"

ary diagnoses were not uniform— some were re-
lated to complications of hemodialysis rather than
a disease related to or concurrent with the primary
renal disease before dialysis. Uremia was reported
in 25 cases, though undoubtedly it was present to
some degree in all cases. Hypertension was report-
ed in seven. Congestive heart failure was reported
in three; renal amyloidosis was reported once.

Of the 103 patients reported, 59 were either be-
ing dialyzed at home, or in training for home
dialysis at the time the report was completed. In
two instances, the patient managed the machine
without another member of the family being
trained.

Complications were reported in 89 of the 103
cases (86 percent) . For 56 of the cases, there were
two or more complications; in the other 33, only
one complication was reported. Incidence by type
of complication is shown in Table VII. Complica-
tions required inpatient hospitalization in 55 cases,
or 53 percent. Of the 103 patients reported, 72
were male, and 31 female.

“Housewife” was given as the occupation in 28
of the female patients. Ten were able to adjust to

TABLE VII

Incidence of Complications

Complication Number of Cases

Arterial or venous thrombosis 46

Cannula infection 43

Psychological or psychiatric problems 26

Peripheral neuropathy 24

Electrolyte imbalance ’ 20

Disequilibrium syndrome 15

Anticoagulation problems n

Abnormalities of calcium metabolism 5

Hypertension 4

Anemia (intractable) 2

Cardiac arrest 2

Septicemia or bacteremia 2

Hepatitis 2

Thrombophlebitis ’ ’ ’ ' ’ 2

Hypotension 1

Miscellaneous .........20

(CVA, congestive failure, pleural effusion,
angina pectoris, ascites, fracture, detached
retina, diabetes)

their duties full-time, 17 part-time, and one not at
all. The other three (nurse, student, waitress)
worked either part-time, or not at all.

A wide variety of occupations was encountered
in the male group, as would be expected. Overall,
15 were able to work full-time, 23 part-time, and
31 not at all. The occupation was either not speci-
fied, or designated “retired,” in three cases.

The occupations and the extent to which the
patient could engage in the work full-time, part-
time, or not at all are shown in Table VIII.

Twenty-five of the 103 patients found it neces-
sary to change their occupation, and of these five
were involved in vocational rehabilitation. No in-
formation was received on seven patients concern-
ing change of occupation.

Patients were seen weekly, or more often, while
in training for home dialysis, or as a regular out-
patient. Replies to the questionnaire indicated
that home dialysis patients requiring the physi-
cian’s attention one to three times per month, and
those requiring it less often than monthly, were
about equal in number.

In 18 of these patients, a renal transplant had
been done once, and in three others, had been
done twice. However, only five of the 21 transplant
recipients required hemodialysis as a result of

426 MICHIGAN MEDICINE MAY 1972

FIGURE 1

Cost Model: One Dialysis in a Training Center
(Travenol RSP Coil Unit)

Personnel Amount*

Administration

(Medical and Clerical) $ 33.00

Physicians

(including trainees) 24.00

Nurses - Technicians 43.00

Psychiatrist

Psychologist Services 10.00

Social Worker

Dietitian 2.00

$112.00

Supplies 30.00

(Administration, Nurse, Tech., Training,
Consumable Supplies)

Other 13.00

(Laboratory Tests, Books, Periodicals,
etc., and Communications)

Overhead 39.00

Total Indirect Charges
(35% of Salary and Wages)

Total Cost of One Dialysis

in a Training Center $194.00

‘Source: Pilot Study Data

FIGURE 2

Cost Model:* Home Hemodialysis

First Year

Training Period

Initial Cannulation $ 250.00

In-center Training

Dialyses: 28 @ $194.00 5,432.00

$ 5,682.00

Equipment

Purchase Cost** 4,200.00

Freight Charges and Installation (Est.) 400.00

$ 4,600.00

Home Dialysis

Second Cannulation 250.00

116 Dialyses @ $32.00 performed at home .... 3,712.00
Back-up Dialyses: (In-center)

10 Dialyses @ $194.00 1,940.00

$ 5,902.00

Total Costs (First Year) $16,184.00

Second Year

Cannulations: 2 $ 500.00

Planned Home Dialyses

142 @ $32.00 4,544.00

Back-up Dialyses (In-center)

12 @ $194.00 2,328.00

$ 7,372.00

‘Assumptions:

1. Percentage of Back-up Dialyses is 8 for the first year.

2. Average number of cannulations per year is 2.

3. Figures based on three dialyses per week.

“Data supplied by the Kidney Foundation of Michigan, Ann Arbor, Michigan,
June 21, 1971.

MICHIGAN MEDICINE MAY 1972 427

BLUE CROSS HEMODIALYSIS/ Continued

TABLE VIII

Occupations of Male Hemodialysis Patients

Number Employed

Type of Occupation Full-Time Part-Time Not at All

Sedentary (auditor, accountant, secretary, 2

tailor, clerk, cashier, executive, super-
visory, managerial, dispatcher)

Skilled trades (tool and die, press, me- 1
chanic, machinist, plumber, technician)
Professional (dentist, doctor, lawyer, en- 4

gineer, teacher, professor)

Unskilled labor 1

Self-employed 4

Student 3

Salesman 0

15

8

4

6

2

0

2

_1

23

4

7

3

11

0

3

3

31

failure of a transplant, so it may be assumed that
16 of the 103 patients were transplanted some
time during the pilot project period, and that they
had not yet failed at the time the report was sub-
mitted. In 16 others, a transplant was being
planned at the time the questionnaire was re-
turned, and in 18 cases a transplant had been re-
fused.

Summary and Conclusions

Michigan Blue Cross, from September 1, 1968
to March 31, 1971, conducted a hemodialysis pilot
project in which payment was made on behalf of
161 patients. Data w'ere obtained on 138 patients.
The study included both patients undergoing
repetitive dialysis at the hospital and patients
dialyzing themselves at home. The cost of dispos-
able supplies, “room charges,’’ laboratory tests,
drugs and home care agency nursing services were
covered. Data were also obtained from a question-
naire completed by the attending physicians for
103 patients.

The average cost of a single dialysis performed
at the hospital was $ 1 59. For patients in training
for home dialysis, it was $194. A single home dial-
ysis averaged $32. Repetitive outpatient hospital
dialysis averaged $18,900 per year. Home dialysis
averaged $16,184 the first year, and $7,372 each
subsequent year.

Michigan Blue Cross projected expenses for out-
patient and home hemodialysis coverage are $6,-
234,000 by 1973, and $8,440,000 by 1975.

Chronic glomerulonephritis was the most fre-
quently reported kidney disease. Dialysis was ac-

companied by a complication in 86 percent of
cases, the most frequent being arterial or venous
thrombosis. Interestingly, 31 of 69 male patients
were unable to work at their usual occupation de-
spite hemodialysis.

There is no question that the cost of hemo-
dialysis is prohibitive for most individuals, and
that third-party coverage is not only desirable but
virtually mandatory. Since July 1, 1971, Michigan
Blue Cross has added outpatient and home hemo-
dialysis as a benefit for all Michigan group sub-
scribers.

References

1. Quinton, W.; Dillard, D.; and Scribner, B.H. “Can-
nulation of Blood Vessels for Prolonged Hemodial-
ysis,” Trans. Amer. Soc. Intern. Organs, 6:104, 1960.

2. National Registry of Long-term Dialysis Patients,
JAMA, 218:718, 1971.

3. Merrill, J.P.; Schupak, E.; Cameron, E.; and Hamp-
ers, C.L. "Hemodialysis in the Home,” JAMA, 1 90:-
468, 1964.

4. Editorial, JAMA, 206:124, 1968.

5. Helmar, O. “Analysis of the Future; The Delphi
Method,” in Technical Forecasting for Industry and
Government, J. E. Bright, Ed., Englewood Cliffs,
N.J., Prentice Hall, Inc., 1960.

Acknowledgements

The authors are indebted to Mac J. Armstrong,
MD; Norma L. Beerweiler, RN, MPH, and Henry
F. Vaughan, AB, MPH, for their valuable assist-
ance and support throughout the pilot project
and in the preparation of this manuscript.

428 MICHIGAN MEDICINE MAY 1972

Value of the neurological examination,
electromyography and myelography
in herniated lumbar disc

By Harold D. Portnoy, MD
Manzoor Ahmad, MD
Pontiac

Particularly in an industrialized state such as
Michigan, physicians see many patients with low
back pain. In most cases the differential diagnosis
is between herniated lumbar disc and lumbo-
sacral strain. Sometimes the diagnosis is clear, but
frequently differentiating these two entities is
difficult.

If the diagnosis is ruptured disc, then how long
should conservative management be tried, when
should surgery be contemplated, and what is the
exact level of the herniation?

To answer these questions a study was under-
taken to determine he value of each of the three
currently available diagnostic measures for differ-
entiating lumbosacral strain from herniated lum-
bar disc, namely, the neurological examination,
electromyography, and myelography.1-11 In addi-
tion these three tests were evaluated as to the
accuracy of localization of a ruptured disc. As a
result of the study a scheme for the evaluation and
treatment of patients with low back pain will be
presented.

Material and Methods

The study was undertaken on 138 consecutive
patients operated upon for ruptured lumbar inter-
vertebral disc from July 1964 through June 1969.
Each had been evaluated by electromyography
(EMG) and myelography. These patients pre-
sented with low back pain, usually with unilateral
leg radiation, and were initially seen either in the
office or in 'hospital consultation. None had prior
surgery. There were 98 males (64.5%) and 49 fe-
males (32.5%) . The great majority of patients
(60.1%) were in the 4th and 5th decades (Table 1).
The youngest patient was 13 years old; the old-
est, 71. This distribution by age and sex is similar
to that reported in other series.5-10-12 In this series
54.3% of the patients had left-sided pain; 44.2%,

Doctor Portnoy is attending neurosurgeon at
Pontiac General Hospital, where Doctor Ahmad
was formerly a resident in surgery.

Decade

TABLE 1
Age Distribution

No. of Patients

Percent

11-20

4

2.9

21-30

20

14.5

31-40

38

27.5

41-50

45

32.6

51-60

25

18.2

61-70

5

3.6

71-80

1

0.7

Total

138

100.0

right-sided pain. A similar left-sided prepond-
erance was likewise noted by O’Connell.8 In 1.5%
of patients, the pain did not localize to either
side. There were 126 Caucasian and 11 Negro pa-
tients.

The neurological examination (NE) was car-
ried out in a uniform manner. The following were
evaluated as non-specific indicators of ruptured
disc: 1) straight leg raising (Laseque’s sign) , 2)
the presence of paravertebral muscle spasm
(PVMS) , 3) the presence of a lumbar list.

Clinical localization was determined according
to the following criteria as modified after Spur-
ling.12

L3 disc herniation (L* nerve root compression) :
1) diminished or absent knee jerk (KJ) with nor-
mal ankle jerk (AJ) ; 2) weakness of the quadri-
ceps femoris; 3) hypesthesia along the medial as-
pect of the leg.

Li disc herniation (Ls nerve root compression) :
1) normal KJ and AJ; 2) weakness of the extensor
hallicus longus muscle (EHL) and dorsiflexion of
the foot; 3) hypesthesia along the anterior aspect
of the leg, medial side of the foot and great toe.

Ls disc herniation (Ls nerve root compression) :
1) diminished or absent AJ; 2) weakness of the
gastrocnemius and soleus muscles; 3) hypesthesia
on the lateral aspect of leg and foot, and the
third, fourth and fifth toes.

Electromyography was performed routinely on
each patient. Nerve root irritation was considered
present if fibrillations or positive sharp waves
were found in the muscles supplied by the root.
Only two patients had positive sharp waves alone.
In one patient the lesion was less than 18 days

MICHIGAN MEDICINE MAY 1972 429

NEUROLOGICAL EXAM/Continued

Figure 1: Sketch illustrating two anomalies noted
at surgery for herniated disc. Left side: Intra-
spinal dorsal root ganglia overlying bulging discs
at L4 and L5 interspaces. Right side: conjoined
L5 and Sx nerve roots forming a conjoined root
with dorsal root ganglion within the spinal canal
and overlying a bulging disc.

old, that is, before fibrillations would be expected.
Two patients with a normal EMG were studied
less than 18 days from onset of symptoms.

Each myelogram was carried out by the co-
operative efforts of a neurosurgeon and radiologist.
Following insertion of an 18 gauge spinal needle,
cerebrospinal fluid manometries were performed
and three to 10 cc. of fluid removed for analysis.
Six cubic centimeters of Pantopaque were intro-
duced into the lumbar subarachnoid space. The
radiopaque media was manipulated under fluor-
oscopy using an image amplifier. The Pantopaque
was passed into the lower thoracic area to rule out
the presence of a tumor of the conus medullaris.
Cross table lateral roentgenograms were obtained
when necessary.

In Table 2 is listed the distribution of the disc
herniations found at operation. Operative explora-
tion of each disc protrusion or protrusions was
based on the preoperative evaluation of the NE,
EMG, and myelogram. When the tests suggested
more than one level of involvement, both levels
were explored. Except in four instances, unilateral
hemilaminectomy at one or more levels was per-
formed. Bilateral exploration was carried out
twice. Two patients had complete laminectomy
at one of two explored levels. Associated bony
spurs were felt to play a part in the etiology of
the nerve root compression in five cases, and epi-
dural varicosities considered significant in the pro-

duction of symptoms in two. Two patients had
anomalous nerve roots.1 The Ls and Si dorsal root
ganglia in one patient were within the spinal
canal and directly overlay small bulging discs.
(Fig. 1, left side) . The other patient demonstrated
a conjoined and Si nerve roots with common
intraspinal dorsal root ganglion. A single root
emerged at the Ls-Si intervertebral foramen. The
ganglion overlay a bulging disc. (Fig. 1, right side) .

One patient with an old fracture of L2 had a
ruptured disc between Li and L2. A sacralized
fifth lumbar segment was noted twice and six
lumbar vertebrae were found in 10 patients. Spon-
dylolesthesis of the fifth lumbar on the first sacral
segment was seen in three instances. Three pa-
tients had a spina bifida occulta.

Results

Neurological Examination: Laseque’s sign was

positive in 83.3% of the patients with lateraliza-
tion to the affected side in all but one case in
which both legs were equally involved (Table 3).
PVMS was noted in 68.2% of patients. Unilateral
PVMS was found on the same side as the lesion
in 31.2%, on the opposite side in 2.9%, and bi-
laterally in 34.1%. A lumbar list with tilt to the
side of the lesion was noted in 25.4%, and to the
opposite side in 17.4%.

The NE was correlated with the disc lesions
found at operation (Table 4). Correct localization
to the involved disc level or levels alone was noted

TABLE 2

Operative Distribution of Disc Herniation

Level

Number

Percent

Li

2

1.4

1-3

4

2.9

L;

39

28.3

L-,

46

33.4

L3, k

2

1.4

L»> L5

43

31.2

L5> Li

1

0.7

L3- *-4, L5

1

0.7

Total . . . .

138

100.0

TABLE 3

Nonspecific Signs of Lumbar Ruptured Disc

No. Percent

SLR

.115

83.3

PVMS same side . . . .

. 43

31.2

opposite side .

. 4

2.9

bilateral

. 47

34.1

Lumbar list

same side . . . .

. 35

25.4

opposite side .

. 24

17.4

430 MICHIGAN MEDICINE MAY 1972

TABLE 4

Correlation of Level of Ruptured Disc with Neurological Examination

Li

(2)

L3

(4)

u

(39)

L5

(46)

La.k

(2)

L3> L4> 1-5
(1)

L5

(45)

L5> L,
(1)

Depressed KJ

1

3

4

1

1

Depressed AJ

1

19

38

2

31

1

Lo

1

•-3

1

u

1

1

1

L5

15

8

1

22

Si

11

25

1

29

1

Correct localization

(level or levels)

2

9(23.1)

34(73.8)

23(51.1)

Correct localization and

additional false pos. .

1

1

14(35.9)

9(19.6)

1(2.2)

1

Correct localization and

additional false neg. . .

2

15(33.3)

No localization

1

1

7(17.9)

2(4.3)

1

4(8.9)

False localization only . . .

9(23.1)

1(2.2)

Dermatome

Hypesthesia

TABLE 5

Correlation of Level of Disc Rupture and EMG

Li

(2)

L3

(4)

Li

(39)

L5

(46)

L3- L4
(2)

L3> L4, L5
(1)

L4. L5
(43)

L51 Ls

(1)

Correct localization

(level or levels)

4

20(54.3)

31(67.5)

15(34.9)

Correct localization

and additional false pos.

7(17.8)

2(4.3)

Correct localization

and additional false neg.

2

1

20(46.4)

1

Normal EMG

2

8(20.5)

9(19.5)

8(18.6)

False localization only ....

4(10.2)

4(8.7)

in only 49.5% of the entire group, greatest accu-
racy being found in determining a L5 herniation.
In patients with a Li ruptured disc, correct local-
ization occurred in only one quarter of the cases.
Of interest is that in patients with isolated Lt rup-
tured disc there was clinical indication of an addi-
tional false positive herniation (usually L5) in
35.9%, no localization in 17.9% and false localiza-
tion in 23.1%. In patients with combined Li and
L5 ruptured discs, both lesions were diagnosed in
only one-half the cases. In one-third of the pa-
tients, only one of these two herniations could be
diagnosed.

For reprints write to: Harold D. Portnoy, MD,
Oakland Neurological Clinic, 445 W. Huron St.,
Pontiac. (After July 1: 1431 Woodward, Bloom-
field Hills)

Electromyography: Fully correct localization was
accomplished in only 50.7% of the patients (Table
5), greatest accuracy occurring with a Ls disc rup-
ture (67.5%) . In an additional 23.9% of the pa-
tients, the correct level(s) was diagnosed, but an
uninvolved level was also incriminated, or the test
failed to detect a second herniation. The EMG
was normal in 18.8% of cases and indicated the
wrong level in 5.8%. In patients with a Li hernia-
tion, the test proved entirely accurate in 54.3%,
and in combined Li and L5 herniations, 34.9%.

Myelography: Correct localization occurred in
82.6% of patients (Table 6). The myelogram was
normal in 6.5%. In 10 cases or 23.3% of com-
bined L4 and L5 ruptured discs the myelogram
detected only one of the 2 lesions. In four pa-
tients with lateral rupture of a disc, the dural sac
was narrow and did not fill out the spinal canal13

MICHIGAN MEDICINE MAY 1972 431

Figure 2: Myelogram which failed to reveal evi-
dence of the bulging disc at left L4 and free
fragment at L5 found at surgery. This patient
had a weak extensor hallicus longus and posi-
tive EMG indicating nerve root irritation of the
left L5 root. The dural sac is narrow relative to
the bony canal and both lesions were found
laterally.

Figure 3: Myelogram which failed to reveal rup-
tured disc at left L5. Note the dural sac termi-
nates at the lumbosacral interspace.

(Fig. 2). In one patient with a ruptured L5-S1 disc,
the dural sac ended at the lumbosacral interspace
(Fig. 3).

Of 132 cerebrospinal fluid specimens obtained
at myelography, 76 (57.5%) had an elevated pro-
tein (over 45 mgm%) . The highest protein con-
centration was 137 mgm%. Cerebrospinal fluid lac-
tate dehydrogenase isozyme studies from some of
these patients indicate the abnormal protein is a

product of red blood cell breakdown.14 This sug-
gests the increased protein is due to an increased
permeability of the local vasculature probably sec-
ondary to compression by the protrusion.

Discussion

The proper management of a patient with a
herniated lumbar disc necessitates an accurate
diagnosis and localization of the lesion. In many

432 MICHIGAN MEDICINE MAY 1972

TABLE 6

Correlation of Level of Ruptured Disc and Myelography

Li

(2)

L3

(4)

k

(39)

L5

(46)

L3> L4
(2)

*-3> L4> L5
(1)

L4> L5
(43)

L5iLc

(1)

Correct localization

level or levels

2

4

37(94.8)

43(93.4)

1

1

26(60.4)

Correct localization

and additional false pos.

1(2.6)

1(2.3)

1

Correct localization

and additional false neg.

10(23.3)

Normal myelogram

3(6.6)

6(13.9)

False localization only

1(2.6)

instances diagnosis or localization may be ob-
scure. Low back and leg pain may present in a
variety of diseases most of which are eliminated
by a good history and physical examination. The
most frequent diagnostic problem lies in differ-
entiating acute or chronic lumbosacral strain from
true ruptured disc. Both problems are usually re-
lated to trauma, and the pain of a lumbosacral
strain can mimic a ruptured disc. The trauma may
be quite slight such as bending over to pick up a
small object. Such a maneuver probably causes
a tear of the spinal ligaments or annulus fi-
brosus with resultant reflex muscle spasm as the
paraspinal musculature cease functioning at 60-75°
of flexion.15 In this situation stress is suddenly
transferred from muscles to ligaments.

Those patients with lumbosacral strain fail to
show neurological deficit and usually improve on
a conservative program of bedrest, analgesics, mus-
cle relaxants, and the use of moist heat to the
lumbosacral area. Fortunately, many patients with
minor neurological changes, suggestive of disc rup-
ture, such as a slightly depressed ankle jerk or
hypesthesia, also improve on conservative therapy.8

The first and most important method of eval-
uating patients with low back pain is the clinical
examination which includes a careful neurological
examination. In this series we found that the
straight leg raising test was a good indicator of a
ruptured disc when performed properly (83.3%
positive) . Patients with acute lumbosacral strain
may also have a simulated Laseque’s sign, which
is caused by simultaneous flexion of the pelvis on
the lumbar spine. A true straight leg raising test
will disappear when the knee is flexed. In con-
trast the presence of paravertebral muscle spasm
and lumbar list has not been helpful in differ-
entiating lumbar disc disease from lumbosacral
strain.

The neurological examination was found to be
most helpful in differentiating herniated disc from
simple strain but could not be relied upon for ac-
curately diagnosing the level of herniation. Thus

while 88.6% of the patients in this series had an
abnormal neurological examination, accurate local-
ization was obtained in only 49.3%. A patient with
a positive straight leg raising test and abnormal
neurological examination usually has a ruptured
disc. But all patients with a ruptured disc need
not be operated upon except in instances where
the neurological deficit is significant or progres-
sive. A trial of conservative therapy is indicated in
most situations. Thus, many patients with a slight-
ly depressed ankle jerk or hypesthesia may weather
the episode on conservative management, and not
require surgery.

We have found electromyography (EMG) of
considerable value as an adjunct to the neurolog-
ical examination, particularly in instances where
the only neurological deficit was sensory loss since
the presence of fibrillations specifically indicates
the presence of nerve damage. Obtaining an EMG
early is valuable since development of an abnor-
mality on repeat study indicates a progressive le-
sion, while clearing of an abnormality is objective
evidence of improvement. The EMG has also been
found helpful in compensation cases in which the
clinical picture is obscure, and in which compensa-
tion neurosis must be considered.16 An abnormal
EMG in this situation indicates that the com-
plaints are most likely due to nerve root irritation.

The conservative care of patients with low back
pain in most instances can be carried out at home
unless significant neurological deficit is present.
Premature hospitalization may be detrimental
since conservative therapy tends to be shortened in
favor of myelography and operative intervention.
Both should not be considered benign procedures.
We have found a program of complete bedrest at
home with a couple of pillows under head and
knees (simulating the William’s position of the
hospital bed) , analgesics and muscle relaxants re-
lieve symptoms in the majority of patients with
low back pain. If pain is severe and persistent,
particularly if the EMG is abnormal, admission to
hospital is indicated. Further conservative therapy
in the hospital including deep moist heat and

MICHIGAN MEDICINE MAY 1972 433

NEUROLOGICAL EXAM/Continued

massage and pelvic traction will benefit many pa-
tients, thus again avoiding surgery. Once the diag-
nosis of intractable pain from a herniated disc has
been made on the basis of the neurological exam-
ination, EMC, futile trial of conservative therapy,
and significant neurological deficit, surgery should
be considered. Myelography is carried out only as
a precursor to surgery to prevent misdiagnosis
(such as with the presence of a conus medullaris
tumor) , and to clearly establish the level of the
lesion. Myelography should not be used as a screen-
ing procedure to make the diagnosis of ruptured
disc, since occasionally it may result in arachnoid-
itis. Because myelography most accurately defines
the correct level (82.6% of patients compared to
only 50% of patients studied by either the neuro-
logical examination or EMG alone) , we feel myel-
ography should be performed before surgery to
accurately localize the lesion rather than investi-
gate multiple interspaces when not necessary.

While myelography appears to present the best
test available for accurate localization, it was
found to be normal in nine cases (6.5%) . In all
but one of the patients with a normal myelogram,
the EMG was positive. A normal myelogram is not
an absolute contraindication for surgery, but a
cause to reflect on a possible wrong diagnosis.
When myelography and electromyography are both
negative, re-evaluation of the clinical status pos-
sibly by another orthopedic surgeon or neuro-
surgeon should be considered before exploratory
surgery.

The above plan for evaluating a patient with
low back pain utilizes the neurological examina-
tion, EMG, and myelography as methods of pre-
venting unnecessary surgery whenever possible.
The simplest, but unfortunately, least accurate
tests are used first. Myelography is used prior to
surgeiy to prevent misdiagnosis and to most accu-
rately determine the level of disc rupture.

Summary

One hundred and thirty-eight patients with a
ruptured lumbar disc at surgery were evaluated
preoperatively by clinical neurological examina-
tion, EMG, and myelography. The neurological
examination and EMG were fully accurate in only
50% of patients and partially accurate in approxi-
mately an .additional 25%. Myelography was found
to be the most accurate (82.6%) for localization of
a ruptured disc. In another 8.0%, only one of two
disc protrusions were detected.

The neurological examination and EMG are
valuable in initially evaluating the patient with
low back pain. If the EMG is positive and the pa-
tient fails to improve on conservative therapy at
home, then hospitalization for controlled conserva-
tive therapy is indicated. Neurological deficit and
failure to improve on conservative therapy are in-

dications for surgery. Myelography is performed
prior to surgery to prevent misdiagnosis and de-
termine the level of the lesion.

Acknowledgement

The authors wish to thank Dr. Nicholas Cherup
who performed most of the EMG examinations.

References

1. Crue, B. L., R. H. Pudenz, and C. H. Shelden.
Observations on the value of Electromyography.
J. Bone Joint Surg. 39A:492-500, 1957.

2. Ford, L. T., R. H. Ramsey, E. P. Halt, and J. A.
Key. An analysis of one hundred consecutive lum-
bar myelograms followed by disc operation for re-
lief of low-back pain and sciatica. Surgery 32:961-
966, 1952.

3. Gurdjian, E. S., J. E. Webster, A. Z. Ostrowski,
W. G. Hardy, D. W. Lindner, and L. M. Thomas.
Herniated lumbar intervertebral discs: An analysis
of 1176 operated cases. J. Trauma 1:158-176, 1961.

4. Kuntsson, B. Comparative value of electro-
myographic, myelographic and clinical-neurological
examinations in the diagnosis of lumbar root com-
pression syndrome. Acta Orthopaed. Scand. 49:-
Suppl. 1-135, 1961.

5. Marinacci, A. A. Electromyogram in the evaluation
of lumbar herniated disc. Bull, Los Angeles Neurol.
Soc. 30:47-62, 1965.

6. Mendelsohn, R. A., and A. Sola. Electromyography
in herniated lumbar discs. Arch. Neurol. Psych.
79:142-145, 1957.

7. Norlen, G. On the value of the neurological symp-
toms in sciatica for localization of a lumbar disc
herniation. Acta. Chir. Scand. 91, Suppl. 95, 1944.

8. O’Connell, J. E. A. Protrusions of the lumbar in-
tervertebral discs: A clinical review based on five
hundred cases treated by excision of protrusion.
J. Bone Joint Surg. 33B:8-30, 1951.

9. Shea, P. A., W. W. Woods, and D. H. Werden.
Electromyography in diagnosis of nerve root com-
pression syndrome. Arch. Neurol. Psych. 64:93-104,
1950.

10. Spurling, R. G. and E. G. Grantham. Neurologic
picture of herniations of nucleus pulposus in
lower part of lumbar region. Arch. Surg. 40:375,
1940.

11. Stahl, F. Clinical diagnosis of lumbar disc hernia-
tions. Acta Orthopaed. Scand. 18:141-152, 1949.

12. Spurling, R. G. Lesions of the lumbar interver-
tebral disc. Charles C. Thomas, Publishers, Spring-
field, 1953.

13. Daum, H. F., A. B. Smith, J. W. Walker, S. B.
Chapman, and G. H. Eversman. Protrusions of the
lumbar disc: A correlation of radiographic diag-
noses and surgical findings, Southern Med. J. 52:-
1479-1484, 1959.

14. Dito, W., Director of Laboratories, Pontiac General
Hospital. Personal communication.

15. Portnoy, H. D. and F. Morin. Electromyographic
study of postural muscles in various positions and
movements. Am. J. Physiol. 186:122-126, 1956.

16. Raaf, J. Some observations regarding 905 patients
operated upon for protruded lumbar interver-
tebral disc. Am. J. Surg. 97:388-399, 1959.

434 MICHIGAN MEDICINE MAY 1972

Zero population growth

An analysis of its implications for Michigan

By Kurt Gorwitz, ScD
Ch. Muhammad Siddique
Lansing

Introduction

Widespread recognition has evolved in recent
years regarding the dangers of continuing popula-
tion growth at present levels. Despite a substantial
decrease in birth and fertility rates in recent years,
the number of Michigan residents is currently in-
creasing 1.1 percent annually, due to an excess of
births over deaths. In-migration and out-migration
are virtually in balance. This growth, if unchecked,
would lead to a doubling of the state’s present
population within less than seventy years. In a
number of foreign countries, and among some seg-
ments of our population, the annual growth rate
is 3.5 percent. This produces a doubling of the
population every 20 years.

Awareness of the dangers inherent in uncon-
trolled growth has led to a number of proposals
for checking or reducing this expansion. One of
the most widely recognized is commonly referred
to as zero population growth (2PG) , a term which
within a few years has become part of the English
language. It is not, as apparently thought by some,
a concept based on an immediate balance between
live births and deaths. This patently is not attain-
able for some time since it would require that the
average number of children per family be limited
to less than 1.3. Michigan, as well as the United
States, currently has about twice as many births as
deaths. Rather, under the ZPG concept, each gen-
eration of women would have only enough chil-
dren to reproduce itself.

Based on present survivorship rates, this would
be equal in Michigan to an average of 2.11 chil-
dren per woman. The current, actual figure is 2.56.
This reduction of 18.4 percent, from the 170,510
reported in 1970 to 139,170 births, would decrease
the annual fertility rate from the present 85.3 per
1,000 to 70.3. If women were to continue having
this average of 2.11 children, a gradual aging of

Doctor Gorwitz is chief of the Center for
Health Statistics, Michigan Department of Public
Health. Mr. Siddique, a candidate for the MSPH
degree at the School of Public Health, Univer-
sity of North Carolina, served his field training
at the Center.

the population would occur, with a resultant de-
crease in the number of births and a concomitant
increase in deaths. Ultimately, around 2030, a bal-
ance would be reached between the two which
would subsequently remain essentially unchanged.

Analysis of Data

The number of Michigan residents increased
1,051,889, or 13.4 percent, between 1960 and 1970
(from 7,823,194 to 8,875,083). Almost all of this
rise (96.7 percent) was the result of an excess of
live births over deaths. In-migration slightly ex-
ceeded out-migration with the difference account-
ing for the remaining 3.3 percent. If this growth
rate were to continue, Michigan’s population
would total 10.1 million in 1980, 13.0 million in
2000, 16.7 million in 2020 and 21.5 million in
2040.

In estimating the effect of zero population
growth on Michigan’s future population size, the
following assumptions have been used:

1. In-migration would equal out-migration.

The two have been in balance in recent
years, and there is no reason for assuming
that this will change.

2. Age-specific death rates for males and fe-
males would remain constant at present
levels (TABLE 1).

In almost all age and sex groups, death
rates changed only negligibly during the
past decade. This is expected to continue
unless a cure or method of prevention is
found for one or more of the leading
causes of death (i.e., heart disease or can-
cer) .

3. Age-specific birth rates would remain con-
stant at levels computed by multiplying all
current rates by ;;•*(, (TABLE 2).

In recent years, birth rates decreased most
rapidly among older women (35-44) and
least among younger (15-19) (TABLE 3).
The former are now at a very low level
and it therefore does not seem likely that
women in this age group could account for
a disproportionate share of further de-
creases in the number of births.

Should the above occur, we could then antici-
pate that

MICHIGAN MEDICINE MAY 1972 435

ZPG IN MICHIGAN /Continued

TABLE 1

Age-Specific Death Rates
(Per 1,000 Estimated Population
in Specified Age and Sex Group)
Michigan, 1970

Age (in years)

Total

Male

Female

Less than 1 . .

21.65

24.72

18.47

1-4

0.85

0.97

0.73

5-9

0.45

0.54

0.36

10-14

0.40

0.49

0.31

15-19

1.11

1.63

0.58

20-24

1.43

2.33

0.64

25-29

1.66

2.28

1.10

30-34

1.40

1.87

0.96

35-39

2.06

2.55

1.61

40-44

3.80

4.78

2.81

45-49

6.18

7.80

4.60

50-54

9.84

12.76

6.97

55-59

13.77

18.48

9.27

60-64

20.47

27.89

13.59

65-69

31.72

41.01

22.98

70-74

49.17

61.47

38.22

75-79

66.13

86.51

51.48

80-84

112.46

140.32

94.67

85 or more . ,

193.03

212.98

181.70

TABLE 2

Age-Specific Birth Rates
(Per 1,000 Females in Specified Age Group)
and Adjusted Age-Specific Birth Rates
(On the Basis of ZPG)

Michigan, 1970

Age of Mother Adjusted

(in years) Birth Rate Birth Rate

10-14 0.888 0.732

15-19 65.020 53.569

20-24 171.225 141.071

25-29 173.938 143.306

30-34 64.441 53.092

35-39 27.319 22.508

40-44 8.914 7.344

45-49* 0.553 0.456

‘Includes a few births to mothers older than this

1. The number of Michigan residents will in-
crease an average of about 0.5 percent per
year until 2030 as compared with a current,
actual growth rate of 1.1 percent annually.

The present population of 9,000,000 should
reach a maximum 12,000,000 around 2030
and will decline slightly thereafter. This
latter figure is 6.9 million (or 36.5 percent)
less than the 18,900,000 residents antici-
pated on the basis of a continuation of
current, actual growth rates (TABLE 4).

2. The median age of the population will in-
crease an average of 0.16 years annually,
from the present 26.5 to 36.3 by 2030 (TABLE
5).

By that year, 15.2 percent of the popula-
tion will be 65 years of age or older com-
pared with the current 8.4 percent. Con-

436 MICHIGAN MEDICINE MAY 1972

versely, the proportion under 20 will de- I
crease from 40.3 to 28.3 percent. Those
between 20 and 64 will increase from the
present 51.3 to 56.5 percent of the total
population.

3. The number of residents under 15 years of
age will decrease 4.9 percent by 2030. All
other age groups will increase (15 to 24 —
1.0%; 25 to 44-50.8%; 45 to 64-62.7%;

65 to 84—151.2%; 85 and over — 43.9%).

While the largest percentage increase will
be between 65 and 84, the largest numer-
ical rise will be between 25 and 44 years
of age. This group accounted for 24.7 per-
cent of the total population in 1970 and is
expected to include 27.5 percent of all
residents in 2030.

4. The ratio of dependent (under 20 and 65 or
more) to working age (20-64) population
will decrease from 0.95 to 1 in 1970 to 0.77
to 1 in 2030.

This changing ratio reflects the sum of
two divergent trends. While the ratio of
older to working age population will rise
(from 0.16 to 1 in 1970 to 0.27 to 1 in
2030) , the ratio of younger to working age
population will drop (from 0.79 to 1 in
1970 to 0.50 to 1 in 2030) . That is, while
less than one-sixth of the dependent pop-
ulation now is 65 or older, by 2030 this
will be more than one-third.

5. Due to the gradual aging of the population,
the crude death rate will increase an average

TABLE 3

Total Fertility Rates
and Age-Specific Birth Rates
by Color

United States. 1940. 1950. 1960-1968

Year and Color

Total Fertility
Rate

10-14

15-19

TOTAL

1968

2,476.8

1.0

66.1

1966

2,736.1

0.9

70.6

1964

3,207.5

0.9

72.8

1962

3,473.5

0.8

81.2

1960

3,653.6

0.8

98.1

1950

3,090.5

1.0

81.6

1940

2,301.3

0.7

54.1

WHITE

1968

2,368.4

0.4

55.3

1966

2,609.2

0.3

60.8

1964

3,073.7

0.3

63.2

1962

3,347.5

0.4

73.1

1960

3,532.9

0.4

79.4

1950

2,976.8

0.4

70.0

1940

2,229.1

0.2

45.3

ALL OTHER

1968

3,196.9

4.4

133.3

1966

3,614.9

4.0

135.5

1964

4,153.4

4.0

138.7

1962

4,395.8

3.9

144.6

1960

4,522.1

4.0

158.2

1950

3,928.3

5.1

163.5

1940

2,870.2

3.7

121.7

of 0.7 percent per year, from the present 8.8
(per 1,000 population) to 12.8 in 2030.

The annual number of deaths will then
be double the current figure. Chronic con-
ditions related to old age should cause an
increasing proportion of this increasing
number of deaths. That is, unless major
cures or preventive measures are found,
the number of deaths from causes such as
heart disease, cancer, vascular lesions, di-
abetes, and arteriosclerosis should rise sig-
nificantly.

6. Due to the declining proportion of women
in the child bearing ages, the crude birth
rate will decrease an average of 0.3 percent
per year, from the present 15.7 (per 1,000
population) to 13.0 in 2030.

Age of Mother (in years)

20-24

25-29

30-34

35-39

40-44

45-49

167.4

140.3

74.9

35.6

9.6

0.6

185.9

149.4

85.9

42.2

11.7

0.7

219.9

179.4

103.9

50.0

13.8

0.8

243.7

191.7

108.9

52.7

14.8

0.9

258.1

197.4

112.7

56.2

15.5

0.9

196.6

166.1

103.7

52.9

15.1

1.2

135.6

122.8

83.4

46.3

15.6

1.9

162.6

139.7

72.5

33.8

8.9

0.5

179.9

146.6

82.7

40.0

10.8

0.7

213.1

176.2

100.5

47.7

13.0

0.7

238.0

187.7

105.2

50.2

14.1

0.8

252.8

194.9

109.6

54.0

14.7

0.8

190.4

165.1

102.6

51.4

14.5

1.0

131.4

123.6

83.4

45.3

15.0

1.6

200.8

144.8

91.2

48.6

15.0

1.2

228.9

169.3

107.9

57.7

18.4

1.4

268.6

202.0

127.5

67.5

20.9

1.5

285.7

217.4

132.4

72.0

21.7

1.5

294.2

214.6

135.6

74.2

22.0

1.7

242.6

173.8

112.6

64.3

21.2

2.6

168.5

116.3

83.5

53.7

21.5

5.2

Despite

this

gradually

declining rate, the

number of

live births

will

increase (re-

fleeting the growth in the total popula-
tion) and then reach a plateau somewhat
above current levels.

7. Due to the greater life expectancy of women
at all ages (TABLE 6), the current excess of
females in the older age groups will widen
considerably.

At present, in the age group 65 to 84,
there are 120 females for every 100 males.
By 2030, this ratio will be 144 to 100.
Among those 85 or older, there are pres-
ently 177 females for every 100 males. By
2030, this ratio will be 254 to 100. The
number of females 65 or older will in-

TABLE 4

Estimated Population
Based on Present Growth Rate and ZPG
Michigan, 1970-2040

ESTIMATED POPULATION DIFFERENCE

Based on Present Based on

Year Growth Rate ZPG Number Percent

1970 8,901,381 8,901,381

1980 10,068,306 9,607,064 461,242 4.6

1990 11,422,084 10,421,627 1,000,457 8.8

2000 12,957,881 11,026,545 1,931,336 14.9

2010 14,700,180 11,424,558 3,275,622 22.3

2020 16,676,745 11,828,016 4,848,729 29.1

2030 18,919,339 12,017,783 6,901,556 36.5

2040 21,462,792 11,967,431 9,495,361 42.8

MICHIGAN MEDICINE MAY 1972 437

ZPG IN MICHIGAN/Continued

TABLE 5

Estimated Population Distribution by Age
Michigan, 1970-2040

YEAR

Age (in years)

1970

1980

1990

2000

2010

2020

2030

2040

0-14

15-24

25-44

45-64

65-84

85 or more .

Total

Median ..

. .2,710,440
. . 1,589,470
. .2,194,971
. .1,658,383
. . 701,227
. . 46,890

. .8,901,381
. 26.5

2,341,060

1,894,503

2,614,788

1,876,794

835,223

44,696

9,607,064

28.3

2,498,333

1,579,445

3,400,942

1,947,926

949,551

45,430

10,421,627

31.8

2,637,624

1,574,967

3,320,849

2,346,327

1,088,493

58,285

11,026,545

33.6

2,437,058

1,773,675

3,013,796

3,039,066

1,098,078

62,985

11,424,658

35.1

2,490,225

1,623,735

3,267,083

2,929,578

1,443,573

73,822

11,828,016

35.3

2,579,131

1,605,730

3,310,699

2,698,615

1,761,346

62,262

12,017,783

36.3

2,478,696

1,712,650

3,148,215

2,911,497

1,610,049

106,324

11,967,431

36.3

crease 163.0 percent by 2030 compared
with a 120.1 percent rise for males.

8. The median age of Michigan’s female resi-
dents will increase more rapidly than for
males.

The median age of females in 1970 was
27.4, or 1.9 years more than the 25.5 for
males. By 2030, the female median age
will be 37.5, or 2.3 years more than the
35.2 projected for males. This widening
disparity primarily reflects the greater in-
ctease of females in the older age groups.

Discussion

A discussion of zero population growth prop-
erly should focus on three major areas. The first
of these is that it has a number of important im-
plications which have not as yet been fully recog-
nized. The most apparent is the resultant aging
of the population with a sizeable reduction in the
proportion of younger residents and a concomitant
increase of those 65 years of age or older. Thus for
example, we can anticipate that the need for addi-
tional school teachers will be minimal unless pres-
ent faculty-student ratios are increased substantial-
ly. If the number of new teachers is not reduced
drastically, we must expect the current excess in
all but a few subject areas of this profession to
evolve into a chronic problem. Related to this,

TABLE 6

Average Life Expectancy by Age and Sex
Michigan, 1970

Average Life Expectancy (years)

Age (in years) Total Male Female

0 70.3 66.9 74 2

5 67.0 63.7 70.6

15 57.3 54.0 60.9

25 47.9 45.0 51.2

35 38.6 35.8 41.7

45 29.6 26.9 32.5

21 6 19.2 24.1

14.6 12.8 16.3

9-2 7.9 10.2

most future school construction will be limited to
new residential areas and to replacement of obso-
lete units. Conversely, the number of retirement
villages, nursing homes and other special facilities
for older residents should continue to rise.

Among physicians, growth should be concen-
trated in specialties such as gerontology, cardiol-
ogy, surgery and psychiatry. The need for obstetri-
cians and pediatricians should remain close to
present levels. Commonly recommended ratios of
physicians to general population will no longer be
applicable since the larger number of older resi-
dents should produce a higher utilization of med-
ical services. Obstetrics wards, which in most cases
now operate at 50-65 percent of capacity, should
not expect any sizeable increase in patients. Ac-
celerated efforts at merger or reduction in bed
capacity should therefore be anticipated.

Not so apparent is the large expected increase
in the working age population. The number of
residents between 20 and 64 will rise nearly 50
percent (or more than two million) at the same
time that the need for workers in many types of
employment remains essentially unchanged. Thus,
unemployment and partial employment should
continue at present, or even higher, levels unless
1) major new industries are developed 2) existing
industries are expanded significantly 3) the av-
erage work week is reduced substantially 4) retire-
ment at an earlier age becomes more widespread.

Much of Michigan's population growth in the
decade between 1960 and 1970 was concentrated
in the metropolitan area surrounding the city of
Detroit. Most of the remainder occurred in the
counties around the state’s other major cities
(Flint, Grand Rapids, Kalamazoo, Lansing) . All
of these experienced significant net in-migration
as well as an excess of births over deaths. The
cities and a majority of Michigan’s 83 counties
had a large scale net out-migration during this
period. In some cases, the 1970 census reported a
population count lower than 1960. In others, a
small population gain resulted from an excess of
births over deaths larger than the migration loss.

438 MICHIGAN MEDICINE MAY 1972

Should present patterns of intrastate population
movement continue, zero population growth would
have a most profound effect on the state’s cities
and non-metropolitan areas. These, in particular,
should anticipate a rapid aging of the population,
a rapid decrease in births and concomitant in-
crease in deaths, and an accelerating population
loss. In the 19 suburban counties changes would
probably be much more gradual. Since there is
little out-migration and immigration is mainly in
the younger age groups, these areas can expect that
the population age composition will change min-
imally for some time, birth and death rates will
remain near present levels, and the population
will continue to increase. The 1970 census re-
ported that, for the first time, a majority (51.3
percent) of Michigan residents lived in the areas
surrounding the state’s major cities. This trend,
particularly under age 45, should accelerate in
coming years. By 2030, with ZPG, three-fourths or
more of the state population will reside in these
counties.

A second factor to be considered is the stated
assumption that age-specific mortality rates would
remain at present levels. We do not, of course,
know whether or not this will be correct. Presi-
dent Nixon has recently proposed a greatly ex-
panded program to find a cure for cancer. This, by
itself, would increase average life expectancy about
five years. Similar efforts are under way regarding
other chronic illnesses. Should these be successful,
we would then experience 1) a more rapid aging
of the population 2) an average annual popula-
tion increase greater than the 0.5 percent esti-
mated with ZPG 3) an extension of the period
required to achieve population stability (a bal-
ance between births and deaths) .

The final focus in a discussion of zero popula-
tion growth should be on the reality of this con-
cept. As mentioned in the introduction, this would
require a reduction of about 20 percent in the

number of births. While an annual decrease of

30.000 births to Michigan women would appear to
involve a mammoth endeavor, it is actually quite
readily attainable. As shown in Table 3, fertility
rates for the United States decreased by nearly
one-third between 1960 and 1968. Although this
decline did not continue in 1969 and 1970, pre-
liminary data for 1971 indicate a resumption of
this trend with fertility rates which are probably
at the lowest level in our country’s history. In
Michigan, as in the rest of the United States, the
number of births in 1971 was lower than in 1970
despite an increase in the number of women in
the child bearing ages. While final data are not as
yet available, we estimate that there were 165,000
live births to Michigan mothers last year, or about

5.000 less than in 1970. This decline was quite un-
expected since most demographers had assumed
that the rising proportion of females in this age
range would result in an increasing number of
births and a rising birth rate.

A number of studies in previous years have
shown that although desired family size in gen-
eral did not differ greatly among women of dif-
ferent socio-economic, ethnic and racial back-
grounds actual family size did differ quite signif-
icantly. The ready availability of the pill, other
devices and methods of birth control is enabling
an increasing number of women to limit the size
of their families to the levels they wish to have.
One indication of this has been the sharp drop in
births of higher order (fourth or more) and to
women in the older ages. Anticipated expansion of
family planning services throughout Michigan
should therefore lead to further reduction in fer-
tility rates. Japan and a number of countries
in northern, central and eastern Europe have
achieved, or are near, zero population growth.
Given the above, there is a distinct possibility
that this will also be reached in Michigan, as in
the rest of the United States, within a few years.

MICHIGAN MEDICINE MAY 1972 439

Si

MICHIGAN
DEPARTMENT
OF PUBLIC
HEALTH

Monthly Surveillance Report

Cases of Certain Diseases Reported
To the Michigan Department of Public Health
For the Five-Week Period Ending March 31, 1972

1972

1971

1972

1971

Total

This

Same

Total

Total

Cases

5-Week

5-Week

To Above

Same

for

Period

Period

Date

Date

1971

Rubella

347

470

583

902

2,955

Congenital Rubella Syndrome

0

1

0

1

1

Measles

382

246

710

375

2,659

Whooping Cough

14

11

35

27

140

Diphtheria

0

0

0

0

1

Mumps

Scarlet Fever &

608

2,457

1,301

4,856

10,748

Strep Sore Throat

1,747

1,965

4,286

4,654

11,244

Tetanus

0

0

0

0

7

Poliomyelitis (paralytic)

0

0

0

0

0

Hepatitis

Salmonellosis

483

552

1,253

1,363

4,828

(other than S. typhi)

66

51

173

153

691

Typhoid Fever (S. typhi)

0

0

1

1

10

Shigellosis

41

18

135

57

295

Aseptic Meningitis

11

9

20

29

239

Encephalitis

4

8

20

32

108

Meningococcic Meningitis

6

14

15

25

64

H. Influenza Meningitis

11

6

20

20

82

Tuberculosis

195

222

439

462

1,824

Syphilis

491

357

1,302

990

4,689

Gonorrhea

2,157

1,759

5,399

4,750

22,115

Information can be supplied by the local health department on the local incidence of disease.

Maurice Reizen, M.D., Director
Michigan Department of Public Health

440 MICHIGAN MEDICINE MAY 1972

A new look at the turtle problem

Editor's Note: At the present time there are
legislative efforts being promulgated to control
the sale of turtles as pets. The following ar-
ticle is a study sponsored by Life Science, Inc.,
79k Woodward Ave., Birmingham, Mich. This
organization is a group of scientists formed in
1971, to provide a multidisciplinary, scientific
base for environmental studies. The group in-
cludes clinical chemists, microbiologists, a ge-
ologist, entymologist, two clinical pathologists,
an internist, an ecologist and others.

John W. Moses, MD
Scientific Editor

By Edwin M. Knights, Jr., MD
Dennis Swieczkowski, MSc
Southfield

Salmonellosis remains an endemic health prob-
lem in Michigan; in fact, reported cases have in-
creased over the past three years:

1969 539

1970 665

1971 700

Obviously all cases are not recognized and re-
ported, so that the true incidence must be appre-
ciably higher. In 1971, 87 of the cases were re-
ported from Oakland County.

The role of pet turtles in the epidemiology of
human salmonellosis has been recognized for some
time.1-3 The Michigan State Department of Public
Health has evidence that at least 31 cases of sal-
monellosis have apparently been due to these pets.4
Two states (Washington and Maryland) and one
county in Michigan have passed legislation effec-
tively controlling their sale. Maryland’s regulation
makes it unlawful to sell or offer for sale to the
public live turtles without acceptable laboratory
proof that such animals are free from salmonella
or other contamination that may cause human dis-
ease. In a survey conducted recently by the Enteric

Doctor Knights is Director of Laboratories,
Providence Hospital, Southfield and Dennis
Swieczkowski is Microbiologist, North land-Oak-
land Medical Laboratories, P.C., Southfield.

Diseases Section of the Bacteriology Branch of the
Center for Disease Control, 24 of 26 state epidemi-
ologists reported that they believe regulation of
the importation, shipment and sale of pet turtles
is desirable.5

Turtle Food

Although there has been rather extensive doc-
umentation of the hazards associated with turtles,
relatively little information is available as to the
quality of commercially available turtle food.1 It
has been shown that baby turtles are frequently
contaminated via the cloaca, but also salmonellae
have been found in the meat meal and bone meal
used for food on the breeding farms. The authors
felt that there was justification for a survey of
turtle foods sold to the retail customers to evaluate
them as possible sources of infection. As these
foods are usually dumped into the aquarium
water, there is good opportunity for prolonged
incubation of bacteria. The aquarium is usually
emptied into the kitchen sink, offering still further
possibilities of contamination.

Turtle foods are readily available on the shelves
of supermarkets, department stores, discount stores
and pet shops. They offer a remarkable degree of
variety designed to tempt the palate of the most
discriminating terrapin:

Brand; Contents: (as listed by manufacturers)

1 Com meal, fly larvae, wheat middlings,

beef liver, soybean meal, fish meal, meat
meal, calcite, alfalfa meal, animal fat pre-
served with BHT.

2 Dried flies.

3 Dried whole flies, meat meal, menhaden

fish meal, 1% precipitated calcium phos-
phate, oat and soy flour.

4 Com meal, wheat middlings, fly larvae,

soybean meal, fish meal, meat meal, calcite,
alfalfa meal, animal fat preserved with
BHT.

5 Corn meal, fly larvae, wheat middlings,

beef liver, soybean meal, fish meal, meat
meal, calcite, alfalfa meal, animal fat pre-
served with BHT.

6 Animal liver meal, menhaden, fish meal,
mosquito larvae, lettuce powder, bone

MICHIGAN MEDICINE MAY 1972 441

TURTLE PROBLEM/Continued

phosphate, dicalcium phosphate, soy le-
cithin, ferrous sulfate exsiccated, irradiated
dried yeast, cod liver oil.

7 Dried ant eggs.

8 Animal liver meal, menhaden, fish meal,
dried whole flies, lettuce powder, bone
phosphate, dicalcium phosphate, soya le-
cithin, ferrous sulfate exsiccated, irradiated
yeast.

9 Same as #5.

10 Dried whole shrimp.

Of the brands studied, only one appeared to
include a lot number identification which might
permit prompt removal of contaminated lots from
the retailers’ shelves.

Methodology

Twenty-four packages of turtle food were pur-
chased at random over a 30-day period from re-
gionally located retail outlets; these included 10
different brand names but were actually processed
by four companies.

Approximately one gram of each turtle food
was added to a tube of Gram Negative Broth
(BBL), mixed well, and incubated in a 5 per cent
carbon dioxide atmosphere at 36°C. After 18
hours incubation, one loopful of each GN broth
was streaked on to each of the following: Salmo-
nella-Shigella, XLD and MacConkey’s agar plates.
The plates were then incubated as described
above. Suspicious colonies from each agar plate (as
described in the BBL manual for each medium)
were selected and inoculated into r/b media (Diag-
nostic Research, Inc., Roslyn, N.Y.). After incuba-
tion, those cultures yielding reactions indicative
of salmonella were typed with polyvalent antisera,
and if found positive, were also typed with salmo-
nella grouping antisera (Lederle) . Bacterial cul-
tures thus identified as salmonella were sent to
the Michigan Department of Public Health lab-
oratories for speciation.

Results

Ten of the turtle food samples were found to
contain numerous coliform organisms (Enterobac-
ter) ; each of these products were ones containing

meat and fish meal. Three of the specimens con-
tained rare Pseudomonas organisms. One sample
was found to contain numerous salmonella, group
E (Lexington) .

Comment

Even from this limited survey it is apparent that
turtle foods, as well as the turtles, offer an excel-
lent vehicle for the potential spread of disease.
The validity of a laboratory report certifying a
“clean bill of health” for a turtle on the basis of
a single laboratory examination must also be ques-
tioned. The situation is analagous to that of the
licensed prostitute with her health card; we must
consider the possibilities of reinfection.

The habits of turtles, plus their environment in
captivity, predispose to such reinfection. Birdsey
and Lynch report that both Testudo graeca and
T. hermanni, sold as household pets, are coproph-
agic. Wild T. hermanni were observed chewing
horse dung, and in captivity they will eat human,
bovine, or their own feces with avidity even when
fresh lettuce leaves are available.6 In view of this
evidence one cannot help but wonder if the gour-
met turtle concoctions are not more impressive to
the turtle owner than to the pets. We are forced
to the conclusion that both humans and turtles
need protection from some of the commercial
turtle foods.

References

1. Williams, L.P., and Helsdon, H.L.: Pet Turtles as a
Cause of Human Salmonellosis. JAMA 192:347-351,
1965.

2. Boycott, J.A.; Taylor, J.; and Douglas, H.S.: Salmo-
nella in Tortoises. J. Path. Bact. 65:401-411, 1953.

3. Editorial: Tortoises, Terrapins, and Turtles. Brit.
Med. J. 4:758-759, 1969.

4. Reizen, M.: Personal communication.

5. Rice, P.A.: Personal communication; Taylor, A.:
Present Status of the Survey of State Epidemiol-
ogists Regarding Legislation to Regulate Importa-
tion, Interstate Shipment, and Sale of Turtles, Dec.
30, 1971.

6. Boycott, J.A.: Salmonella Species in Turtles. Science
137:761-762, 1962.

442 MICHIGAN MEDICINE MAY 1972

cperiiiatal Tips

By Paul M. Zavell, MD
Detroit

The following case from the files of the Wayne
County Medical Society Perinatal Mortality Com-
mittee is presented as an aid in continuing educa-
tion.

Maternal

This was the first pregnancy for this 17ryear-old
O+, white, unmarried clinic patient.

She had had no prenatal care prior to the sixth
month of pregnancy. At this time she had both a
sore throat and noted the onset of a thick yellow
vaginal discharge.

When seen her throat was injected but she was
afebrile and the rest of the physical exam was nor-
mal except for the pregnancy and a small amount
of vaginal discharge. Her white blood count was
10,200 and 'a vaginal smear failed to reveal any
organisms. Because she was a clinic patient and
had received no prior prenatal care she was given
a shot of 1,200,000 units of all purpose Bicillin IM
and started on Oral Triple Sulfa 500 mgm q.i.d.

Following this visit she failed to return for any
more prenatal care.

Doctor Zavell is chairman, Neo-Natal and Hos-
pital Care Committee, Michigan Chapter, A.A.P.,
and Chairman, Paranatal Mortality Study Com-
mittee, Wayne County Medical Society.

At about 38 weeks of pregnancy she reappeared
in the emergency room in active labor of about
14 hours duration with labor pains three to five
minutes apart. It was learned her membranes had
ruptured “hours before” she started in active labor
and that she had felt sick for several days with a
“cold” (low grade fever, cough and stuffy nose).
Studies done upon admission were as follows:

(1) VDRL was non-reactive

(2) CBS: Hgb = 9.8 gm WBC = 4500 PMN
= 70 Bd = 04, Lymph = 26

(3) Urine: S.G. = 1,020, Albumin, Sugar, Ace-
tone and Microscopic all negative.

Four hours after admission she delivered her
daughter. Her “estimated” weight gain was 10
pounds during pregnancy and she had a blood
pressure of 130/86.

Following delivery a throat culture revealed H
Influenza and she was treated with Ampicillin 250
mgm q.i.d. This with bed rest resulted in a “cure”
of her cold. She was discharged home on Feosol
Tablets.

Fetal

A five-pound, 12-oz. white female was born with
Apgar Scoring of 10 at both one and five minutes.

The initial physical exam was entirely normal
but because of the mother’s OB history the infant
was placed in a “suspect” nursery and observed for
24 hours. No symptoms developed except the be-
ginning of slight jaundice at about 24 hours which
worsened in the next 24 hours. She was transferred
to the regular nursery at the end of 24 hours of
age.

By 48 hours of age it was felt the jaundice was
on an A-O basis since cord blood was A+. She was
placed under the Bilirubin light. Bilirubin at 24
hours was 7.0 mgm % indirect and 0.5 mgm %
direct and at 48 hours was 14.5 mgm % with 1.0
mgm % direct.

On the third day of life with the jaundice
worsening it was also noted that the infant had a
rectal temperature of 97° (despite being under the
Bilirubin light) and she began to “spit-up” occa-
sionally.

The pediatrician on call for staff pediatrics
examined the patient and found little to alarm
him. However, he alerted the blood bank that he

MICHIGAN MEDICINE MAY 1972 443

PERINATAL TIPS /Continued

(^Micliigari author's

M. A. Block, MD, Detroit, “Neurotic Woman with
Questionable Carcinoma,” Questions and Answers
section, Journal of the American Medical Associa-
tion, page 1771, March 27, 1972.

C. D. Jackson, MD; E. J. Van Slyck, MD; E. S.
Caldwell, MD, Detroit, “Genetic Counseling in
Hemoglobinopathies,” a letter, Journal of the Amer-
ican Medical Association, page 1633, March 20.

Frank A. Smith; Geoffrey Trivax; David A. Zuehl-
ke; Paul Lowinger, MD, and Thieu L. Nghiem, MD,
MPH, Detroit, “Health Information During a Week of
Television,” New England Journal of Medicine,
page 516, March 9.

M. J. Tabaee-Zadeh, MD; Boy Frame, MD, and
Kenneth Kapphahn, MD, Detroit, “Kinesiogenic
Choreoathetosis and Idiopathic Hypoparathyroid-
ism,” page 762, The New England Journal of Med-
icine, April 6, 1972.

T. J. Vecchio, MD, Kalamazoo, “Resistance to
Antibiotics by Gonococci,” a letter, page 128, Jour-
nal of the American Medical Association, April 3,
1972.

might need O Negative blood of low titer if the
Bilirubin went any higher.

About six hours later he was called because the
infant seemed a little more irritable and was suck-
ing poorly. He ordered the blood from the blood
bank and told the nursery to call him when it was
ready. Three hours later the infant’s blood was not
ready but the infant had a “prolonged” convul-
sion and “arching” was noted. The pediatrician
came in to see the infant but before he came the
infant had two more “prolonged” convulsions and
expired.

A post-mortem was done revealing E-Coli Sepsis
with positive blood and C.S.F. cultures and signs
of infection in C.N.S. (Meninges with some PMN’s
and Exudate) and in the lungs (bilateral Broncho-
pneumonia).

Perinatal Committee Comments

1. The committee felt both a culture and
VDRL should have been done when the mother
was seen in the sixth month of pregnancy.

2. Penicillin -G is still preferable (but Ampi-
cillin is acceptable) in Gonococcal V.D. However,
failure or recurrence rates have risen in recent
years. The committee feels this is due to inade-
quate amounts being used and recommends two
to four million units (or more) . No rationale for
the use of Triple Sulfa could be seen here.

3. On initial contact with an indigent pregnant
patient where it is doubtful prenatal care will be
continued, it is felt wise to assign a public health
nurse to visit and follow the patient.

4. In a case such as this with evident infection
in the mother and jaundice in the first 24 to 48
hours of life one should be alerted to possible in-
fection in the infant and antibiotics should be
started.

444 MICHIGAN MEDICINE MAY 1972

This is the month that Michigan's cit-
izens take an appreciative look around
them and celebrate their state. Their
celebration hits a high during Michigan
Week (May 20-27 this year). Three of

Michigan's greatest assets are her med-
ical schools , and so, this May, MICH-
IGAN MEDICINE presents the follow-
ing articles by the deans of those
schools, who express their hopes and
aspirations for their schools.

University of Michigan:

Meeting the challenges of research,
basic health care and specialized training

By John A. Gronvall, MD
Dean, U-M Medical School
Director, University Medical Center

The unique mission of a medical school is to
educate and prepare students for the career of
physician. In the special instance of the University
of Michigan Medical Center, consisting as it does
not only of a medical school but also of the Uni-
versity Hospital and the School of Nursing, this
mission is broader and deeper. It includes, in ad-
dition to satisfying certain academic and clinical
requirements for the practice of medicine, the
training of supporting health personnel, the investi-
gation of biomedical problems, and the care of
patients. Ultimately an institution such as ours ad-
dresses its total resources to maintaining health
as a primary human value and the indispensable
basis for the enjoyment of all other human values.

As the product of another medical school and
as a relative newcomer to the Michigan scene, I
can bear relatively unbiased witness to the way
in which, historically, the University of Michigan
has carried out its mission.

Examples of excellence can be found in virtually
all of the biomedical specialties, literally from an-
atomy to zoology, from the laboratory to the clinic,
and from the classroom to the patient care unit.
From the U-M Medical School faculty have come
textbooks used by faculties of other medical
schools. From the U-M Medical School faculty
have come the department chairmen, deans, and
executive officers of other universities and colleges.
And from the U-M Medical School have come
techniques, program models, and scientific dis-
coveries which have had immeasurable impact on
the health of people throughout the world. Basic
pioneering work on steroids, enzymes, tissue re-
jection, genetics, nuclear diagnostics, virology, re-
productive biology and a host of other endeavors
continue to carry the UM reputation for excellence.

In the clinical field one need only recall the
past 30 to 40 years to find the names of doctors
who contributed to this reputation: Alexander,
Badgley, Coller, Curtis, Furstenberg, Hodges, Kahn,
Miller, Nesbit, Peet, Sturgis, Weller, and Wilson.
It would be difficult to find a more formidable list
of teachers than these in the history and the halls
of many institutions.

Behind the great names are pioneering programs.
Perhaps one of the most far-reaching of these in
the lives of many Michigan physicians is the post-
graduate medicine program developed under the
leadership of Doctors John Sheldon and Harry
A. Towsley. Beginning in 1927 as the first state-
wide program in the country in continuing medical
education, the U-M postgraduate program today
conducts sessions at 15 established centers, is
affiliated with 13 Michigan hospitals, and enrolls
upwards of 1,500 Michigan physicians annually in
its intramural medical courses. In the U-M post-
graduate model are to be found the antecedents
of affiliations and regionalization. The current coro-
nary care program carried out in 10 Michigan
community hospitals and underwritten by the Kel-
logg Foundation is but a single example of how
smaller community hospitals participate in the
technical resources of a medical center.

Dean Gronvall

MICHIGAN MEDICINE MAY 1972 445

MICHIGAN’S MEDICAL SCHOOLS/Continued

The past 30 years

An historic survey of the U-M Medical Center
for the past 30 years is impressive, indeed:

... In 1940-41, research funds, both private
and federal, amounted to no more than $137,000
per year. Within 15 years this sum grew to more
than $12 million.

. . . The total square footage of buildings for
medical education, research and patient care pro-
grams increased from 950,000 to 2,409,632 sq. ft.
Fifteen new buildings have been constructed and
occupied during this period.

. . . Three new departments were created: physi-
cal medicine, anesthesiology and human genetics.
Four new institutes have been established: the
Mental Health Research Institute, the Buhl Center
for Human Genetics Research, and the Upjohn
Center for Clinical Pharmacology. The fourth, the
James and Lynelle Holden Perinatal Research
Laboratories, will soon be occupied.

. . . The total undergraduate student body of
the Medical School in 1940-41 was 472 compared
with 881 in 1971-72. Three times that number, over
2,700, are taught or trained by medical school
faculty when hospital housestaff, graduate dental,
pharmacy, nursing and postgraduate students are
counted.

. . . Incoming classes of medical students were
increased in size from the 1940 number of 120
to 225 at present. The largest class ever to be
graduated from the U-M Medical School, 202, re-
ceived their diplomas in June, 1971. Plans and pro-
grams are now being developed to accommodate
an entering class of 300, and a new integrated
premedical-medical curriculum is about to begin
on an experimental basis that will not only broaden
the intellectual content of medical students but also
enable them to obtain their degrees in five or six
years after high school.

. . . The U-M Medical School is said to have
graduated more Black physicians than any other
American medical schools, excepting Howard and
Meharry. The U-M Medical School has already
exceeded the 1975 University-at-large Black stu-
dent enrollment goal.

. . . The size of the medical school faculty has
grown from 164 to 578 between 1970-71.

. . . Administratively the Medical Center is
served by a Dean-Director, consists of the Medical
School, the University Hospital, and the School of
Nursing, and is supported by a Board-in-Control
now including representatives of the public-at-
large. The Center staff also includes a fulltime di-
rector of planning, a director of public information,
and a soon-to-be-appointed director of develop-
ment.

Soren Kierkegaard, the Danish philosopher who
greatly influenced modern thought, once wrote:
“Life must be lived forwards but can only be
understood backwards.” Annual reports and ency-
clopedic histories reflect that truth, for they are
recitations of the past, which is the whole basis

for our understanding, but they are also a fore-
telling of the future toward which we all look. I
did not think it possible to present a prospective
picture of the U-M Medical Center without this brief
retrospective review. The important questions and
issues which face us as a center for medical and
health education are critical questions, and their
answers are based on certain assumptions, not
the least of which is that the U-M medical center
should continue to apply its historic standards
of excellence to changing health care patterns and
to solving dominant health care problems.

There is still a critical shortage of health man-
power. There is still inadequate distribution and
availability of health services. And there is still
inadequate control of the rising cost of these
services. These are problems which cannot be
swept away by rhetoric, nor for that matter by
short-term solutions. They cannot because they
speak to the physician as an educated citizen as
much as a trained clinician. They challenge the
teaching hospital as a community institution as
much as a highly specialized clinical resource.
And because these problems touch on the very
quality of human life, they go beyond the im-
mediate, practical medical solution for a specific
disease to our total concept of humanity.

Space does not here permit examination on
depth of the presuppositions, assumptions, ideas
and concepts which always underlie practical solu-
tions to pressing social problems. But they are
there, and examine them we must. I would hope
that every physician in Michigan will re-examine his
instincts, his motivations and his goals, as we at
the University have done each year at our faculty
retreats. The day-to-day practice of medicine, not
to say its teaching, requires introspection if we
are to make meaningful progress in the solution
of health care problems. Without this sense of his-
tory and tradition a commitment becomes a com-
pulsion, a solution becomes an expediency, and
action becomes an end-in-itself. I doubt that ever
before has the physician, or the teacher of phy-
sicians, faced such a staggering test of statesman-
ship. Our entire value system is being challenged
by the very forces of change which give it mean-
ing.

Combining tradition with innovation

Against this, then, the U-M Medical Center has
faced the question of its own future. Rich in his-
tory and deep in intellectual content, we are sensi-
tive about these values; we also remain alert to the
pressing need for practical solutions to urgent
problems.

First, we make the all-inclusive, philosophical
assumption that the medical profession is at its
roots a learned profession. It makes little sense
to prolong human life if, in the end, living it mean-
ingless as it is for so many people. Yet as phy-
sicians we are committed to prolonging life; we
are equally committed to making life bearable
and productive.

This assumption makes the U-M Medical Cen-

446 MICHIGAN MEDICINE MAY 1972

ter more than a doctor factory. It makes it, hope-
fully, an institution not only of technical learning
but a place where learning is respected beyond its
technical capacity.

The new integrated premedical-medical curricu-
lum is based on dual and sometimes competing
assumptions: we plan to train more doctors faster,
but by eliminating course duplications and by
closer attention to moral, social and attitudinal
growth, we hope our physicians who graduate
from this program will be better equipped to
deal with increasingly complex human problems.
The training and production of more paramedical
personnel and physician assistants will define even
more precisely the physician’s judgment; he will
need even more to know how to manage and
motivate a more complex health care team.

Second, we recognize that during the past 25
years the community hospital has achieved levels
of competence thought once only to be possible
in a teaching hospital or in a medical center. We
like to believe that the U-M Medical School and
the University Hospital through its postgraduate
program and its affiliations with community hos-
pitals in intern and residency programs contributed
to the high level of care now available throughout
Michigan. This, however, has been a successfully
self-limiting relationship; it has created a new role
for the University Hospital, and it appears to be
a dual role.

Stretched between teaching extremes

With the emergence of excellent acute care
facilities throughout Michigan, the University Hos-
pital will find its teaching obligations stretched
between the two exremes of primary and tertiary
care. As a teaching institution, it will be able to
apply its resources to experimental programs in
basic, primary hospital care for a given community
on the one hand; and it will also have to continue
to provide highly sophisticated, specialized care
and training on the other.

The Hospital has renovation and remodeling
programs which, costly though they are, will carry
it through a very important period of transition.
The hospital is rapidly reaching the point-of-no-
return in such renovation programs, and because
it is obsolete the main unit of the hospital will
have to be replaced in order for it to meet its joint
responsibilities of community and specialty care.
The simple statistical fact that one-third of the
people who die do so not because the causes of
mysterious diseases are unknown but because they
lacked simple, basic, primary care, is enough to
support experimentation in the delivery of this
care. This the University Hospital expects to do.
The simple fact is that equipping a neurosurgical
suite costs over a quarter of a million dollars,
and staffing and equipping a burn unit run per
diem costs upwards of $250 to $300 a day. These
facts force regionalization of care and concentra-
tion of such resources.

Finally, as a medical center, primarily responsible
to the State which supports it, we see a continuing
need for attention to basic biomedical problems.
In a real sense this is the global mission to which
great universities have always been committed.
The poliomyelitis vaccine was such a global chal-
lenge, and it was met by marshalling all of the
many resources of several universities. The epi-
demiology of high blood pressure and coronary
artery disease, the biochemistry of mental and
emotional disease, muscle and limb regeneration,
the impact of virus on birth defects, the synthesis
of enzymes, prostaglandins and many others —
these require inter-disciplinary scrutiny that is pos-
sible only in a medical center environment. As
pressure mounts to divert time and resources to
health care delivery problems, it will not be easy
financing a better future through basic research.

I believe the obligation for more imaginative
teaching, more responsive patient care, and more
rewarding research at the University of Michigan
Medical Center must and will be met.

Wayne State University:

Medical education in the horse

latitudes

By Robert D. Coye, MD
Dean, Wayne State University
School of Medicine

Medical schools during the past 15 years have
grown into academic medical centers. This has
been a very rapid passage on a steady course with
favoring winds of federal funding for research and
expansion of facilities, faculty and student enroll-
ment. This wind has now abated; and for most
schools, the sails are barely filled. Should we, like
the sailor explorers in the southern latitudes be-
calmed between the southern and northern trade

Dean Coye

MICHIGAN MEDICINE MAY 1972 447

MICHIGAN’S MEDICAL SCHOOLS/Continued

winds, lighten ship by throwing our horses over-
board and make the most of what little wind there
is? Obviously the horses are not needed for sail-
ing, but they are needed for further exploration
when a landfall is made. Our “horses” are the tra-
ditional academic requirements for admission to
and completion of the medical educational pro-
gram, and the faculty and curriculum that have
made the program work. During this lull, we have
some time — not much — to reconsider our past and
plot what our future course should be. Throwing
the horses overboard is one choice, but not the
only one.

We are, of course, in these latitudes because of
the “health care crisis.” The exact dimensions of
the crisis are arguable in terms of physician num-
bers, physician distribution, curricula for health
care personnel, systems of delivering health care,
health care economics, use of ancillary health per-
sonnel, and so on. However, there seems to be
little disagreement with the widely held view that
there is serious trouble with the provision of health
care for all of the citizens of this country. From the
public’s point of view, medical care is frequently
seen as being deficient in the four “A’s” of accept-
ability, accountability, availability and adequacy.
The situation is in many ways similar to that which
existed in the early 1900’s. The Flexner report grew
out of a concern that the public’s health was not
being well served by the then existing trade
schools of medicine. The reform suggested by Flex-
ner drove the trade schools out of business and
put medical education on a firm scientific base in
the universities. This time a variety of forces are
bringing us to a long, hard look at how the aca-
demic medical centers can best serve the public’s
health.

Health care answers will determine
medical center’s form

The basic questions are not too difficult to pose.
What does the public sense as the high priority
health needs? What will they pay taxes or give
gifts to support? What are the needs as seen by
the professionals? How can these views be
meshed? What then should be the role of the med-
ical center? What kinds of needs are there for
what kinds of health professionals, and how many
of each should we educate? What is the medical
center’s role in providing services to individuals,
families, and communities? What kinds of research
should we be doing, and for what purpose? How
can we evaluate how well we are doing these jobs?

The answers to these questions are harder to
come by. There is some data, but not nearly
enough to make easy and clearly correct decisions.
There is, for example, much doubt about how much
health care the public is really willing to pay for.
Certainly for “access to adequate health care,” but
what does this mean? Certainly not a board certi-
fied plastic surgeon in each hamlet, but is a family
physician or a “medex” or a good bus service to
the nearest city the answer? There are similar gaps
in our knowledge which pertain to answering most
of the other questions stated or implied above.

I doubt that we will soon have sufficient data,
agreement, or social organization to decide on how
we should proceed, but proceed we must. The an-
swer to this dilemma seems to be that we must
experiment, set up models, try out a variety of ways
of doing these jobs to see which one or ones work
best. This state of experimentation or lack of clear
and purposeful decision is alarming to many, and
quite properly so. Anxiety and tension mount. It is
a perfect seedbed for those with instant solutions,
divinely revealed truth or very strongly held but
vague ideas about the future of medical education
and medical care. This suggests that there should
be some guidelines for what is permissible and
what is not in our experiments.

I suggest one guideline. We should not under
any circumstances throw our academic horses
overboard. By this, I mean that we must be very
careful to preserve the notion that we want better-
educated, rather than less well-educated physicians
in the future. Reduction of premedical and medical
curricular time, pruning out “irrelevance,” use of
“on-the-job” training rather than academically su-
pervised education in the clinical years are all ap-
pealing in ways — mostly because they reduce costs
— but are steps in the direction of vocational rather
than professional education. Granted, many changes
are desirable in methods, content and sequence of
teaching, in evaluating students’ potential for study-
ing and practicing medicine, and in the postgrad-
uate education of physicians, but the urge to do
away with all that cannot be shown by objective
testing to be immediately “helpful to the doctor in
his regular work” must be resisted. Proficiency
testing for doctors is still a very long way from
being a reality. A necessary corollary of this argu-
ment is that while the education of doctors of med-
icine is very lengthy and expensive, not all that
doctors presently do requires this education. I
agree wholeheartedly with the concept of the phy-
sician’s assistant, who, with less lengthy and less
costly education, can work with the physician and
extend his capacity.

Dean Coye hopes to test
variety of theories & models

Beyond this single constraint, I hope that this
medical school will be very actively engaged in
testing a wide variety of theories and models of
medical education and practice. Being located in
the center of a very large urban area with all the
problems associated with the inner city right at our
doorstep, it is inconceivable that we will not be
involved in more outreach medical programs which
at the same time provide service to those living
in this area, and teach our staff and students how
such care can best be given and what kinds of
teams of health professionals must be trained to
provide it.

With the need for primary care so great, it is
clear that we must develop programs of under-
graduate and graduate training to do this work.
Present plans envisage an ambulatory care facility
to be called the University Clinics Building which

448 MICHIGAN MEDICINE MAY 1972

will provide for these kinds of programs as well as
the traditional specialty care of ambulatory pa-
tients. These programs obviously extend well be-
yond the traditional boundaries of the medical
school, and require carefully worked out linkages
with existing and yet-to-be-developed private health
related organizations and institutions of federal,
state and local government.

Similarly, as Wayne State has no “university hos-
pital” and will use the ambulatory care clinics as a
major base for clinical teaching, very close and
effective associations with the Detroit Medical Cen-
ter hospitals and the Veterans Administration Hos-
pital at Allen Park will be required to provide most
of the in-hospital learning experiences for our third-
year students. I also hope that hospitals and clinics
in the Detroit area and throughout the state will be
included in a network system which will provide
educational opportunities for medical students and
house staff for all of the Michigan medical schools.
This will be a new and exciting venture into what
in the past has been a “town-gown jungle.” We
must make the concerns of community hospitals for
quality medical care with sound financial base and
of private practitioners for continuing participation
in all areas of hospital care a real and apparent
part of our thinking. They, in turn, must understand
our problems and help us to provide the necessary
educational environment.

Research and graduate training will continue to
be a solid and indispensable part of our overall
responsibility. I see very great possibilities for new
research programs which gather strength from link-

ages with other schools of this University and with
other institutions such as the Michigan Cancer So-
ciety which are not formally a part of the univer-
sity.

Staggering number of plans
in medical school's future

This forecast of the future shows Wayne State
with a staggering number of new facilities, pro-
grams and agreements among institutions to be
planned and developed. The burden, however, will
be lessened by attitudes of cooperation resulting
from the recognition by those with whom we will
be working — whether a community organization, a
community hospital or another school of this uni-
versity— that their goals and ours have many more
points of convergence than divergence than ever
before.

We will continue to intensify our efforts in the
future because we believe that these new and ex-
perimental ways of accomplishing our objectives
will not only provide a clearer direction for us to
take in the future, but will also work toward bring-
ing the University and the community closer to-
gether so that our joint efforts magnify our chances
to succeed. It is both too late and too wrong to go
back to the isolated medical school of the 50’s,
and certainly too wrong to abandon the academic
basis of medical education. It is time, though, to
put the academic and the community’s interests in
good health into an appropriate harness where
both can pull together. Wayne Slate University
School of Medicine will be on this track.

MSU College of Human Medicine:

Committed to helping Michigan’s citizens

By Andrew D. Hunt, Jr., MD
Dean, Michigan State University
College of Human Medicine

It is now five and a half years since our first
class of 26 students was admitted. We were then
a “two-year medical school,” and two classes were
transferred to other medical schools to complete
their preparation for the M.D. degree. In general
those students did very well in the schools to
which they were transferred, and a considerable
number have returned to Michigan for internships
or residencies, and soon will be part of the Mich-
igan medical community.

In July, 1970, the Governor’s recommendation
that we be financed for a complete four-year school
was approved by the Michigan legislature, and the
class entering its second year became the first to
obtain the Doctor of Medicine degree from Mich-
igan State University. This group of 32 students
will, in fact, be graduating in the June 1972 Com-
mencement, and a new era in medical education in
Michigan will definitely have been established.

This, then, provides an opportunity to review and
analyze past history and make some hazardous
predictions into the future.

Original idea to

utilize existing departments

The initial plan for a medical school was that it
be integrated within the fabric of the university,

MICHIGAN MEDICINE MAY 1972 449

MICHIGAN’S MEDICAL SCHOOLS/Continued

utilizing the basic science departments already in
existence and serving the College of Veterinary
Medicine and the undergraduate and graduate pro-
grams in the College of Natural Science. To this
original concept was added the recognition of the
essential nature of the behavioral and social sci-
ences to medical education, and the Departments
of Sociology, Anthropology and Psychology, pre-
viously administered only by the College of Social
Science, were added to the administrative structure
of the College of Human Medicine.

This basic idea; namely of utilizing the all-uni-
versity biological and behavioral science depart-
ments within the College of Human Medicine, inno-
vative as it was, has stood the test of time and, in
general, is working very well. The departments
have been strengthened and augmented appropri-
ately, and have adapted well to the demanding re-
quirements of a modern curriculum for medical
education.

To this basic structure, in order of establishment,
have been added the following administrative en-
tities: The Office of Medical Education Research
and Development, the Department of Medicine, the
Department of Psychiatry, the Department of Hu-
man Development (pediatrics), the Department of
Surgery, the Office of Health Services Education
and Research, and the Department of Obstetrics,
Gynecology and Reproductive Biology.

The faculty which has been recruited is of a high
degree of excellence, and is both productive in
basic and clinical research and extraordinarily in-
terested in and dedicated to the improvement of
medical education. The curriculum, therefore, has
been a constantly changing one.

Sparing the reader the technical details of that
for which we are striving, suffice it to say that the
curricular goals and objectives include the follow-
ing:

1. Emphasis on the student’s responsibility for
learning so that he be prepared to be a continual
self-learner throughout his career.

2. Establishment of problem-solving as a funda-
mental method by which learning is achieved,
wherever appropriate, in favor of the more usual
didactic presentation and memorizing method.

3. Study and ultimate understanding of human
development from fertilization of the ovum through
senescence and death as a fundamental basic or-
ientation for medical education.

4. Strong emphasis on the doctor-patient relation-
ship and professionalization of the student, with
recognition that the establishment and maintenance
of an appropriate therapeutic relationship with the
patient is perhaps the major and most important
task of the physician.

5. Flexibility through the introduction of self-in-
structional media and provision of numerous op-
tions by which students can achieve the M.D. de-
gree, so that the time required to graduate may
vary from three years or less to four years or more,

according to the abilities, desires, or propensities
of the students themselves.

New curriculum
planned for '72

Next fall, an essentially new curriculum will be
instituted which, with new advising techniques,
evaluation methods, and elective arrangements
should have the effect of bringing such goals and
objectives closer to reality.

Since it is incumbent upon us to do all we can
to provide Michigan with as many physicians who
will practice in areas of need as possible, it was,
from the beginning, decided that a major part of
our students’ clinical experience would occur in
community settings where they would learn at first
hand real life problems of medical care where they
really happen, and, perhaps, be attracted eventual-
ly to opt in favor of a practicing career either in
communities in which part of their training was
obtained, or in similar ones.

Thus, for the past several years we have been
developing relationships with hospitals in such
communities as Lansing, Howell, Alma, Jackson,
Grand Rapids, Flint, Kalamazoo, Saginaw, and the
Detroit area so that students may obtain appro-
priately graduated clinical experiences ranging
from so-called primary clerkships starting in the
second or third year of medical education to more
sophisticated clinical hospital experiences appro-
priate for senior students. Cooperation of commu-
nity-based physicians, hospital staffs, hospital ad-
ministrators, and boards of trustees in the develop-
ment of various arrangements to implement our
goals and objectives has been truly extraordinary,
and we appear successfully to be demonstrating
how it is not only possible, but even desirable to
operate a program in medical education in hos-
pitals neither controlled nor owned by the medical
school.

By way of physical facilities, we have operated
until this year in improvised and renovated quarters
which, while serving with a considerable degree of
adequacy, have imposed much inconvenience on
faculty and students alike. The opening of Life Sci-
ences I in September of 1971, housing the Depart-
ments of Medicine, Human Development, and
Pharmacology, the Office of Student Affairs, the
Human Biology Laboratories, the Medical Media
Center, the Dean of Veterinary Medicine, and tele-
vision studios, as well as classroom facilities, has
improved this situation enormously. Fine teaching,
research, and faculty office space are provided.
Since the School of Nursing also occupies this
building, collaborative relationships between med-
icine and nursing have been developing in a very
gratifying fashion.

The next building, currently in the active phase
of planning, will include laboratory and office space
for departments such as Surgery, Obstetrics and
Gynecology, Anesthesiology, and Radiology, ex-
panded animal facilities, and an ambulatory care
facility designed for teaching and patient care at

450 MICHIGAN MEDICINE MAY 1972

both the primary and referral levels. Planning for
this phase of the building is being jointly under-
taken with the College of Osteopathic Medicine,
and the ambulatory program will serve both col-
leges as well as the needs of those providing med-
ical care for the student body.

A university such as Michigan State is particular-
ly committed to using its resources to assist the
people of the state in achieving their goals con-
cerning the quality of their lives. It does so largely
through education and by adapting education pro-
grams to the people’s needs, but also through
service and research.

A medical school within such a university, like-
wise, must be committed to using its resources to
assist the people of the state in whatever ways are
appropriate, to achieve their goals in the field of
health.

The most frequently and loudly expressed need
by the people of the state currently is for increased
availability of primary medical care. Solving of this
problem involves not only the production of in-
creased manpower, but also devising a selection
process in an educational program for medical stu-
dents whose outcome will insure a high percent
entering the field of primary care in needy com-
munities. Furthermore, there must also be exten-
sive research and demonstration leading to new
ways to provide health care to areas not readily
served through the normal route of physicians in
the practice of medicine.

So far as numbers are concerned, we are com-
mitted to admitting a class of 100 students two or
three years hence. The current first year class of
85, an increase of 40 over the previous year, repre-
sented an enormous expansion of class size which
has put serious strains on students, faculty, and
supporting community resources alike, and it is im-
perative that we be permitted to adjust to a steady
state of approximately 100 students per class for
at least a few years. Indeed, the accrediting team
was quite specific in December, 1971 on this point;
namely that while recommending essentially full
accreditation, this accreditation is, in fact, linked
to a limitation of enrollment at this level.

Family medicine
underlies program

The issue of family medicine in medical schools
is one of great importance today. The emphasis of
our curriculum on doctor-patient interactions, hu-
man growth and development, community clinical
experiences, and broadly based problem solving
exercises has been described. Family medicine,
then, underlies our entire educational program. The
Admissions Committee deliberately makes an effort
to select students who appear to have primary fam-
ily medicine as a career goal, and there is an ef-
fort towards student advising and counseling to
nurture such students while they are with us.

We have strongly encouraged development of
residency programs in family practice in Lansing
and other communities and have done what we
have been asked to do in assisting them in their

operation. Several new family practice residencies
have been established and others are in various
stages of planning. Much-needed opportunities for
graduate training in the new specialty of family
practice are therefore becoming increasingly avail-
able, and with definitely increasing numbers of
well-qualified applicants.

Our college is currently developing an applica-
tion for federal funding for a state-wide preceptor-
ship program in family practice, which will be me-
diated through a consortium to include the medical
schools of Wayne State University and the Univer-
sity of Michigan. At present, it appears that the
University of Michigan will be the delegate agency,
and that Michigan State would have responsibility
for the evaluation phases of the program. A for-
malized student experience in the field of family
medicine may therefore come to pass and be avail-
able to all medical students in Michigan.

The College of Osteopathic Medicine at Michigan
State has established a Department of Family Med-
icine and an appropriate faculty committee of the
College of Human Medicine is in the process of
studying ways in which family medicine might be
administratively organized within the college and
how it might relate to the Department in the Col-
lege of Osteopathic Medicine.

One can predict with confidence a steady in-
crease in involvement at all levels in the college,
not only in the education of increased numbers of
family physicians, but also in the promotion and
development of this new specialty and its academic
base.

Finally, our new Office of Health Services Educa-
tion and Research, established in July 1971, is
steadily developing its role as an agency to assist
the state in resolving some of its problems in pro-
vision of health care, especially in rural areas.

An overview

In summary, then, as I complete my eighth year
as dean of this new college, I am well satisfied
with progress that has been made. We have re-
cruited a superb faculty whose dedication to teach-
ing and meeting the needs of this state led to an
effort which is truly unique in its intensity and ef-
fectiveness in spite of often inadequate and make-
shift facilities and periods of stress and uncertain-
ty. Our first two classes of students, who trans-
ferred elsewhere to complete their medical educa-
tion while we were a “two-year” school, have done
very well and testify to our early adequacy. There
is every reason to believe that our first MD grad-
uates in June 1972, will inaugurate a tradition of
graduates of this college achieving excellence not
only as members of their profession but also as
effective and influential members of society.

Throughout this developmental period, relation-
ships with the Michigan State Medical Society have
been extremely cordial, and the help given us by
the staff, The Council, resolutions from the House
and Delegates, and in countless other ways are
most appreciated and it is a great pleasure to have
this opportunity to express my personal thanks.

MICHIGAN MEDICINE MAY 1972 451

The chairman of the outstate caucus of
the MSMS Hous6 of Delegates, Edward E.
Elder, Jr., MD, Pontiac, waves for recog-
nition from the floor during the first-ever
House of Delegates spring meeting March
1 9-20 in Detroit.

In major action at the 1972 Spring House of Dele-
gates meeting, the MSMS delegates approved a
foundation for peer review and accepted the Rela-
tive Value Study Committee report for 1971, without
approval of the Michigan Society of Internal Med-
icine. Debate waxed long and hard during the two-
day meeting, with one evening session lasting until
4 a.m.

The eighth draft of the
articles of incorporation
and bylaws for a foun-
dation, Michigan Medical
Programs, Inc., was writ-
ten by Reference Com-
mittee A, headed by
Richard J. McMurray,
MD, Flint, at the podium
above. The foundation is
to be established at the
state level and to be im-
plemented at the discre-
tion of The MS MS Coun-
cil.

The MSMS staff members at the spring House of
Delegates meeting, including Mrs. Vada Davis, as-
sistant to Director Warren F. Tryloff, did yeoman's
work. Mrs. Davis above cuts a stencil for one of
the reference committee reports which totaled 42
pages. Reference Committee A, which debated the
Michigan Medical Programs, Inc., foundation, sub-
mitted a report of 26 pages, the longest in the
memory of MSMS staff.

MSMS delegates
meet in the spring

BECAUSE ALLERGIES
AREA

YEAR-ROHNB

THING.

NOVAHIST1NELP

placed high in the vaginal vault each
day for ten days and the oral dosage is
reduced to two 250-mg. tablets daily
during the ten-day course of treatment.
Do not use the vaginal inserts as the
sole form of therapy. In the Male: Pre-
scribe Flagyl only when trichomonads
are demonstrated in the urogenital
tract, one 250-mg. tablet two times daily
for ten days. Flagyl should be taken by
both partners over the same ten-day pe-
riod when it is prescribed for the male
in conjunction with the treatment of his
female partner.

For Amebiasis. Adults: For acute intes-
tinal amebiasis, 750 mg. orally three
times daily for 5 to 10 days. For amebic
liver abscess, 500 to 750 mg. orally three
times daily for 5 to 10 days.

Children: 35 to 50 mg. /kg. of body
weight/24 hours, divided into three
doses, orally for ten days.

Dosage forms: Oral tablets 250 mg.

Vaginal inserts 500 mg.

Flagyl (metronidazole)

|SEAREE| Manufactured by SEARLE & CO.

I I San Juan, Puerto Rico 00936

Address medical inquiries to:

G. D. Searle & Co., Medical Department
P. O. Box 5110, Chicago, Illinois 60680

Research in the Service of Medicine

241

ny women still believe that a
iche is a cure-all forvaginal
retions and malodor. Mother
3 daughter and the myth is
petuated.

Dther cosmetic products are not
ch better. Though they may be
jctive in some minor infections,
y cannot touch the real medical
iblem, which very often is
hormonal vaginitis.

Medicine’s most effective
cure fortrichomonal
vaginitis is Flagyl®
(metronidazole).

It is also pleasantly

feminine because it provides the
simplicity of oral medication . . .
frees women from the unpleasant
mess and bother of douches.

When the problem is trichomonal
vaginitis . . . remember Flagyl. It
cures trichomoniasis with an
unmatched high degree of
effectiveness.

Flagyl is indicated for the treat-
ment of trichomoniasis in both male
and female patients and the sexual
partners of patients with a recurrence
of the infection provided tricho-
monads have been demonstrated
by wet smear or culture.

Indications: For the treatment of trich-
omoniasis in both male and female
patients and the sexual partners of pa-
tients with a recurrence of the infection
provided trichomonads have been dem-
onstrated by wet smear or culture. The
oral form is indicated also for intestinal
amebiasis and amebic liver abscess.
Contraindications: Evidence or history
of blood dyscrasia, active organic dis-
ease of the CNS, the first trimester of
pregnancy and a history of hypersensi-
tivity to metronidazole.

Warnings: Use with discretion during
the second and third trimesters of preg-
nancy and restrict to those pregnant
patients not cured by topical measures.
Flagyl (metronidazole) is secreted in
the breast milk of nursing mothers. It
is not known whether this can be in-
jurious to the newborn.

Precautions: Mild leukopenia has been
reported during Flagyl use; total and
differential leukocyte counts are recom-
mended before and after treatment with
the drug, especially if a second course
is rtecessary. Avoid alcoholic beverages
during Flagyl therapy because abdom-
inal cramps, vomiting and flushing may
occur. Discontinue Fiagyl promptly if
abnormal neurologic signs occur. Ex-
acerbation of moniliasis may occur. In
amebic liver abscess, aspirate pus dur-
ing metronidazole therapy.

Adverse Reactions: Nausea, headache,
anorexia, vomiting, diarrhea, epigastric
distress, abdominal cramping, consti-

pation, a metallic, sharp and unpleasant
taste, furry or sore tongue, glossitis and
stomatitis possibly associated with a
sudden overgrowth of Monilia, exacer-
bation of vaginal moniliasis, an occa-
sional reversible moderate leukopenia,
dizziness, vertigo, incoordination and
ataxia, numbness or paresthesia of an
extremity, fleeting joint pains, confu-
sion, irritability, depression, insomnia,
mild erythematous eruptions, “weak-
ness,” urticaria, flushing, dryness of the
mouth, vagina or vulva, pruritus, dysuria,
cystitis, a sense of pelvic pressure, dys-
pareunia, fever, polyuria, incontinence,
decrease of libido, nasal congestion,
proctitis, pyuria and darkened urine
have occurred in patients receiving the
drug. Patients receiving Flagyl may ex-
perience abdominal distress, nausea,
vomiting or headache if alcoholic bev-
erages are consumed. The taste of alco-
holic beverages may also be modified.
Flattening of the T wave may be seen in
EKG tracings.

Dosage and Administration

For Trichomoniasis. In the Female: One
250-mg. tablet orally three times daily
for ten days. Courses may be repeated
if required in especially stubborn cases;
in such patients an interval of four to
six weeks between courses and total
and differential leukocyte counts be-
fore, during, and after treatment are
recommended. Vaginal inserts of 500
mg. are available for use, particularly
in stubborn cases. When the vaginal in-
serts are used, one 500-mg. insert is

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□ more neutralizing action per

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□ without the acid rebound
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< zMict\igaii medisceqe

May 10 — Michigan Association for Medical Educa-
tion, regular membership meeting, 2 p.m., MSMS
Headquarters, contact: Roger Carbeck, MD, St.
Joseph Mercy Hospital, 326 N. Ingalls, Ann Ar-
bor, 48104

May 10-12 — Annual meeting, Michigan Public
Health Association, Park Place Motor Inn, Trav-
erse City, contact: Ralph Lewis, Department of
Postgraduate Medicine, Towsley Center, The
University of Michigan, Ann Arbor, 48104

May 13 — Annual May Seminar, “Comparative
Pathology,” Michigan Society of Pathologists,
Hurley Hospital, Flint, contact: Jacob E. Briski,
MD, Saint John Hospital, 22101 Moross Road,
Detroit, 48236

May 13 — 17th annual all-day scientific meeting,
Michigan Society of Anesthesiologists, Sheraton-
Cadillac Hotel, Detroit, contact: Ralph E. Bauer,
MD, MSA secretary-treasurer, Henry Ford Hos-
pital, Detroit, 48202

May 18-19 — Annual Gull Lake meeting, MSMS
Committee on Maternal and Perinatal Health,
Kellogg Biological Station, Gull Lake, contact:
Helen Schulte, MSMS Headquarters

May 18-19 — 15th Annual Clinic Days, emphasis
“Team Medicine,” Children’s Hospitals of Mich-
igan and Wayne State University School of Med-
icine, at the hospital, contact: Larry E. Fleisch-
mann, MD, chairman, 3901 Beaubien, Detroit,
48201

May 19-20 — 11th annual Kidney Disease Sympo-
sium, sponsored by Kidney Foundation of Mich-
igan, at Mercy College Conference Center, De-
troit, contact: Sidney Baskin, MD, chairman, 3378
Washtenaw Ave., Ann Arbor, 48104

May 20-27 — Michigan Week

May 22-23 — National chapter meeting and scientific
session, American College of Emergency Physi-
cians, Shanty Creek, Bellaire, contact: Gaius
Clark, MD, 865 Pebblebrook Lane, East Lansing,
48823

May 22-23 — National Conference on Instrumenta-
tion and Hazards in Cardiac Care, Towsley Cen-
ter, University Medical Center, Ann Arbor, spon-
sored by Council on Clinical Cardiology of the
American Heart Association and the Michigan
Heart Association, contact: Harold Arnow, public
information director, MHA, P.O. Box L-V 160,
Southfield, 48076

May 24 — Michigan Hospital Day, sponsored by the
University of Michigan Department of Postgrad-
uate Medicine, at Towsley Center, U-M, contact:
Joseph H. Owsley, U-M Health Science Informa-
tion Service, University Hospital, Ann Arbor,
48104.

May 24-26 — Annual Medical Staff-Trustee-Admin-
istrator Forum, sponsored by Michigan Hos-
pital Association, Boyne Mountain Lodge, Boyne
Falls, contact: Frank A. Drazkowski, Administra-
tor, Grand View Hospital, US 2, Ironwood, 49938

May 31-June 3 — Continuing Medical Education
course on “Treatment of the Seriously Injured
or III in the Emergency Department,” American

College of Surgeons Committee on Trauma, in
Detroit, contact: Oscar P. Hampton, Jr., MD, Di-
rector of Trauma Division, ACS, 55 E. Erie St.,
Chicago, 60611

June 2-3 — Gaylord Trauma Day, Hidden Valley Ot-
sego Ski Club, Gaylord, contact: Benjamin He-
nig, MD, Keyport Clinic, 308 Michigan Ave.,
Grayling, 59738

June 5-6 — Annual Spring Mental Health Meeting,
Kellogg Center, MSU, contact: Bruce Alderman,
conference consultant for medical continuing ed-
ucation, Continuing Education Service, MSU,
East Lansing, 48823

June 5-7 — Initial Management of the Acutely III and
Injured Patient, Ann Arbor, contact: Charles F.
Frey, MD, Department of Surgery, University of
Michigan Medical Center, Ann Arbor, 48104
June 7 — The Council, MSMS Headquarters, con-
tact: Warren F. Tryloff, Director
June 12-16 — Eighth Annual Northern Michigan
Summer Program, “Diagnosis and Treatment of
Some Common Medical Problems,” sponsored by
Department of Postgraduate Medical Education,
University of Michigan, at Shanty Creek Lodge,
Bellaire, contact: Neal A. Vanselow, MD, acting
chairman, U-M Department of PG Medicine,
Towsley Center, Ann Arbor, 48104
June 18-22 — Many Michigan physicians will attend
AMA Annual Convention in San Francisco
June 23-24 — Annual Meeting, Upper Peninsula
Medical Society, Holiday Inn, Marquette, contact:
Thomas B. Bolitho, MD, UPMS president, 1414
W. Fair Ave., Marquette, 49855
June 26-29 — International Symposium on Clinical
Aspects of Metabolic Bone Disease, Henry Ford
Hospital, contact: Boy Frame, MD, Henry Ford
Hospital, Detroit, 48202

June 26-30 — American College of Physicians, Con-
ference on Medical Interviewing, Kellogg Center,
MSU, contact: Allen Enelow, MD, chairman, De-
partment of Psychiatry, MSU, East Lansing, 48823
July 15-16 — “Summer of ’72” seminar weekend
for State of Michigan Medical Assistants, Schuss
Mountain, Mancelona, contact: Mrs. Audrie

Chute, chairman, 3600 W. 13 Mile Road, Royal
Oak, 48072

July 15-19 — 26th Annual Postgraduate Scientific
Assembly of Michigan Academy of Family Phy-
sicians, Boyne Highlands, Harbor Springs, con-
tact: George Hoekstra, MD, chairman, 100 Maple
St., Parchment, 49004

July 27-28 — Coller - Penberthy - Thirlby Conference,
Park Place Motor Inn, Traverse City, contact: L.
P. Skendzel, MD, Traverse City, chairman
September 21-24 — Michigan Regional Meeting,
American College of Physicians and Michigan
Society of Internal Medicine, Otsego Ski Club,
Gaylord, contact: Muir Clapper, MD, ACP Gov-
ernor for Michigan, Wayne State University
School of Medicine, 540 E. Canfield, Detroit,
48201

Oct. 1 and 4 — The Council, Sheraton-Cadillac Ho-
tel, Detroit, contact: Warren F. Tryloff, Director
Oct. 1-5 — 107th Annual Session of the Michigan
State Medical Society, Sheraton-Cadillac Hotel,
Detroit, contact: Richard Campau, MSMS Head-
quarters, Box 950, East Lansing, 48823

MICHIGAN MEDICINE MAY 1972 457

t4 is the

PREDICTABLE
HORMONE BECAUSE
IT LOVES PROTEIN.

SYNTHROID® (sodium
levothyroxine) is pure synthetic T4,
the major circulating thyroid
hormone. It is reliable to use
because of its affinity for protein-
binding sites in the blood. T3 is
more fickle. Sometimes it binds.
Sometimes it doesn’t. T4 more
predictably binds to protein.

ALL THYROID-
FUNCTION TESTS ARE
USEFUL IN
MONITORING
SYNTHROID THERAPY

No calculations are needed, test
interpretation is simple.

Any of the commonly used T4
thyroid function tests (P.B.I., T4 By
Column, Murphy-Pattee, Free
Thyroxine) are useful in monitoring
patients on T4 because they all
measure T4. Patients on
SYNTHROID are thereby easy to
monitor because their results will
fall within predictable, elevated
test ranges. Of course, clinical
assessment is the best criterion of
the thyroid status of the drug-
treated patient.

TEST

HYPOTHYROID

SYNTHROID

THERAPEUTIC

NORMAL

P.B.I.

Less than 4 meg %

6-1 0 meg %

T4 By Column

Less than 3 meg %

7-9 meg %

T3 (Resin)

Less than 25%

27-35%

Ta (Red Cell)

Less than 11%

11.5-18%

Free Thyroxine

Less than 0.7
nanograms %

0. 7-2.5

nanograms %

Murphy-Pattee

Less than 2.9
meg %

4-1 1 meg %

Glipose
tife Smootii

HISTORICAL
MARKER

TWO GOOD REASONS I
WHY THE ROAD TO
NORMALIZED
THYROID STATUS IS
SO SMOOTH FOR THE
SYNTHROID PATIENT.

(1) The onset of action of T4 is
gradual. It has a long in vivo
“half-life” of over six days.
(Occasional missed doses or
accidental double-doses are of les |
concern because of this factor)’;

(2) since SYNTHROID contains on! |
T4, the potential for metabolic
surges traceable to more potent
iodides (T3) is eliminated.

AS WITH ANY
THYROID
PREPARATION,
CAUTIOUS
OBSERVATION OF THE
PATIENT DURING THE
BEGINNING OF
THERAPY WILL ALERT!
THE PHYSICIAN TO
ANY UNTOWARD
EFFECTS.

Side effects, when they do occur,
are related to excessive dosage.
Caution should be exercised in
administering the drug to patients
with cardiovascular disease. Reat
the accompanying prescribing
information for additional data or
write Flint Laboratories.

...to t fry void replacement tl\erapy'

ONE

WAY

’ATIENTS CAN BE
•UCCESSFULLY
MAINTAINED ON A
)RUG CONTAINING
'HYROXINE ALONE.

hyroxine (T4) is, as you know,
le major circulating hormone
roduced by the thyroid gland.

3 is also produced, in smaller
mounts, and is active at the
ellular level. For years it has been
working hypothesis among
ndocrinologists that T4 is
onverted by the body to T3. In
970 this process, called
deiodination,” was demonstrated

y Braverman, Ingbar, and Sterling2.

4 does convert to T3, though the
recise quantities are still being
tudied.

The conversion has been
linically demonstrated during the
dministration of T4 to athyrotic
atients. Their thyroid status is
ormalized on SYNTHROID alone,
et the presence of T3 in these
atients has been clearly shown.

WHY DOES SYNTHROID
COST LESS THAN
SYNTHETIC DRUGS
CONTAINING T3?

Very simple. T3 costs more to make
synthetically than does T4. So it is
economically necessary for a
synthetic thyroid medication
containing T3 to cost more than
one containing T4 alone. Synthetic
combinations cost patients nearly
50% more than SYNTHROID3
because the T3 costs more to start
with; also there is the additional
expense of formulating a tablet
containing two active ingredients.

1. Latiolais, C. J., and Berry, C. C.: Misuse of
Prescription Medications by Outpatients,

Drug Intelligence & Clin. Pharm. 3:270-7, 1969.

2. Braverman, L. E., Ingbar, S. H., and
Sterling, K.: Conversion of Thyroxine (T4) to
Triiodothyronine (T3) in Athyreotic Human
Subjects, J. Clin. Invest. 49:855-64, 1970.

3. American Druggist BLUEBOOK, March, 1971.

Synthroid

(sodium levothyroxine)

THE FACTS ARE
CLEAR AND HERE
IS OUR OFFER.

FACTS:

Synthetic thyroid drugs are an
mprovement over animal gland
products. Patients, even athyrotic
ones, can be completely
maintained on SYNTHROID (T4)
alone. Thyroid function tests are
easy to interpret since they are
predictably elevated when the
patient adheres to SYNTHROID.
Of all synthetic thyroid drugs,
SYNTHROID is the most
economical to the patient.

I 71

OFFER:

Free TAB-MINDER medication
dispensers to start or convert all
your hypothyroid patients to
SYNTHROID. Free information to
physicians on role of thyroid
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Name

Address

City State Zip |

I 1

Indications: SYNTHROID (sodium levothyroxine) is spe
cific replacement therapy for diminished or absen'
thyroid function resulting from primary or secondary
atrophy of the gland, congenital defect, surgery, ex
cessive radiation, or antithyroid drugs. Indications foi
SYNTHROID (sodium levothyr 'xine) Tablets include
myxedema, hypothyroidism without myxedema, hypo
thyroidism in pregnancy, pediatric and geriatric hypo
thyroidism, hypopituitary hypothyroidism, simple
(nontoxic) goiter, and reproductive disorders asso
ciated with hypothyroidism. SYNTHROID (sodium ievo-
thyroxine) for Injection is indicated for intravenous
use in myxedematous coma and other thyroid dysfunc-
tions where rapid replacement of the hormone is re-
quired.The injection is also indicated for intramusculai 1
use in cases where the oral route is suspect or con-
traindicated due to existing conditions or to absorp-
tion defects, and when a rapid onset of effect is not
desired.

Precautions: As with other thyroid preparations, an
overdosage may cause diarrhea or cramps, nervous-
ness, tremors, tachycardia, vomiting and continued
weight loss. These effects may begin after four or five
days or may not become apparent for one to three
weeks. Patients receiving the drug should be observed
closely for signs of thyrotoxicosis. If indications of
overdosage appear, discontinue medication for 2-6
days, then resume at a lower dosage level. In patients
with diabetes mellitus, careful observations should be
made for changes in insulin or other antidiabetic drug
dosage requirements. If hypothyroidism is accom-
panied by adrenal insufficiency, as Addison’s Disease
(chronic subcortical insufficiency), Simmonds’s Dis-
ease (panhypopituitarism) or Cushing’s syndrome (hy-
peradrenalism), these dysfunctions must be corrected
prior to and during SYNTHROID (sodium levothyroxine)
administration. The drug should be administered with
caution to patients with cardiovascular disease; devel-
opment of chest pains or other aggravations of cardio-
vascular disease requires a reduction in dosage.
Contraindications: Thyrotoxicosis, acute myocardial
infarction. Side effects: The effects of SYNTHROID
(sodium levothyroxine) therapy are slow in being mani-
fested. Side effects, when they do occur, are secondary
to increased rates of body metabolism; sweating, lieart
palpitations with or without pain, leg cramps, and
weight loss. Diarrhea, vomiting, and nervousness have
also been observed. Myxedematous patients with heart
disease have died from abrupt increases in dosage of
thyroid drugs. Careful observation of the patient during
the beginning of any thyroid therapy will alert the
physician to any untoward effects.

In most cases with side effects, a reduction of dos-
age followed by a more gradual adjustment upward
will result in a more accurate indication of the pa-
tient’s dosage requirements without the appearance
of side effects.

Dosage and Administration: The activity of a 0.1 mg.
SYNTHROID (sodium levothyroxine) TABLET is equiva-
lent to approximately one grain thyroid, U.S.P. Admin-
ister SYNTHROID tablets as a single daily dose,
preferably after breakfast. In hypothyroidism without
myxedema, the usual initial adult dose is 0.1 mg. daily,
and may be increased by 0.1 mg. every 30 days until
proper metabolic balance is attained. Clinical evalua-
tion should be made monthly and PBI measurements
about every 90 days. Final maintenance dosage will
usually range from 0.2-0.4 mg. daily. In adult myx-
edema, starting dose should be 0.025 mg. daily. The
dose may be increased to 0.05 mg. after two weeks
and to 0.1 mg. at the end of a second two weeks. The
daily dose may be further increased at two-month in-
tervals by 0.1 mg. until the optimum maintenance dose
is reached (0. 1-1.0 mg. daily).

Supplied: Tablets: 0.025 mg., 0.05 mg., 0.1 mg., 0.15
mg., 0.2 mg., 0.3 mg., 0.5 mg., scored and color-coded,
in bottles of 100, 500, and 1000. Injection: 500 meg.
lyophilized active ingredient and 10 mg. of Mannitol,
N.F., in 10 ml. single-dose vial, with 5 ml. vial of So-
dium Chloride Injection, U.S.P., as a diluent.
SYNTHROID (sodium levothyroxine) for Injection may
be administered intravenously utilizing 200-400 meg.
of a solution containing 100 meg. per ml. If significant
improvement is not shown the following day, a repeat
injection of 100-200 meg. may be given.

FUNT LABORATORIES

DIVISION OF TRAVENOL LABORATORIES. INC
Morton Grove, Illinois 60053

Highlights

of March 19, 1972 meeting —
The MSMS Council

(prior to spring

house of delegates meeting)

RELATIVE VALUE STUDY— The
Council accepted the report of the
MSMS Relative Value Study Com-
mittee transmitting the schedules
for the remaining two sections
(ophthalmology and medicine) to
the House for approval.

MEDICAID DISCOUNT — The
Council deferred action on a pos-
sible poll of MSMS members until
the next meeting of The Council.
The proposal of Governor Milliken
that Medicaid payments be dis-
counted by 3% is not part of the
budget bill before the state legis-
lature.

MEDICAL ADVISORY COMMIT-
TEE— The Council authorized the
nomination of Lionel Swan, MD,
Detroit, and Leland E. Holly, II, MD,
of Muskegon, to fill the post of
Richard Pomeroy, MD, Lansing,
one of the MSMS representatives
on the Medical Advisory Committee
to the Department of Social Serv-
ices.

JOINT PRACTICES COMMIS-
SION— The Council appointed Ray
Heifer, MD, MSU College of Hu-
man Medicine; Thomas Setter, MD,
Mt. Clemens; Lee B. Stevenson,
MD, Detroit, and Louis R. Zako,
MD, as members of the proposed
joint Practices Commission with
the Michigan Nurses Association,
similar to one already organized
between the two national organiza-
tions.

GROUP TRAVEL — The Council
authorized a letter to the MSMS
membership informing them that
MSMS has approved a company
offering economy-class travel to
European cities. The letter would
be especially aimed at younger
MSMS members and families of
members.

HEALTH CARE PACKAGE— The
Council authorized $1,000 for the

President’s Project to develop a
position paper on the scope of
benefits in any governmental health
care package. Doctor Adler is to
review the present medical care
facilities, including cost, and pre-
sent his information to The Council.

EMERGENCY BOOKLET — The
Council endorsed preparation of
a booklet on emergency medical
care which is proposed as a joint
venture of the Michigan Hospital
Association, Michigan Association
of Osteopathic Physicians and Sur-
geons, and MSMS.

STUDENT PRECEPTORSHIPS —
The Council approved in principle
a recommendation that MSMS de-
velop a program to place second
and third year medical students
with family physicians on a non-
credit basis to help alleviate the
exodus of Michigan medical grad-
uates to other states. The Council
authorized the Education Liaison
Committee to submit a proposal
to the University of Michigan to
be included in a Michigan request
for federal funds available to uni-
versities under the 1972 Health
Professions Special Grant for Pre-
ceptorship Training.

EMERGENCY PERSONNEL— The
Council approved the Legislative
Policy Committee’s recommended
procedure for handling applications
to the National Health Services
Corps to alleviate critical health
manpower shortages. The commit-
tee’s recommended procedure is
designed to give decision-making
power to the component medical
society and includes six guidelines.

INTERNS’, RESIDENTS’ INSUR-
ANCE— The Council approved ex-
tending the MSMS Group Disability
Insurance Program to Michigan
interns and residents who would
become MSMS associate members
for a minimal fee.

NO SMOKING— The Council ap-
proved a recommendation that
MSMS adopt a position on smoking
and health that would encourage
doctors, physicians’ employees and
hospital staff members to quit
smoking, that MSMS members
work to ban the sale of tobacco
products in all hospitals and health
facilities, and that MSMS lead in
publicizing the hazards of smoking.

ENVIRONMENTAL CONFER-
ENCE— The Council authorized a
transfer of $1,000 from the budget
of the Committee on Postgraduate
Medical Education to cover the
cost of a MSMS-sponsored inter-
national conference next fall for
physicians about environmental
quality control.

MATERNAL HEALTH— The Coun-
cil approved a recommendation
that MSMS support legislation to
appropriate additional funds to the
MDPH to expand the Detroit Ma-
ternity and Infant Care Project, and
to create similar projects in Jack-
son, Battle Creek, Grand Rapids,
Muskegon, Flint and Benton Har-
bor.

LEGISLATION — The Council did
not approve MSMS support of HB
4949 and HB 5574, but did approve
MSMS agreement in principle with
some of their provisions — that
there be some legislated restric-
tions on hospital expansion and
construction; that coverage of
existing licensed hospitals should
be provided by all corporations
who provide health benefits, and
that two practicing physicians
should be appointed to a Health
Facilities Council if it is estab-
lished.

The Council approved MSMS
support of SB 1133, to require
certification that turtles sold as
pets are free of salmonella bac-
teria contamination;

The Council approved support
of SB 1136 and HB 5883, to repeal
the Basic Science Law;

The Council approved MSMS
support of SB 1212, to exempt
Canadian medical school graduates
from the basic science examina-
tion;

The Council approved MSMS
support of HB 5921 which repeals
only the requirement for smallpox
vaccination.

460 MICHIGAN MEDICINE MAY 1972

choose the topicajs
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a lowallergenic risk— prompt clinical response

Special Petrolatum Base

Neosporin* Ointment

(polymyxin B-bacitracin-neomycin)

Each gram contains: Aerosporin® brand polymyxin B sulfate, 5000 units;
zinc bacitracin, 400 units; neomycin sulfate 5 mg. (equivalent to 3.5 mg.
neomycin. base); special white petrolatum q. s.

In tubes of 1 oz. and Vz oz. for topical use only.

a

!

Vanishing Cream Base

NeosporinrG

(polymyxin B-neomycin-gramicidin) ;

Each gram contains: Aerosporin® brand polymyxin B sulfate, 10,000 f
units; neomycin sulfate, 5 mg. (equivalent to 3.5 mg. neomycin base); i
gramicidin, 0.25 mg., in a smooth, white, water-washable vanishing
cream base with a pH of approximately 5.0. Inactive ingredients: liquid .
petrolatum, white petrolatum, propylene glycol, polyoxyethylene
polyoxypropylene compound, emulsifying wax, purified water, and 0.25%
methylparaben as preservative.

In tubes of 15 g.

NEOSPORIN for topical infections due to susceptible organisms, as in
impetigo, surgical after-care, and pyogenic dermatoses.

Precaution: As with other antibiotic preparations, prolonged use may |
result in overgrowth of nonsusceptible organisms and/or fungi. Appropriate
measures should be taken if this occurs. Articles in the current medical
literature indicate an increase in the prevalence of persons allergic to (|
neomycin. The possibility of such a reaction should be borne in mind. .
Contraindications: Not for use in the external ear canal if the eardrum is -
perforated. These products are contraindicated in those individuals who
have shown hypersensitivity to any of the components.

Complete literature available on request from Professional Services
Dept. PML

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habit-forming); 0.1 mg. hyoscyamine sulfate; 0.02 mg.
atropine sulfate; 0.007 mg. scopolamine hydrobromide;
40 mg. simethicone.

Contraindications: Hypersensitivity to barbiturates or
belladonna alkaloids, glaucoma, advanced rentrl or he-
patic disease.

Precautions: Administer with caution to patients with
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be habit-forming.

Side effects: Blurred vision, dry mouth, dysuria, and
other atropine-like side effects may occur at high doses,
but are only rarely noted at recommended dosages.
Dosage: Adults: One or two tablets three or four times
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this small amphibian can expand
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twice the size of its head.

MICHIGAN MEDICINE MAY 1972 463

What to do with multiphasic screening referrals?
AMA guidelines give directions

By Donald N. Sweeny, Jr., MD
Chairman, Michigan Delegation to AMA

Physicians engaged in all types of health care-
office, school programs, and industrial annual sur-
veys— have emphasized the importance of screen-
ing programs in the management of their patients.
This emphasis has been greatly intensified over the
past few years with the rapid growth in the number
of multiphasic health testing programs. Medical
societies as well as individual physicians are being
called upon, either directly or indirectly, to help
plan or participate in these survey procedures. The
use of automated as well as non-automated tech-
niques has become one method of initial health
care data aquisition.

Disseminating AMA Guidelines

The House of Delegates of the American Medical
Association has recently approved a report of its
Council on Medical Service concerning this method
of collection, recording, and reporting of test re-
sults. It seems appropriate that the guidelines de-
veloped should be widely disseminated among
practicing physicians.

It must be emphasized that multiphasic health
testing is only a collecting device and therefore
not a complete health service. Unfortunately there
are misinterpretations of the value of MHT among
the laity and it is important that these groups
know that to be meaningful such data must have
physician interpretation and evaluation. Without
this, multiphasic health testing is ineffective. It
should also be understood that MHT in no way
replaces skilled diagnosis and treatment by the
physician although it may serve as a substantial
aid to him in the practice of medicine.

The concept of multiphasic health testing is
not new to the American health system — such
a program was established in the United States
as early as 1914. In 1971, however, it is estimated
that there were over 140 programs testing more
than two million persons.

Substantial variety exists between the testing
routine in the multiphasic health programs in
operation throughout this country. There are pro-
grams in which the routine is fixed — a standardized
battery of tests being offered with no flexibility.
There are other plans with a variable routine
which selects tests for the individual being tested.

These programs are operated under a variety
of agencies — private corporations; labor unions;
federal, city, county, and state health departments;
individual physicians; group practices; insurance
companies; medical societies, and clinical labora-
tories. Some of these are on a fixed fee and others
on a fee-for-service basis.

The cost of these programs varies greatly and
is influenced by a number of factors — such as
scope of the procedures included in the testing
program, the number of persons tested, personnel
utilized, sources of the funds, whether or not the
MHT unit is operated as a part of another health
service program and whether it is operated on a
profit or a non-profit basis. Standardized charges
range from $2 to $150. There are a number of
plans that have variations in their testing routine
and these variable fees range from $5 to $225.

Benefits of MHT programs

In assessing the need for and the quality of
any medical service, the benefits and limitations
of all available patient management techniques
should be considered. Alternative methods should
also be evaluated.

Where MHT programs are properly integrated
into the health care system, the following may be
listed as benefits: (1) improved quality of records;
(2) more efficient use of physicians’ time by use
of allied health personnel and technical aids; (3)
earlier detection of a wider range and greater
number of asymptomatic diseases in apparently
healthy people; (4) improved opportunity for pre-
ventive care through accumulation of baseline
health data; (5) possible reduction of overall costs
for health care by early detection of disease and
decrease in hospitalization; (6) improved health
education and patient counseling.

There are, however, many problems associated
with multiphasic health testing which must be un-
derstood. Some of these limitations are: (1) false
positives and false negatives on test results; (2)
depersonalization of health care; (3) misconception
by some users that MHT is a complete diagnostic
procedure that replaces the need for periodic
examinations by a physician; (4) many abnormal-
ities appearing in the test results which were

464 MICHIGAN MEDICINE MAY 1972

known or suspected before; and (5) possible over-
load on the health delivery system by identification
of questionable findings.

Accurate cost benefit analysis has not been pos-
sible because of the many and complex variables.
Research must be pursued in order to determine
properly and accurately the cost in relation to the
true yield of the multiple tests in terms of disease
processes that can be corrected or interrupted.
Such an analysis is necessary to determine the
proper role for MHT in positive health maintenance
and preventive medicine.

We in private medicine strongly support a plural-
istic health care delivery system. The diversity of
such a system allows for innovations, competition,
incentives for organizational change, and improve-
ment of quality. We support research and demon-
stration programs and we encourage physicians to
exercise medical leadership in planning, develop-
ing, and operating multiphasic health testing pro-
grams which will meet the needs of the community
involved.

By designating a physician to whom his MHT
results are to be sent, the individual has requested
the performance of professional services by that
physician. The extent to which that physician is
obligated, if at all, to furnish such services involves
legal questions for which neither the courts nor
state legislatures thus far have provided answers.
There are many humanitarian implications as well.

The following recommendations for handling
unsolicited MHT reports have been developed by
the House of Delegates of the AMA in consulta-
tion with the Office of General Counsel of that
organization:

1. A physician who receives reports from a
MHT organization involving persons who have
made no prior arrangements with him for
their evaluation may choose to accept such
persons as his patients and communicate
with them and provide such additional serv-
ices as are necessary and usual in the physi-
cian-patient relationship.

As in all endeavors today, there are legal con-
siderations surrounding unsolicited reports. Many
programs accept and test persons who have not
been referred by a physician. Generally the per-
son tested is asked to designate a physician to
whom the report is to be sent. This has resulted
in many reports being sent to practicing physicians
without any advance notice or arrangement by
the persons tested regarding services involved
in evaluating and implementing such reports.

2. If, however, the physician elects not to ac-
cept the patient, he may return the reports to
the MHT organization. If he does so, it is
recommended that a covering letter be sent
stating that he has not evaluated such reports
and that the MHT organization must take the
necessary steps to inform the persons tested
of the need to make arrangements with a phy-
sician for their evaluation and follow up care
if required.

The treatment of

impotence

\ due to androgenic deficiency in the American male.

The concept of chemotherapy plus the
Jhk Physician’s psychological support is confirmed
mMm as effective therapy.

The Treatment of Impotence
with Methyltestosterone Thyroid
(100 patients — -Double Blind Study)
T. Jakobovits

Fertility and Sterility, January 1970
Official Journal of the
American Fertility Society

Android

(thyroid-androgen) tablets

Double-Blind Study and Type of Patient:

100 patients suffering from impotence. Of
the patients receiving the active medication
(Android) a favourable response was seen
in 78%. This compares with 40% on
placebo. Although psychotherapy is indi-
cated in patients suffering from functional
impotence the concomitant role of chemo-
therapy (Android) cannot be disputed.

Choice of 4 strengths:

Android

Each yellow tablet contains:

Methyl Testosterone ..2.5 mg.
Thyroid Eit. (1/6 gr.) .10 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 tablet 3 times daily.
Available:

Bottles of 100, 500, 1000.

Android-HP

HIGH POTENCY

Each red tablet contains:

Methyl Testosterone ..5.0 mg.
Thyroid Ext. (’/a gr.) ...30 mg.

Glutamic Acid 50 mg.

Thiamine HCL . ... ... 10 mg.

Dose: 1 tablet 3 times daily.
Available:

Bottles of 100, 500, 1000.

Androiti-x

EXTRA HIGH POTENCY

Each orange tablet contains:

Methyl Testosterone .12.5 mg.

Thyroid Ext. (1 gr.) 64 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 or 2 tablets daily.
Available:

Bottles of 60, 500.

Android-Plus

WITH HIGH POTENCY
B-C0MPLEX AND VITAMIN C

Each white tablet contains:

Methyl Testosterone ..2.5 mg.
Thyroid Ext. C/4 gr.) ...15 mg.

Ascorbic Acid (Vit. C) .250 mg.

Thiamine HCL 25 mg.

Glutamic Acid 100 mg.

Pyridoxine HCL 5 mg.

Niacinamide 75 mg.

Calcium Pantothenate . 10 mg.

Vitamin B-12 2.5 meg.

Riboflavin 5 mg.

Dose: 2 tablets daily.
Available: Bottles Of 60, 500.

Contraindications: Android is contraindicated in patients with prostatic carcinoma, severe cardiorenal
disease and severe persistent hypercalcemia, coronary heart disease and hyperthyroidism. Occasional
cases of jaundice with plugging biliary canaliculi have occurred with average doses of Methyl Testos-
terone. Thyroid is not to be used in heart disease and hypertension.

Warnings: Large dosages may cause anorexia, nausea, vomiting abdominal pain, diarrhea, headache,
dizziness, lethargy, paresthesia, skin eruptions, loss of libido in males, dysuria, edema, congestive heart
failure and mammary carcinoma in males.

Precautions: If hypothyroidism is accompanied by adrenal insufficiency the latter must be corrected prior
to and during thyroid administration.

Adverse Reactions: Since Androgens, in general, tend to promote retention of sodium and water, patients
receiving Methyl Testosterone, in particular elderly patients, should be observed for edema.

Hypercalcemia may occur, particularly in immobilized patients: use of Testosterone should be discontinued
as soon as hypercalcemia is detected.

References: 1. Montesano, P., and Evangelista, I. Methyltestosterone-thyroid treatment of sexual
impotence. Clin Med 12:69, 1966. 2. Dublin, M. F. Treatment of impotence with methyltestosterone-
thyroid compound. West Med 5:67, 1964 3. Titeff, A. S. Methyltestosterone-thyroid in treating impotence.
Gen Prac 25:6, 1962. 4. Heilman, L., Bradlow, H. 1., Zumoff, B., Fukushima, D. K., and Gallagher, T. F.
Thyroid-andro§en interrelations and the hypocholesteremic effect of androsterone. J Clin Endocr 19:936,
1959. 5. Farris. E. J., and Colton, S. W. Effects of L-thyroxine and liothyronine on spermatogenesis.
J Urol 79:863, 1958 6. Osol, A., and Farrar, G. E. United States Dispensatory (ed. 25). Lippincott, Phila-
delphia, 1955, p. 1432. 7. Wershub, L. P. Sexual Impotence in the Male. Thomas, Springfield,

III., 1959, pp. 79-99.

Write lor literature and samples: (br^^Q THE BROWN PHARMACEUTICAL CO., INC. 2500 West 6th Street, Los Angefes, California 90057

MULTIPHASIC SCREENING GUIDELINES/Continued

3. It is recommended that the physician evaluate
any MHT reports involving any patient whom
he is actively treating or has treated in the
past and that he communicate with that pa-
tient. Failure to do so may result in liability
for malpractice if as a consequence the pa-
tient is not provided with prompt necessary
treatment.

4. Even though the person involved is a stranger
to the physician, if the testing results for that
person indicate an urgent need for medical
treatment suggesting a possible emergency
situation, it is recommended that the physi-
cian communicate directly with the patient
wihout delay for humanitarian reasons.

In summary, the House of Delegates of the AMA
has adopted (Dec. 1971) the following guidelines
for the use of physicians and medical societies in
providing technical advice and assistance in plan-
ning, development, implementation, and operation
of multiphasic health testing programs: (Report
of Council on Medical Service C — Clinical Session
1971)

AMA Guidelines

for multiphasic health testing

1. Multiphasic health testing is a method of
acquiring, storing, collating, and repro-
ducing medical data on individual pa-

New Blue Shield Board
includes five physicians

Five Michigan physicians are new members of
the second Michigan Blue Shield board elected
under a restructuring of both the corporate body
and board in 1970.

They are William O. Mays, MD, and Louis E.
Heideman, MD, Detroit; W. Kaye Locklin, MD,
Kalamazoo; George M. Wilson, Jr., MD, Marquette,
and Stuart L. Cohn, MD, Alpena.

The five were chosen at the recent annual meet-
ing of the corporate body in Detroit. In addition,
eight more physicians were named as new mem-
bers of the corporate body, to replace those who
did not choose to continue as members.

The new corporate body members are William
F. Bowden, MD, Marine City; Marion G. McCall,
MD, John W. Moses, MD and Robert W. Black,
MD, Detroit; Louis R. Zako, MD, Allen Park; Ray-
mond L. Hockstad, MD, Escanaha; William S.
Smith, MD, Ann Arbor, and Kenneth J. Ray, MD,
Grosse lie.

tients. The testing procedures are con-
sidered to be incomplete health services.
Provisions must be made for a physician
to interpret and evaluate this medical
data base as an aid in continuing patient
care.

2. The multiphasic testing program should
meet applicable licensing requirements
and be appropriately evaluated for qual-
ity control.

3. Physicians should be involved in the
planning and development of testing pro-
grams, and the operation of all programs
should be supervised by qualified physi-
cians.

4. The system should be designed to make
maximum use of allied health profession-
als and should utilize technical and auto-
mated techniques where justified.

5. For professional value and economic
feasibility, the program should include
tests that are simple, safe, easy to inter-
pret, inexpensive and quick to perform,
and that have acceptable sensitivity, spe-
cificity, high predictive value, and patient
acceptance.

6. The testing system should include the
following criteria: reliability, accuracy of
output, saving of time of physicians and
allied health personnel, adequate utiliza-
tion, and sufficient flexibility for custom-
ization to physician and patient needs.
The program should establish individual
ethnic, geographic, and other variations
of normal and abnormal patterns.

7. The program should provide for confiden-
tiality of patient data.

8. The testing program should be used,
where feasible, to meet otherwise unmet
community health needs and should be
integrated into the continuing health care
system.

9. The testing program should be designed
to meet various objectives such as diag-
nostic services, health maintenance, and
guidance in management of ongoing ill-
ness including chronic disease.

10. Evaluation methodology should be built
into the program to determine the accept-
ance and use, yield, false positives and
false negatives, as well as the long-term
effects of the program on illness and the
need and demand for health services.
The program should include a document-
ed accounting system, at least for internal
use, and a reasonable cost finding sys-
tem that would allow for cost analysis
and cost summaries.

11. The program should maintain freedom of
choice for both the physician and the pa-
tient.

466 MICHIGAN MEDICINE MAY 1972

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scientists and physicians
play a role in drug
regulation?

c

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Lv

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hi

Results of a questionnaire to
7000 physicians:

82.8%

Physicians should play a role

78.3%

Independent scientists should
play a role

69.8%

Medical academicians should
play a role

I

Should nongovernment scientists and physicians
play a role in drug regulation?

Doctor

of

Medicine

Herbert L. Ley, Jr.,

M.D., Formerly

Commissioner, F.D.A.

(1968-1969)

Currently Medical Consultant

In order for drug regula-
tion to be effective, partici-
pation in the regulatory
process from nongovern-
ment physicians and scien-
tists must be encouraged.
Without such involvement,
there will continue to be a
high degree of controversy
surrounding any regula-
tions promulgated by the
Food and Drug Adminis-
tration.

There are two areas in
which participation and
communication by non-
government physicians and
scientists could signifi-
cantly improve the process
of regulation. First, scien-
tists and physicians
throughout the country
could become involved in
consulting relationships
with the Food and Drug
Administration in impor-
tant scientific areas while
regulatory policies are be-
ing evolved. If nongovern-
ment professionals could
bring their expertise and
experience to bear early in
the decision-making proc-
ess, they would have less
reason to criticize the final
outcome.

Secondly, practicing
physicians, academic phy-
sicians, and academic-
based scientists could make
it their business to com-
ment on proposed regu-
lations appearing in the

Federal Register. Ideally,
a system could be instituted
whereby medical, scientific
and technical people could
see the Federal Register
regularly, and provide the
Food and Drug Administra-
tion with a body of opinion
that has so far gone un-
heard. The FDA is caught
among pressures from in-
dustry, Congress, the Pres-
idential Administration
and consumers. It should
also feel pressures from
practicing physicians and
scientists.

In order to become more
involved in these stages of
the drug regulatory process,
nongovernment physicians
and scientists should begin
to exercise their influence
through their respective
professional organizations,

state and national medical
societies, and specialty
groups. Logically, a letter
from these organizations
representing a collective
opinion has far greater
weight in the regulatory
process than individual let-
ters. If the Food and Drug
Administration receives
opinions from these organi-
zations early, before a reg-
ulation gets into the Fed-
eral Register, they are in a
good position to respond
with further study and re-
view. Without such dissent-
ing opinions, there is very
little incentive to make

changes in proposed regu-
lations.

One instance in which
practitioners did influence
drug regulatory affairs in
this way is the recent con-
troversy that arose over the
legitimacy of drug combi-
nations. The strong opinion
of practitioners on the
value of such medication
in clinical practice played
a very prominent role in
making the Food and Drug
Administration modify its
rather restrictive policy.

Another way in which
practitioners can effectively
influence drug regulations
is by working with drug
manufacturers conducting
clinical trials of chemo-
therapeutic agents. When a
drug is rated other than ef-
fective it may only mean
that there is a lack of con-
trolled clinical evidence as
to efficacy. Thus, physicians
might offer to conduct clin-
ical studies that could help
keep a truly effective drug
in the marketplace. The
treatment of diseases such
as diabetes and angina are
areas where the practi-
tioner can aid in clinical
studies because patients
suffering from these dis-
eases are rarely found in
the conventional hospital
setting.

By working with ethi-
cally and scientifically
sound study designs in his
everyday practice, the
practitioner could begin to
play an important part in
determining official ratings
on drug efficacy.

Nongovernment physi-
cians and scientists and the
FDA should also improve
their lines of communica-
tion to the public. The
medical community must
develop a voice every bit as
loud as that of the consum-
erists, the press, and others
who sometimes criticize
without complete informa-

tion. If not, much of what
the medical community
and federal regulators dc
will often be represented ir
simplistic and somewhat
misleading terms.

One illustration of thei
misuse of the media in this
regard is the recall of anti-
coagulant drugs several
years ago. This FDA action'
was given publicity by the
press and television that it
went far beyond its prob- (
able importance. The result
was a very uncomfortable1
situation for the practi-
tioner who had patients ■
taking these medications.
Since the practitioner and
pharmacist had not been »
informed of the action by '
the time it was publicized,
in most states they were :
deluged with calls from I
worried patients.

The practitioner can at- 1
tempt to solve these prob-
lems of inadequate commu-
nication in several ways.
One would be the creation
of a communications line1
in state pharmacy societies. 1 1?
When drug regulation news *
is to be announced, the so-
ciety could immediately
distribute a message to ev- j #
ery pharmacist in the state. ' "
The pharmacist, in turn, 1 •
could notify the physicians j
in his local community so pt
that he and the physician
could be prepared to an-
swer inquiries from pa-
tients. Another approach
would be to use profes- •
sional publications the
practitioner receives.

All of this leads back to
my opening contention: if
drug regulation is to be ef-
fective, timely, and related
to the realities of clinical
practice, a better method of
communication and feed- j
back must be developed be-
tween the nongovernmen-
tal medical and scientific
communities and the regu-
latory agency.

dvertisement

One of a series

Henry W. Gadsden,
chairman & Chief Executive
Officer, Merck & Co., Inc.

In my opinion, it is the
■esponsibility of all physi-
ians and medical scientists
o take whatever steps they
hink are desirable in a law-
tnd regulation-making
process that can have far-
•eaching impact on the
practice of medicine. Yet
nany events in the recent
oast indicate that this is
lot happening. For exam-
ole, it is apparent from
irug efficacy studies that
;he NAS/NRC panels gave
ittle consideration to the
evidence that could have
oeen provided by practic-
ing physicians.

There are several current
developments that should
increase the concern of
practicing physicians about
drug regulatory affairs. One
is the proliferation of mal-
practice claims and litiga-
tion. Another is the effort
by government to establish
the relative efficacy of
drugs. This implies that if
a physician prescribes a
drug other than the “estab-
lished” drug of choice, he
may be accused of practic-
ing something less than
first-class medicine. It
would come perilously
close to federal direction of
how medicine should be
practiced.

Tn order to minimize this
kind of arbitrary federal
action, a way must be
found to give practitioners
both voice and represen-

tation in government af-
fairs. Government must be
caused to recognize the
essentiality of seeking their
views. One of the difficul-
ties today, however, is that
there is no way for con-
cerned practitioners to par-
ticipate in the early stages
of decision-making proc-
esses. They usually don't
hear about regulations until
a proposal appears in the
Federal Register, if then.
By that time a lot of con-
crete has been poured, and
a lot of boots are in the con-
crete.

Physicians in private
practice, and particularly
clinicians, should press for
representation on the ad-
visory committees of the
Food and Drug Admin-
istration, joining with
academic and teaching hos-
pital physicians and scien-
tists who are already serv-
ing. Though practitioners
may not have access to all
available information, the
value of their clinical expe-
rience should be recognized.
Clinicians, for example,
rightly remind us that diffi-
culty in proving precise ef-
fects does not necessarily
mean a drug is ineffective.

Unless practitioners are
more involved in drug reg-
ulations, it will be increas-
ingly difficult for the phar-
maceutical industry and
scientists elsewhere to

make optimal progress in
drug development. The
benefit/ risk ratio must be
re-emphasized, and as part
of this it must be acknowl-
edged that benefit can come
from the judgments of med-
ical science as a whole.
Even this concept, unfor-
tunately, is not always ac-
cepted in drug regulatory
processes. For example, if
current medical opinion
holds that an excess of total
lipids and cholesterol in the
blood is probably predis-
posing to atherosclerosis,
and if a drug is discovered
which reduces total lipids
and cholesterol, the drug
ought to be accepted prirna
facie as a contribution to
medical science . . . until
someone disproves the
theory. The sponsor should
not have to prove the the-
ory as well as to develop
and test the drug.

I feel a major new effort
must also be made to erase
the feeling of mistrust of
medicine and of medicines

that seems to be growing in
the public consciousness.
Triggered primarily by stri-
dent announcements in
Washington, people are
reading and hearing con-
fidence-shaking things
almost continuously. Al-
though challenge and
awareness are essential to
medical advancement, our
long-term goal is construc-
tively to build, not destroy.
This means strengthening
patient-physician relation-
ships based on mutual con-
fidence and trust. And in
matters of health policy, it
means working toward par-
ticipatory rather than ad-
versary proceedings— where
everyone with an interest
and a capacity to contrib-
ute has an opportunity to
be heard . . . and, if that op-
portunity is not spontane-
ously afforded him, he may
seek it.

Opinion ^Dialogue

What is your opinion, doctor?

We would welcome your comments.

[IHL

The Pharmaceutical Manufacturers Association
1155 Fifteenth Street, N.W., Washington, D.C. 20005

£MSmS ill actiori

MSMS leads
in student contacts

Efforts are being continued by MSMS leaders
and staff to increase liaison with the medical stu-
dents at the three Michigan medical schools. An
AMA official recently observed that MSMS is one
of the pace-setters in this important work.

MSMS in 1971 became one of the first state so-
cieties to seat students as full voting members of
the House of Delegates. Representing each of the
three Michigan SAMA chapters is one delegate and
one alternate. The delegates may introduce and
lobby for resolution on any subject. One of the
student delegates served on a reference committee
at the 1972 Spring House session. Only 13 states
seat delegates.

In 1970, MSMS took the lead to work with three
SAMA chapters to interest hospitals and doctors in
the SAMA-MECO summer project. Eleven students
were placed in 1970 and 51 students last summer.
This year MSMS has obtained spots already for 90
students who will spend 10 weeks in community
orientation programs across the state. The Mich-
igan Hospital Association and Michigan Academy
of Family Physicians cooperate in the project.

A cash contribution of $500 is given by MSMS
each year to each SAMA chapter.

Mark your calendar:
1972 Annual Session
looms Oct. 1-5

It’s time to make plans for the 1972 MSMS An-
nual Session.

The dates are Oct. 1-5, the place is again the
Sheraton-Cadillac Hotel in Detroit, and, as usual,
the annual meeting will be divided into two major
parts: the three-day House of Delegates meeting
and the two-day scientific sessions.

But the Michigan physicians who will travel to
Detroit to attend the wide variety of stimulating
and informing scientific meetings will find a new
organization to the technical subjects.

Throughout Wednesday and Thursday mornings,
Oct. 4 and 5, two scientific meetings will meet con-
currently. Specialty societies and related groups
are being encouraged to hold their meetings dur-
ing the afternoons.

Co-chairmen of the 1972 scientific program are
Robert L. Tupper, MD, newly-appointed executive

Beginning in 1970, MSMS has appointed students
from the three medical schools to MSMS commit-
tees. There are students participating on about 10
committees now.

MSMS has a Planning and Priorities Committee
working on future plans. The select committee in-
cludes a student.

Many doctors contribute to AMA-ERF to help
make loans possible to students. In about 10 years,
the AMA-ERF has loaned more than 1 Vi million
dollars. During 1971, the AMA-ERF guaranteed
loans for 73 U-M students, 88 WSU students and
20 MSU students for a total of $268,000. MSMS also
encourages county medical societies to operate
loan and grant programs.

MSMS has a liaison Committee with Medical Stu-
dents, comprised of six students and six doctors.

The MSMS Liaison Committee with Medical Stu-
dents (George Koepke, MD, Ann Arbor, Chairman)
and the MSMS Education Liaison Committee (Brock
E. Brush, MD, Detroit, Chairman) are working now
on two matters of concern to students and the pro-
fession. Ways are being explored to provide MSMS
financial assistance to needy medical students; and
the two committees were designated by the MSMS
Speaker to study reasons why a growing percent-
age of Michigan medical school graduates go to
other states for internships.

director of the Michigan Association for Regional
Medical Programs, Lansing, and Richard D. Judge,
MD, Ann Arbor, Department of Postgraduate Med-
ical Education, The University of Michigan.

Preceding the Wednesday and Thursday sci-
entific programs, a special session is planned from
2 to 5 p.m. Tuesday for MD and DO chiefs and
vice chiefs of staff, chiefs of clinical departments
and administrators of all Michigan medical and
osteopathic hospitals. Its chairman is Richard W.
Pomeroy, MD, director of medical education at
E. W. Sparrow Hospital, Lansing.

On Wednesday afternoon, two postgraduate
courses will be held. Their subjects will be fainting
and strategies in the diagnosis and management of
patients with recurrent chest pain. A postgraduate
course on surgical approaches to coronary disease
is planned from 2 to 5 p.m. Thursday afternoon.

The two concurrent sessions planned Wednesday
morning, from 9 to 12 a.m., will take up surgical
scientific and medical practical programs. On
Thursday morning, the concurrent sessions will of-
fer topics of medical scientific and surgical prac-
tical interest. Locations of the concurrent sessions
will be the Grand and Crystal Ballrooms of the
Sheraton-Cadillac.

470 MICHIGAN MEDICINE MAY 1972

Our mid-engine
car is a fair-
weather friend
that won’t let
you down in foul weather.

On sunny days, the top snaps
off in thirty-seven seconds, stores
under the rear
trunk lid and
^ Jll I I takes up virtu-
ally no space.

On rainy days the top locks
back on almost as fast. And be-
cause it’s fiberglass, it
won’t leak or rip. Unlike
fabric.

But a friend is more than a
fiberglass top.

First of all, it’s a two-seater
in the classic sports car tradition.
And because two’s company.

Right behind the two seats
is an engine in our race car tradi-
tion.

With the engine in the mid-
dle, handling must be felt to be
believed.
The car
simply

Aim oe- uie, naimiing niusi u

Rjrsche

goes where you point it.

Also with the engine in the
middle, you get a trunk in the
front and the back. A sort of his
and hers. Together they give
16 cubic feet trunk space.

And also rack-and-pinion
steering, and a five-speed gear-
box, 4-wheel disc brakes and a
built-in roll bar as standard equip-
ment.

So see your friendly dealer
and let the sun shine in.

Camp’s Cars, Inc. Northland Imports Wood Imports, Inc.

2000 S. Saginaw Rd., Midland U.S. 41 West, Marquette 15415 Gratiot Ave., Detroit

Traverse Motors, Inc. Prestige Porsche Audi, Ine. Williams Porsche Audi

1301 Garfield Ave., Traverse City 2955 S. Division Ave., Grand Rapids 2924 E. Grand River Ave., Lansing

Tom Sullivan Porsche Audi Co. Soo Imports, Inc.

499 S. Hunter Blvd., Birmingham 1-75 Business Spur, Sault Ste. Marie

OVERSEAS DELIVERY AVAILABLE

Here are the facts on physicians’ fees

by area
and procedure

Michigan physicians charge a wide variety of
fees for the same medical procedure, depending
on the part of the state in which they reside.

That is the major conclusion of the 1971 MSMS
survey of physician fees. The survey was initiated
in July, 1971, by the MSMS Bureau of Economic
Information, under the direction of the MSMS Com-
mittee on Medical Socio-Economics and The MSMS
Council.

Nearly 3,500 completed surveys were returned,
indicating Michigan physicians’ great willingness to
supply data to the Bureau of Economic Informa-
tion.

The results of the fee survey are being made
public here in Michigan Medicine and now will be-
come a part of the statistical bank of the MSMS
Bureau.

The actual state mean fee for a specific pro-
cedure or procedures can be obtained by request-
ing the data from the Bureau of Economic Infor-
mation at MSMS Headquarters.

M

1

till

abi

sic

0*

lie

Tl

M

In

P'

SOME PHYSICIANS KNOW what to do with
their alcohol and drug dependent patients.

SOME PHYSICIANS WISH they knew what
to do with them.

Have you thought of the Addiction Services
of the Battle Creek Sanitarium Hospital?
Since 1965 we have maintained an enviable
record in the rehabilitation of the alcoholic
or problem drinker. We are now serving the
needs of persons dependent on other
chemicals.

A full range of services and specialties.

Give us a call

616-964-7121 Ext. 588 or 589

Battle Creek Sanitarium and Hospital
197 N. Washington Avenue
Battle Creek, Michigan 49016

“Sorry, Sire, but
‘DicarbosiV hasn't
been invented yet."

Dicarbosil

ANTACID

Write for Clinical Samples

ARCH LABORATORIES

319 South Fourth Street. St. Louis, Missouri 63102

472 MICHIGAN MEDICINE MAY 1972

An Explanation:

The procedures below are just a few of the
hundreds of fees the Bureau now has information
about. They demonstrate the wide variance of phy-
sicians’ charges that now exist.

In light of the data generated by the “Physician
Overhead Cost Study,” where costs of providing
health care were quite similar throughout the state,
The MSMS Council assigned the Committee on
Medical Socio-Economics to investigate the matter
further, and to suggest possible alternatives to the
present physician reimbursement mechanism.

The data below should be interpreted in the fol-
lowing manner:

If the state mean fee (x) for a tonsillectomy (code
2992) is $100, then the Area 1 mean fee is .88 mul-
tiplied by $100, or $88. Area 2’s mean fee is $87,
Area 3’s mean fee is $83, Area 4’s mean fee is
$102, Area 5’s mean fee is $106 and Area 6’s mean
fee is $112.

One more example will make it even clearer:

Let’s assume the mean fee (x) is $175, then Area
1’s mean fee is .91 multiplied by $175, or $159;
Area 6’s mean fee is 1.10 multiplied by $175, or
$193.

MICHIGAN STATE MEDICAL SOCIETY
Physician Fee Survey

Code No.

State

Description Median Fee

State
Mean Fee

Area 1
Mean Fee

Area 2
Mean Fee

Area 3
Mean Fee

Area 4
Mean Fee

Area 5
Mean Fee

Area 6
Mean Fee

1046

Puncture for aspiration of
joint, initial

.92X

X

1.08X

.88X

1.08X

.92X

.96X

1.04X

2111

Bronchoscopy, diagnostic

.93X

X

.81X

.81X

.93X

1.38X

.85X

1.00X

2992

Tonsillectomy, with or
without adenoidectomy,
under age (12)

1.06X

X

.88X

.87X

.83X

1.02X

1.06X

1.12X

3261

Appendectomy

.98X

X

.91X

.93X

.76X

.99X

.94X

1.10X

3311

Sigmoidoscopy, diagnostic,
initial

1.00X

X

.85X

.95X

.80X

1.00X

.95X

1.05X

3375

Hemorrhoidectomy, internal
plus external

.94X

X

.87X

.84X

.76X

•98X

.92X

1.14X

3517

Cholecystectomy and pyloroplasty
with partial vagectomy, with
exploration of common duct

1.05X

X

.89X

,89X

.88X

.97X

.92X

1.09X

3631

Hernioplasty; herniorraphy;
herniotomy, inguinal, unilateral

.96X

X

.99X

.92X

.80X

.99X

.91X

1.09X

3931

Cystoscopy: diagnostic, initial

1.04X

X

.75X

.96X

.77X

.73X

1.08X

1.13X

4321

Transurethral electrosection
of prostate, including control
of post operative bleeding,
complete

1.01X

X

.89X

.90X

.91X

•94X

.97X

1.08X

4617

Panhysterectomy: total
hysterectomy (corpus
and cervix)

1.01X

X

.91X

.87X

.83X

.97X

.97X

1.12X

4646

Dilatation and curettage
of uterus

1.00X

X

.87X

,78X

.73X

.85X

.92X

1.18X

4880

Obstetrical delivery and
complete pre-partum and
post-partum care

.97X

X

.85X

.86X

.96X

.97X

1.03X

1.15X

5611

Extraction of lens, intra-
capsular, or extracapsular,
unilateral

.98X

X

1.02X

1.03X

.90X

.91X

.93X

1.09X

5998

Stapedectomy with reconstruc-
tion of ossicular chain, with
vein graft or with intro-
duction of prosthesis

.97X

X

N/A

,97X

.96X

.96X

1.06X

1.01X

7102

X-ray chest — 2 views

1.00X

X

1.06X

1.00X

.69X

1.00X

1.00X

1.00X

7337

Upper gastro-intestinal tract,
with or without delayed films

1.09X

X

.88X

1.00X

.84X

1.06X

.97X

1.03X

8957

Electrocardiogram, with
interpretation and report

.94X

X

1.06X

.94X

1.06X

1.00X

1.06X

1.00X

Initial visit with history
and physical — office

.92X

X

.75X

.76X

.99X

.95X

1.09X

1.09X

Initial visit with limited
work-up — office

.75X

X

.68X

.71X

.89X

.92X

.94X

1.17X

Follow-up or return visit — office

.80X

X

.65X

.67X

.91X

.97X

1.00X

1.14X

MICHIGAN MEDICINE MAY 1972 473

Michigan’s only
EKG phone service
helps lower mortality

Transmission of EKGS by telephone from
rural areas to medical centers for analysis by
trained personnel is a concept now in use in a
few areas of the United States.

Michigan has one such program, inspired by
a Regional Medical Programs project to im-
prove cardiac care in southwestern Michigan.
The independent EKG program, under the di-
rection of John H. Carter, MD, Benton Har-
bor, is one and a half years old.

Since the inception of the full RMP cardiac
care project, according to Frank H. Blinker,
MD, Benton Harbor, project director, mortal-
ity rates in severe myocardial infarction cases
have dropped from 30 to 13 percent. The EKG
program has played a part in this dramatic
drop.

A similar project, involving the University
of Michigan Hospital and nearby Saline, Mich.,
was expected to go before the MARMP board
in April, and if approved, would become the
second in Michigan. The Ann Arbor project
would provide for telephone transmission of
EKGs from Saline Community Hospital to
University Hospital for interpretation there
by the cardiac staff. The major difference over
the Southwestern Michigan project would be
the addition of medical histories to the infor-
mation transmitted with each EKG from Sa-
line.

In the following article, Doctor Carter de-
scribes the Southwestern Michigan EKG pro-
gram:

By John H. Carter, MD
Clinton Wilson, MD
Benton Harbor

As electrocardiographic computer interpretations
have become a useful adjunct to health care de-
livery, a new method of regional monitoring of the
computer has been developed in six hospitals in
(Continued on page 476)

Pre-Sate ®

(chlorphenterniine HC1)

CAUTION: Federal law prohibits dispensing without
prescription.

Indications: Pre-Sate (chlorphentermine hydrochlo-
ride) is indicated in exogenous obesity, as a short
term (/'.e., several weeks) adjunct in a regimen of
weight reduction based upon caloric restriction.
Contraindications: Glaucoma, hyperthyroidism, phe-
ochromocytoma, hypersensitivity to sympathomi-
metic amines, and agitated states. Pre-Sate
(chlorphentermine hydrochloride) is also contrain-
dicated in patients with a history of drug abuse or
symptomatic cardiovascular disease of the following
types: advanced arteriosclerosis, severe coronary
artery disease, moderate to severe hypertension, or
cardiac conduction abnormalities with danger of ar-
rhythmias. The drug is also contraindicated during
or within 14 days following administration of mona-
mine oxidase inhibitors, since hypertensive crises
may result.

Warnings: When weight loss is unsatisfactory the
recommended dosage should not be increased in
an attempt to obtain increased anorexigenic effect;
discontinue the drug. Tolerance to the anorectic
effect may develop. Drowsiness or stimulation may
occur and may impair ability to engage in potenti-
ally hazardous activities such as operating ma-
chinery, driving a motor vehicle, or performing
tasks requiring precision work or critical judgment.
Therefore, such patients should be cautioned ac-
cordingly. Caution must be exercised if Pre-Sate
(chlorphentermine hydrochloride) is used concom-
itantly with other central nervous system stimu-
lants. There have been reports of pulmonary hyper-
tension in patients who received related drugs.
Drug Dependence: Drugs of this type have a poten-
tial for abuse. Patients have been known to increase
the intake of drugs of this type to many times the
dosages recommended. In long-term controlled
studies with high dosages of Pre-Sate, abrupt ces-
sation did not result in symptoms of withdrawal.
Usage In Pregnancy: The safety of Pre-Sate (chlor-
phentermine hydrochloride) in human pregnancy has
not yet been clearly established. The use of ano-
rectic agents by women who are or who may be-
come pregnant, and especially those in the first
trimester of pregnancy, requires that the potential
benefit be weighed against the possible hazard to
mother and child. Use of the drug during lactation
is not recommended. Mammalian reproductive and
teratogenic studies with high multiples of the human
dose have been negative.

Usage In Children: Not recommended for use in
children under 12 years of age.

Precautions: In patients with diabetes mellitus there
may be alteration of insulin requirements due to
dietary restrictions and weight loss. Pre-Sate (chlor-
phentermine hydrochloride) should be used with
caution when obesity complicates the management
of patients with mild to moderate cardiovascular
disease or diabetes mellitus, and only when dietary
restriction alone has been unsuccessful in achieving
desired weight reduction. In prescribing this drug
for obese patients in whom it is undesirable to in-
troduce CNS stimulation or pressor effect, the phy-
sician should be alert to the individual who may be
overly sensitive to this drug. Psychologic disturb-
ances have been reported in patients who concomi-
tantly receive an anorexic agent and a restrictive
dietary regimen.

Adverse Reactions: Central Nervous System: When

CNS side effects occur, they are most often mani-
fested as drowsiness or sedation or overstimulation
and restlessness. Insomnia, dizziness, headache,
euphoria, dysphoria, and tremor may also occur.
Psychotic episodes, although rare, have been noted
even at recommended doses. Cardiovascular: tachy-
cardia, palpitation, elevation of blood pressure.
Gastrointestinal: nausea and vomiting, diarrhea, un-
pleasant taste, constipation. Endocrine: changes
in libido, impotence. Autonomic: dryness of mouth,
sweating, mydriasis. Allergic: urticaria. Genitouri-
nary: diuresis and, rarely, difficulty in initiating
micturition Others: Paresthesias, sural spasms.
Dosage and Administration: The recommended adult
daily dose of Pre-Sate (chlorphentermine hydrochlo-
ride) is one tablet (equivalent to 65 mg chlorphen-
termine base) taken after the first meal of the day.
Use in children under 12 not recommended.
Overdosage: Manifestations: Restlessness, confu-
sion, assaultiveness, hallucinations, panic states,
and hyperpyrexia may be manifestations of acute in-
toxication with anorectic agents. Fatigue and de-
pression usually follow the central stimulation.
Cardiovascular effects include arrhythmias, hyper-
tension, or hypotension and circulatory collapse.
Gastrointestinal symptoms include nausea, vomiting,
diarrhea, and abdominal cramps. Fatal poisoning
usually terminates in convulsions and coma.
Management: Management of acute intoxication with
sympathomimetic amines is largely symptomatic and
supportive and often includes sedation with a bar-
biturate. If hypertension is marked, the use of a
nitrate or rapidly acting alpha-receptor blocking
agent should be considered. Experience with he-
modialysis or peritoneal dialysis is inadequate to
permit recommendations in this regard.

How Supplied: Each Pre-Sate (chlorphentermine
hydrochloride) tablet contains the equivalent of
65 mg chlorphentermine base; bottles of 100 and
1000 tablets.

Full information available on request.

WARNER-CHILCOTT

Division, Warner-Lambert Company
Morris Plains, New Jersey 07950

474 MICHIGAN MEDICINE MAY 1972

Not a controlled drag tinder the Comprehensive
Drag Abuse Prevention and Control Act

# low potential for abuse

♦ less CNS stimulation than with 4-amphetamine
or phenmetrazine

Effective anorectic adjunct to your program
of caloric restriction and diet re-education

* weight loss comparable to d-amphetamine and
phenmetrazine, superior to placebo

# convenient one-a-day dosage

Pre-Sate® (chlorphentermine HCl)...the increasingly practical appetite suppressant

John Carter, MD, checks an interpretation of
an EKG that has just been received over the
interphase at Benton Harbor’s Mercy Hos-
pital from an outlying hospital taking part
in Michigan’s only program to transmit EKGs
by telephone.

TELEPHONE SERVICE/Continued

the tri-county area of southwestern Michigan. The
service began in March, 1971.

Background

In 1969, a Regional Medical Program grant was
obtained to improve diagnostic facilities and train

Physician Summer Placement
in

Beautiful Upper Peninsula

Hospital sixty (60) miles east of Mackinac
Bridge is seeking a Physician with Mich-
igan license to provide partial coverage in
Emergency Room during summer months.
References requested with terms to be
negotiated.

Call or write:

Helen Newberry Joy Hospital
Newberry, Michigan
906-293-5181

Jack Vantassel, Administrator

physicians in the area of cardiovascular disease.
The program prompted the coordination of hospital
activities in the tri-county area (Berrien-Van Buren-
Cass). Physicians were educated in the manage-
ment of cardiovascular problems, particularly in
hospitals where no internists were available. Aid
had been furnished in developing new ICU’s at
three of these hospitals through the RMP grant.

By visits to outlying hospitals, the need for better
and more rapid interpretation of EKG’s, in all hos-
pitals, became evident. Ten of the 11 internists
serving a population of 140,000 were located in the
single urban area of Benton Harbor and St. Joseph.
EKG’s to four hospitals were read by mail or tele-
phone, but even telephoned transmitted EKG’s were
not available in the evening or on weekends. In
1970, regional monitoring of computer EKG anal-
ysis for tri-county hospitals was planned on an
independent basis. Since it was not part of the
RMP grant, it was important that the project be
self-sufficient.

Methods and Materials

In October, 1970, the Interstate Computer Sys-
tems for Medicine in Kalamazoo, under direction
of Roberta Barcala, MD, offered the computer anal-
ysis of EKG’s using an IBM 1800 computer and a
modified Smith Vector Program. A Marquette three
channel cart prints and transmits a vector and 12
lead EKG by Wats line EKG to the computer from
any patient’s bed, ER, OR and ICU, and returns an
interpretation by teletype within one to five minutes.

Marquette Electronics was asked to develop an
interface that would furnish copies of all EKG’s
done at outlying hospitals with computer interpre-
tation for immediate monitoring by an internist
panel at Mercy Hospital. We planned to send cor-
rections by teletype directly to the initiating hos-
pitals. (See pictures 2 and 3.) The interface costing
over $11,000 was available March, 1971. Monthly
lease on the cart and teletype, plus special tele-
phone lines, would total $470. Monthly costs for
lease equipment for initiating hospitals is $240. The
24 hour coverage of taking tracings and teletype
operation is furnished by three EKG technicians
during the day and by Inhalation Therapy tech-
nicians at night, all locally trained. A monthly
charge of $1 for each EKG which goes through the
interphase is used to defray costs of equipment
and personnel.

An EKG panel of 10 Benton Harbor-St. Joseph
internists was formed that would verify, correct,
compare previous EKG’s and suggest appropriate
tests on every computer-read EKG. A panel mem-
ber on a rotating basis reads routinely at noon and
5 p.m., seven days a week. A panel call system
provides an emergency interpretation. Readings
needing immediate action are telephoned to the
family physician. Well-attended monthly EKG panel
meetings are held, summarizing numbers of EKG’s
(normal and abnormal) and accuracy of computer.
Analysis of computer differences are relayed to the
programmer at ICSM. Doctor Barcala has also been
monitoring the computer for other hospitals and has

476 MICHIGAN MEDICINE MAY 1972

The

SENSI-SYSTEM
for Allergy
Diagnosis
& Treatment

History-Careful History is essential to de-
termine symptomatology leading to success-
ful diagnosis and treatment. Self-screening
patient review forms are furnished at no
charge to help evaluate suspected allergy
patients.

Diagnosis-The Diagnostic Kit permits fast,
accurate confirmation of suspected irritants
of 50 of the most commonly encountered al-
lergens. In addition, the Kit also contains
pollens for your botanical area, a scarifier
and individual scarification tips.

Treatment-A personalized prescription for
your patient is compounded based on results
of history and skin-test reactions. This spe-
cific treatment is meant to restore the pa-
tients allergic balance.

For complete information on The Sensi-Sys-
tem of Allergy Diagnosis and Treatment . , .
CALL (Toll Free) ... 800-327-1141.

From Benton Harbor Mercy Hospital, an EKG
is being transmitted through the EKG cart to
the computer in Kalamazoo.

made improvements in the program. The panel also
reviews interesting and difficult EKG’s, pertinent
literature on electrocardiography and correlations
with coronary angiogram, pathology and other
clinical information. These measures provide con-
tinuing updating of the system and panel.

Results and Discussion

Over 14,000 EKG’s have gone through the inter-
face during the last year. By July, 1971, the panel
corrected tracings for six hospitals with a total of
650 acute care beds. Considering the complexity
of the interface, the equipment has been very re-
liable.

Through continuing computer reprogramming, the
accuracy of the computer has improved from 92
to 96 percent for normals and 65 to 81 percent for
abnormals. The most common deficiencies are: 1.
Sino-atrial arrhythmias 2. Electrical pacemakers 3.
Bilateral bundle branch block. The computer tends
to slightly overread eight percent e.g. L.V.H.

The benefits and problems encountered during
the last year are summarized in Table I. Problems
have been less than anticipated and for the most
part, have been solved.

Address

City

Rtete

7 in

(Hin)

Since y 1928

Barry Laboratories, Inc.,

461 N.E. 27th Street,
Pompano Beach, Fla. 33064

Table I

Benefits

1. Early monitoring of the computer interpretation and
consultation for emergency cardiovascular problems for
the non-reader of EKG's.

2. Regional storage of EKG's. All are compared with pre-
vious tracing when available.

3. No additional cost to patient.

4. More consistent interpretations of EKG's.

MICHIGAN MEDICINE MAY 1972 477

EKG TELEPHONE SERVICE/Continued

EKG transmission service showing organiza-
tion of project.

5. Continued education in monthly EKG panel meetings.

6. Opportunity for new internists to equally participate in
the program.

7. Example of tri-county interhospital and physician co-
operation beneficial to all participants.

8. More general and comprehensive review of interesting
cardiovascular pathology in the area.

9. Better utilization of internists’ time.

10. Availability of the computer to expand its services to
other areas of diagnosis such as pulmonary function
tests, cardiac catheterization, ICU monitoring and elec-
trolytes.

Problems

1. At this time most computer programs need improve-
ment in interpretation of arrhythmias. Reprogramming
has improved this and other problems. A new revision
of the arrhythmia section will be ready next month with
an expected accuracy greater than 90 percent.

2. Language of the computer interpretation is new to the
physician, i.e., “unusual early depolarization.” This has
been steadily improved.

3. Programs for pediatric EKG’s are inadequate because of
variation with age.

4. Physician may be overly impressed with the computer
interpretation and clinical information may be disre-
garded.

5. Internists must adjust to multichannel and a new cardi-
ography method of interpreting EKG’s. The internist
must make his diagnosis, then check the computer diag-
nosis.

Conclusion

The EKG computer regional monitoring program
has improved the accuracy and prompt delivery of
EKG interpretations. It has made consultation in
management readily available. The computer and
internist complement each other in attaining this
goal. It has provided another basis for a cooperat-
ing spirit among participating hospitals resulting in
better patient care and making possible future co-
operative endeavors.

The hospitals involved in this project are Mercy
Hospital, Benton Harbor; Memorial Hospital, St. Jo-
seph; Watervliet Community Hospital, Watervliet;
Lee Memorial Hospital, Dowagiac; South Haven
Community Hospital, South Haven; and Berrien
General Hospital, Berrien Springs, Michigan. We
would like to thank the staffs, administrations and
boards for their cooperation.

478 MICHIGAN MEDICINE MAY 1972

Specifically formulated with
vitamins and minerals important
in the treatment of anemia

PHASE 1

Enhanced Absorption

Each tablet provides 1 1 5 mg
elemental iron asthe highly
absorbable ferrous fumarate plus 600
mg of Vitamin C.

PHASE 2

Erythrocyte Formation

Each tablet provides Vitamin B12
(25 meg) and Folic Acid (1 mg) to
replace deficiencies.

PHASE 3

Premature Hemolysis

Each tablet provides Vitamin E, which
may be involved in lessening red
blood cell fragility.

For common anemias
as well as problem ones

HEMATINIC TABLETS

Tri-Phasic Hematinic with 600 mg Vitamin C PLUS Vitamin E

Each tablet contains:
Vitamin C (Ascorbic Acid)

600 mg.

Vitamin Em (Cobalamin
Concentrate, N.F.)

25 meg.

Intrinsic Factor Concentrate

75 mg.

Folic Acid

1 mg.

Vitamin Efd-AlphaTocopheryl
Acid Succinate)

30 Int. Units

Elemental Iron (as present in
350 mg. of
Ferrous Fumarate)

115 mg.

Dioctyl Sodium
Sulfosuccinate U.S.P.

50 mg.

Dosage: One Tablet Daily.
Available in Bottles of 30 Tablets.
On Your Prescription Only.

Precautions: Some patients affected with pernicious anemia may not respond to orally
administered Vitamin B,2 with intrinsic factor concentrate and there is no known way to
predict which patients will respond or which patients may cease to respond. Periodic
examinations and laboratory studies of pernicious anemia patients are essential and
recommended. If any symptoms of intolerance occur, discontinue drug temporarily or
permanently. Folic acid, especially in doses above 1 mg. daily, may obscure pernipious
anemia, in that hematologic remission may occur while neurological manifestations re-
main progressive.

Adverse Reactions: G.I.: nausea, vomiting, diarrhea, abdominal pain. Skin rashes may
occur. Such reactions may necessitate temporary or permanent changes in dosage or
usage. Allergic sensitization has been reported following both oral and parenteral admin-
istration of folic acid.

HEMATINIC TABLETS

Tri-Phasic Hematinic with 600 mg Vitamin C PLUS Vitamin E

Specifically formulated with vitamins and minerals
important in the treatment of anemias, plus a stool
softener to counteract the constipating effects of iron.

LEDERLE LABORATORIES

A Division of American Cyanamid Company, Pearl River, New York 1 0965 421-1

MOVE-OUT STICKY MUCUS

In asthma, bronchitis

"Many physicians use iodides intravenously when they suspect that the main
reason for airway obstruction is sticky mucus but oral iodides are more
likely to exert an expectorant action.”1

"For the viscid sputum, potassium iodide (. . . preferable as enteric coated
tablets) may be best.”2

Provide tastefree, well-tolerated KI in convenient SLOSOL coated tablets

IODO-NIACIN

Each SLOSOL coated tablet contains potassium COLE m

iodide 135 mg. and niacinamide hydroiodide 25 mg.

please see next page for prescribing information —

Promote Productive Cough

"The productive cough
serves the necessary
purpose of removing
excess mucus from
the bronchial tree.”3

”... there is clear evidence
that the loosening of the bronchial mucus
blanket must begin from within the under-
lying mucus glands where it is anchored
and not from the surface. Complications
of iodides are too occasional to avoid the
use of this valuable medication.”3

Rx Information:

INDICATIONS: The primary indication for lodo-Niacin is in any clinical
condition where iodide therapy is desired. All of the usual indications for the
iodides apply to lodo-Niacin and include:

RESPIRATORY DISEASE: The use of lodo-Niacin is indicated whenever an
expectorant action is desired to increase the flow of bronchial secretion and
thin out tenacious mucus as seen in bronchial asthma, and other chronic
pulmonary disease. lodo-Niacin has also proven of value in sinusitis, bron-
chitis, bronchiectasis, and other chronic and acute respiratory diseases
where the expectorant action of iodide is desired.

THYROID DISEASE: lodo Niacin is indicated in any thyroid disorder due to
iodine deficiency, such as endemic goiter or hypoplastic goiter, and where
hypothyroidism is secondary to iodine deficiency. lodo-Niacin will suppress
mild hyperthyroidism completely, and partially suppress more severe hyper-
thyroid states. lodo-Niacin is also of value in suppressing the symptoms of
hyperthyroidism and decreasing the size and vascularity of the thyroid gland
prior to thyroidectomy.

ARTERIOSCLEROSIS: Iodides have been reported as relieving some of the
symptoms associated with arteriosclerosis. The mechanism of action is un-
known, but the effects are documented.

OPHTHALMOLOGY: lodo Niacin has been reported to be of value in retinal and
vitreous hemorrhages. The mechanism of action is unknown, but absorption

of the hemorrhagic areas has been observed following use of this drug. It is
also reported to be of value in reducing or removing vitreous floaters.

SIDE EFFECTS: Serious adverse side effects from the use of lodo-Niacin are
rare. Mild symptoms of iodism such as metallic taste, skin rash, mucous
meiriDrane ulceration, salivary gland swelling, ana gastric distress have
occurred occasionally. These generally subside promptly when the drug is
discontinued. Pulmonary tuberculosis is considered a contraindication to
the use of iodides by some authorities, and the drug should be used with cau-
tion in such cases. Rare cases of goiter with hypothyroidism have been
reported in adults who had taken iodides over a prolonged period of time,
and in newborn infants whose mothers had taken iodides for prolonged
periods. The signs and symptoms regressed spontaneously after iodides were
discontinued. The causal relationship and exact mechanism of action of
iodides in this phenomenon are unknown. Appropriate precautions should be
followed in pregnancy and in individuals receiving lodo-Niacin for prolonged
periods.

DOSAGE: The oral dose for adults is two tablets after meals taken with a
glass of water. For children over eight years, one tablet after meals with
water. The dosage should be individualized according to the needs of the
patient on long-term therapy

HOW SUPPLIED: Cole's lodo-Niacin tablets are available in bottles of 100,
500 and 1,000 Slosol coated pink NDC 55-6458.

IODO-NIACIN

Each SLOSOL tablet contains potassium iodide 135 mg. and
niacinamide hydroiodide 25 mg. Sig. // tabs, t.i.d. p.c.

References: 1. Itkin, 1 H., Am. Fam. Phys. 4:83, 1971 2. Feinberg, S. M., Consultant
Sept., 1971, pg. 32. 3. Bookman, R., Ann. Allerg. 29:367, 1971.

COLE

PHARMACAL CO. INC.

St. Louis, Mo. 63108

Wellcome

Burroughs Wellcome Co.

Research Triangle Park
North Carolina 27709

A gratifying
announcement about
Empirin Compound
with Codeine

You may now specify up to five refills
within six months when you prescribe
Empirin Compound with Codeine
(unless restricted by state law).

It is significant in this era of increased
regulation, that Empirin Compound with Co-
deine has been placed in a less restrictive category.
You may now wish to consider Empirin with
Codeine even more frequently for its predictable
analgesia in acute or protracted pain of moderate
to severe intensity.

Empirin Compound with Codeine No. 3 contains
codeine phosphate* (32.4 mg.) gr. Vi. No. 4
contains codeine phosphate* (64.8 mg.) gr. 1.
*( Warning— may be habit-forming.) Each tablet
also contains: aspirin gr. 3 Vi, phenacetin gr. 2 Vi,
caffeine gr. Vi.

When you select this familiar antibiotic for
IV infusion you have available a broad dosage range
that hospitalized patients may need.

if

Intravenous Lincocin (lincomycin
hydrochloride, Upjohn), with its 1.2 to
8 grams/ day dosage range, covers many
serious and even life-threatening
infections. Lincocin is effective in
infections due to susceptible strains of
streptococci, pneumococci, and
staphylococci. Lincocin IV therefore
can be as useful in your hospitalized
patients as its IM use has proved to be in
your office patients. As with all
antibiotics, in vitro susceptibility studies
should be performed.

In life-threatening situations as much
as 8 grams/ day has been administered
intravenously to adults.

1.2 to 8 grams/ day IV dosage ranges j

Most hospitalized patients with
uncomplicated pneumonias respond
satisfactorily to 1 .2 to 1 .8 grams/ day of
Lincocin IV. These doses may have to
be increased for more serious infections.

In usual IV doses, Lincocin (lincomycin
hydrochloride, Upjohn) should be
diluted in 250 ml or more of normal
saline solution or 5% glucose in water
But when 4 grams or more per day is
given, Lincocin should be diluted in not
less than 500 ml of either solution,
and the rate of administration should
not exceed 100 ml/hour. Too rapid
intravenous administration of doses
exceeding 4 grams may result in
hypotension or, in rare instances,
cardiopulmonary arrest.

Effective gram-positive antibiotic:

Lincocin IV is effective in respiratory
tract, skin and soft-tissue, and bone

■

f

'i

> 1972

tfections caused by susceptible strains
[pneumococci, streptococci, and
aphylococci, including penicillin-
;sistant strains. Staphylococcal strains
distant to Lincocin (lincomycin
ydrochloride, Upjohn) have been
^covered. Before initiating therapy,
alture and susceptibility studies should
2 performed. Lincocin has proved
iluable in treating patients hyper-
msitive to penicillin or cephalosporins,
nee Lincocin does not share
itigenicity with these compounds,
owever, hypersensitivity reactions
ave been reported, some of these in
atients known to be sensitive to
enicillin.

Pell tolerated at infusion site: Lincocin
itravenous infusions have not
roduced local irritation or phlebitis,
hen given as recommended. Lincocin
usually well tolerated in patients who
re hypersensitive to other drugs,
evertheless, Lincocin should be used
autiously in patients with asthma or
gnificant allergies.

i patients with impaired renal function,
le recommended dose of Lincocin
lould be reduced to 25—30% of
le dose for patients with normal
idney function. Its safety in
regnant patients and in infants
;ss than one month of age has
ot been established.

Jncocin may be used with other
ntimicrohial agents: Since Lincocin
; stable over a wide pH range, it is
aitable for incorporation in

administered concomitantly with other
antimicrobial agents when indicated.
However, Lincocin should not be used
with erythromycin, as in vitro antagonism
has been reported.

Lincocitr

Sterile Solution (300 mg per ml)

(lincomycin hydrochloride,Upjohn)

For further prescribing information, please see following page.

Sterile Solution (300 mg. per ml.)

(lincomycin hydrochloride, Upjohn)

Up to 8 grams per day by IV infusion for
hospitalized patients with life-threatening infections.
Lincocin is effective in infections due to
susceptible strains of streptococci, pneumococci,
and staphylococci. As with all antibiotics,
in vitro susceptibility studies should be performed.

Each Lincomycin

preparation hydrochloride

contains: monohydrate

equivalent to
lincomycin base

250 mg Pediatric Capsule 250 mg

500 mg Capsule 500 mg

^Sterile Solution per 1 ml 300 mg

Syrup per 5 ml 250 mg

"'Contains also: Benzyl Alcohol 9 mg; and,
Water for Injection — q.s.

Lincocin (lincomycin hydrochloride) is in-
dicated in infections due to susceptible strains
of staphylococci, pneumococci, and strepto-
cocci. In vitro susceptibility studies should
be performed. Cross resistance has not been
demonstrated with penicillin, ampicillin,
cephalosporins, chloramphenicol or the tet-
racyclines. Some cross resistance with eryth-
romycin has been reported. Studies indicate
that Lincocin does not share antigenicity
with penicillin compounds.

CONTRAINDICATIONS: History of prior
hypersensitivity to lincomycin or clindamy-
cin. Not indicated in the treatment of viral
or minor bacterial infections.

BEEN REPORTED FOLLOWING PA-
RENTERAL THERAPY. A careful inquiry
should be made concerning previous sensi-
tivities to drugs or other allergens. Safety
for use in pregnancy has not been estab-
lished and Lincocin (lincomycin hydrochlo-
ride) is not indicated in the newborn. Reduce
dose 25 to 30% in patients with severe im-
pairment of renal function.

PRECAUTIONS: Like any drug, Lincocin
should be used with caution in patients
having a history of asthma or significant
allergies. Overgrowth of nonsusceptible or-
ganisms, particularly yeasts, may occur and
require appropriate measures. Patients with
pre-existing monilial infections requiring
Lincocin therapy should be given concomi-
tant antimonilial treatment. During pro-
longed Lincocin therapy, periodic liver
function studies and blood counts should be
performed. Not recommended (inadequate
data) in patients with pre-existing liver dis-
ease unless special clinical circumstances in-
dicate. Continue treatment of /3-hemolytic
streptococci infections for 10 days to
diminish likelihood of rheumatic fever or
glomerulonephritis.

mines available for emergency treatment
Skin and mucous membranes— Skin rashe' S
urticaria, vaginitis, and rare instances of ex | |
foliative and vesiculobullous dermatitis hav ,
been reported. Liver— Although no direct re
lationship to liver dysfunction is establishec
jaundice and abnormal liver function test) (
(particularly serum transaminase) have bee:
observed in a few instances. Cardiovascula
—Instances of hypotension following paren
teral administration have been reported
particularly after too rapid IV administra
tion. Rare instances of cardiopulmonary ar
rest have been reported after too rapid I\
administration. If 4.0 grams or more admin
istered IV, dilute in 500 ml of fluid ani
administer no faster than 100 ml per hour
Special senses— Tinnitus and vertigo havi
been reported occasionally. Local reaction
—Excellent local tolerance demonstrated ti
intramuscularly administered Lincocii
(lincomycin hydrochloride). Reports of paii
following injection have been infrequent
Intravenous administration of Lincocin ii
250 to 500 ml of 5% glucose in distillet
water or normal saline has produced m
local irritation or phlebitis.

WARNINGS: CASES OF SEVERE AND
PERSISTENT DIARRHEA HAVE BEEN
REPORTED AND HAVE AT TIMES
NECESSITATED DISCONTINUANCE
OF THE DRUG. THIS DIARRHEA HAS
BEEN OCCASIONALLY ASSOCIATED
WITH BLOOD AND MUCUS IN THE
STOOLS AND HAS AT TIMES RE-
SULTED IN AN ACUTE COLITIS. THIS
SIDE EFFECT USUALLY HAS BEEN
ASSOCIATED WITH THE ORAL DOS-
AGE FORM BUT OCCASIONALLY HAS

ADVERSE REACTIONS: Gastrointestinal
—Glossitis, stomatitis, nausea, vomiting. Per-
sistent diarrhea, enterocolitis, and pruritus
ani. Hemopoietic— Neutropenia, leukopenia,
agranulocytosis, and thrombocytopenic pur-
pura have been reported. Hypersensitivity
reactions— Hypersensitivity reactions such
as angioneurotic edema, serum sickness, and
anaphylaxis have been reported, sometimes
in patients sensitive to penicillin. If allergic
reaction occurs, discontinue drug. Have
epinephrine, corticosteroids, and antihista-

HOW SUPPLIED: 250 mg and 500 mt
Capsules— bottles of 24 and 100. Sterilt
Solution, 300 mg per ml— 2 and 10 ml vial'
and 2 ml syringe. Syrup, 250 mg per 5 tn
—60 ml and pint bottles.

For additional product information, consul .
the package insert or see your Upjohi
representative.

MED B-6-S (KZL-7) JA71-1631

The Upjohn Company
Kalamazoo, Michigan 49001

Upjohn

c Your opir\iori please

MSMS asked the question:

“How would you propose that
MSMS , the component societies , or
the specialty societies work to fur-
ther improve the access to health
care , or the entry of the patient into
the present modes of medical prac-
tice?”

These doctors replied :

Joseph W. Christie, MD
St. James, Beaver Island

Let your physician direct your medical destinies
as he knows and he cares. The medical society
must urge all patients to have a personal physi-
cian, meeting him and registering the name with
the physician’s receptionist! In this way if sickness
strikes, the patient will be cared for or be referred
to the proper specialist. When therapy is over, the
specialist will then send the patient back with diag-
nosis and treatment. The receptionist will keep a
current alphabetical file with pertinent data in the
physician’s office. Should the load become too
heavy, the physician must not take new families or
he might decide to take in an associate MD. When
away, the physician will have another MD take over
until he returns.

The so-called “Welcome Wagon Approach” will
be made to all newcomers to the community, al-
lowing them to know the medical society does care
about their health needs, as a family doctor is
eager to counsel the parents and teenagers on nar-
cotics and dangerous drugs as well as sex and ve-
nereal disease.

We should say to all patients, “Allow your family
physician to be your ‘clearing house’ for com-
plete medical services as he is a professional in
the art and his credentials and character have been
well checked out by the state and county medical
society. You are entitled to the best medical serv-
ice and you will and can secure the best.”

(A fine idea as our “Image” is tarnished by our
politicians. If we don’t act now, this may be “Cus-
ter’s Last Stand.”)

Robert E. Fisher, MD
Battle Creek

Since access to education has become a “right,”
the product of the system has not shown more
rationality, wisdom, self-discipline, or humaneness.

Access to health care is not going to produce
healthier citizens, and incentives for restraints
on access against both the consumer and the
provider must be contained in any national health
care scheme which is to succeed. We are pres-
ently spending $78 billion annually on health care
and could spend 50 percent of the Gross National
Product on it if we were so disposed. Society is
so far away from knowing what it wants that any
plan should have provisions for changing priorities
among health services and between health care
and other types of social investment in the quality
of life; furthermore, delivery plans should not be
firmly fixed in basic law.

If the British people were satisfied with their
end of their system there would be no room for
“The Patients’ Association” — a “flourishing organi-
zation with the stated purpose of safeguarding the
rights and dignities of those entrusted to our care”
and if the Minister of Health 1964-68 was pleased
with his end of the system he would not have
stated in 1971 “some social processes, such as
national health programs, are irreversible by the
destruction of the alternatives to them.”

It is our duty to try to preserve the alternatives
until sanity returns. We have no other administra-
tive duty at this time. If it is difficult for patients
to “get into” the system, other than through an
emergency room, some such plan as the following
might be tried.

1. Physicians of all specialties would agree to
respond to telephone calls from would-be patients,
and give information, not medical advice.

2. Physicians, and clinics, and hospitals would
agree to accept patients referred from (1), and

MICHIGAN MEDICINE MAY 1972 489

YOUR OPINION /Continued

Doctor Haeck Doctor Redmon

hospital emergency rooms would cease being the
point of entry except for medical emergencies.

3. A doctor (and this is the essence of the plan)
would reassure the would-be patient, and tell him
what to do and where to go and how to get there,
and to go at once if there was really urgency ap-
parent.

4. Once this was set up, the society would com-
mence an intensive campaign to familiarize the
citizens with a single telephone number, 769 74-
2426 (PHYSICIAN) state-wide, but by districts.

5. The society would set up switchboards by
districts and record each call, on tape. The tapes
would be transcribed with copies for the patient-
to-be, the responding physician, the referred-to
physician or clinic or agency, and to a file.

6. The file would be analyzed for intensity of
use and quality of advice given, the findings re-
ported to the membership.

7. For the experimental period, physician time
would not be carried as an expense; other costs
would be charged to the would-be patient or the
intermediary. A permanent program would have to
include cost of physician time.

8. There is no way to provide access to those
who do not have access to a telephone.

William Haeck, MD
Grand Rapids

The question presupposes that the method of
the delivery of health care remain as it is today;
and as I understand the question, that it be made
more available to the general public.

The only way that it can be made more avail-
able to the public is to increase the number of
doctors providing patient care; and to increase
the efficiency of those already providing that pa-
tient care. The private free enterprise system of
medicine recognizes that it must do a better job of
delivering health care and therefore has advocated
changes which even now are being put into effect.

We should:

1) Advocate a re-emphasis on education in the
medical schools; rather than that medical schools
continue primarily as research centers. This in it-
self would allow enrollments to increase.

2) Reduce the number of physicians now work-
ing for the government. There are now 30,000 doc-
tors working for Uncle Sam, more than 6,000 of
whom are not involved in patient care.

3) Continue to innovate new teaching programs
which have their emphasis on patient care, such
as those now being carried out by Michigan State
University’s College of Human Medicine. We should
get away from the emphasis in our medical schools
on research, academic or government work.

4) Return to the use of practitioners as part
time medical faculty. This will release some full
time teachers for the care of patients and it will
expose students to practicing physicians.

5) Shorten the education process by rearranging
curriculums. This will permit schools to graduate
more physicians and yet not reduce the quality
of the graduate.

6) Encourage hospitals to establish “self care”
units. This will not only reduce hospitalization
costs but will also save physicians’ time.

7) Encourage the use of surgical out patient units
for minor surgery. Again, this will reduce the cost
of medical care and save physicians’ time.

8) Make more extensive use of paramedical
personnel in various ways to reduce the time a
physician must spend with patients.

All of the above suggestions have in mind two
ways in which access to medical care can be im-
proved: increase the number of physicians who
will care for patients; and increase the time that
a physician has to spend in patient care. MSMS
should continue to work towards these ends.

William B. Redmon, MD
Midland

The first thought that comes to mind in attempt-
ing to improve access to health care is to broaden,
as much as possible, the use of paramedical per-
sonnel. Much has recently been said and written
concerning this subject and steps are, indeed, be-
ing taken to implement it. In talking to other physi-
cians (both in Michigan and elsewhere) my impres-
sion is that everyone is “for it” at the same time
“afraid of it.” Much of this fear seems to center
around the problem of legal liability and the diffi-
culties in establishing boundaries for the activities
of paramedical personnel.

We should utilize all facilities in the training of
such individuals — for example, services of hospital
emergency rooms or general hospital services
(such as surgery — Dr. Richard Pomeroy’s Program
for orthopaedic technicians certainly fits here) and
especially in our own offices. I do believe that
physicians should be encouraged, as much as pos-
sible, to participate in such programs of training
and to utilize, as much as possible, the services of
these individuals when trained and available.

I do believe that we should ask the state legisla-
ture, and, if possible, the courts to help us in accu-
( Continued on page 492)

490 MICHIGAN MEDICINE MAY 1972

CHIGAN STATE MEDICAL SOCIETY

IRIENT ADVENTURE

!898

DRESS

V STATE ZIP PHONE

U<E YOUR RESERVATIONS EARLY-
ACE STRICTLY LIMITED!

e's what is included :

;ct flights via World Airways 707
ate jets, featuring stretch-out
ting . . . deluxe hotels . . . full
erican breakfasts and gourmet
ners at a selection of the
st restaurants in each city . . .
i pounds baggage allowance . . .
isfers . . . tips . . . and much more.

3ARTING :

troit July 11, 1972

TURN THIS COUPON NOW!

, , Michigan State Medical Society
10 t0 P.0. Box 950

East Lansing, Michigan 48823

:losed is my check for $ ($1 00 per

son) as Orient Adventure deposit.

I s $45 Tax and Service

• over two of the most exciting cities in
world — TOKYO and HONG KONG.

14 days live in a world you've only dreamed
3eishas . . . the Ginza . . . pagodas . . .
rious hotels . . . exquisite dining. Places
people you'll never forget.

jnt Adventure offers you the unique chance
xplore on your own or take advantage
roup activity. Sightsee, shop, golf,
itclub . . . it's your vacation and the choice
Durs.

YOUR OPINION /Continued

rately defining legal liability in order to remove, in-
sofar as possible, the ever-present fear of litiga-
tion.

I feel, also, that the local societies, in particular,
could render considerable service by helping to or-
ganize clinics for mass examinations of groups of
youngsters. These would include athletic examina-
tions necessary for intermediate and high school
athletics; camp examinations and similar services.
Such arrangements are already being carried out
in some communities. These are, regretfully, not
state-wide as they perhaps could and should be.
With greater emphasis being continually placed on
physical fitness and participation in athletics, the
necessity for examination of larger groups of
youngsters for participation in such athletics (this
is particularly true in women’s athletics at the high
school level) will continue to be a great need.

Finally, the various specialty groups could, I be-
lieve, broaden their educational programs and ex-
tend their educational programs by lecture and
demonstrations by physicians in smaller and out-
lying communities. Some effort is already being
made In this direction. ! believe that it could be
considerably extended.

MSMS offers
group insurance
to interns, residents

Michigan Interns and residents are now eligible
to subscribe to the MSMS Group Disability Insur-
ance Program for the minimal charge of $10. The
payment of the fee also makes the intern or resi-
dent an associate member of MSMS.

At its March 19 meeting, the MSMS Council
approved the new insurance proposal of the MSMS
Committee on Professional Insurance Plans. The
insurance is carried by the Provident Life and
Accident Insurance Co. and handled for MSMS
by the Ben P. Stratton Agency of Lansing.

The MSMS Disability Insurance Program is avail-
able to interns residents under age 34 and offers
$325 monthly indemnity on a lifetime-accident, five
year sickness plan. Benefits commence the first
day for accident and 16th day for sickness at the
annual premium of $10.

By offering the plan to interns and residents,
MSMS demonstrates its vital interest in the future
members which provide the lifeblood of the society,
and also provides a continual influx of new, young
physicians in the group disability program.

Doctors

tell your AMA leaders
what you want

By Brooker L. Masters, MD
Chairman, MSMS Council

Tell your AMA Delegates what you think.

Recently, the AMA made an unprecedented move
in seeking opinions of the dues-paying members in
matters which will guide House and Board of Trus-
tees in the development of policies.

Yet, there is more you can do. You owe it to
yourself and organized medicine to talk to your
Michigan Delegate to the AMA and tell him what
you think AMA ought to be doing for physicians
and the future of medicine.

Leadership must know what the constituency
wants. Without this knowledge, leadership votes its
own personal opinions.

Here is a list of your Delegates and Alternates,
call or write today.

AMA delegates

John J. Coury, MD, 1225 Tenth St., Port Huron,
48060; George W. Slagle, MD, 203 Capital Ave.,
NE, Battle Creek, 49017; Donald N. Sweeny, Jr.,
MD, 8445 E. Jefferson Ave., Detroit, 48214; Joseph
A. Witter, MD, 1745 Tiverton Road, #23, Bloom-
field Hills, 48013; Otto K. Engelke, MD, 313 Wash-
tenaw Co. Bldg., Ann Arbor; Paul T. Lahti, MD,
3600 W. 13 Mile Road, Royal Oak, 48072; John W.
Moses, MD, Mt. Carmel Mercy Hospital, Detroit,
48235, and Robert E. Rice, MD, Memorial Clinic,
420 S. Bower St., Greenville, 48838.

Alternates

James C. Danforth, Jr., MD, 20175 Mack Avenue,
Grosse Pointe Woods, 48236; Marjorie Peebles
Meyers, MD, 3790 Woodward Ave., Detroit, 48201;
Robert C. Prophater, MD, 202 Boehringer Court,
Bay City, 48706; Vernon V. Bass, MD, 3322 Daven-
port St., Saginaw, 48602; Frank B. Walker II, MD,
1206 Balfour Road, Grosse Pointe Park, 48230;
Donald T. Anderson, MD, 408 Hamilton Road,
Kingsford, 49801; Richard J. McMurray, MD,
2675 Flushing Road, Flint, 48504, and Brooker L.
Masters, MD, 111 W. Dayton St., Fremont, 49412.

492 MICHIGAN MEDICINE MAY 1972

the ampicillin derivative

Each capsule contains potassium hetaeillin equivalent to
225 mg. or 450 mg. ampicillin

BRISTOL I AH0RA10RIES
Division ol Bristol Myers Company
Syracuse, New York 13201

The MSMS conference room was filled with
members of MSMS committees on Govern-
ment Medical Care Programs and Rural Med-

Maurice S. Reizen, MD, left, director of the
State Health Department, visits with Robert
E. Rice, MD, right, chairman of the MSMS
Committee on Government Medical Care Pro-
grams, and Donald R. McCorvie, MD, stand-
ing, chairman of the MSMS Committee on
Rural Medical Service.

ical Service when they dined jointly to hear
progress reports on two health delivery proj-
ects in Detroit.

Homer C. Smothers, MD, center, Wayne
County Medical Society president, views one
of the slides used during a presentation by
Thomas Batchelor, MD, right, about medical
care provided by the Model Neighborhood
Comprehensive Health Programs, Inc. John
Mucasey, MD, left, also spoke at a joint
meeting of the MSMS Committees on Govern-
ment Medical Care Programs and Rural Med-
ical Service at the MSMS building. Topic was
the Woodland Medical Group, Inc., P.C.

New delivery systems
studied by committees

Participating in one of the informal
discussions at the joint meeting
were Robert E. Stelle, MD, stand-
ing, Crystal Falls, and George
Drake, seated, third-year MSU med-
ical student. A growing number of
MSMS committees include medical
students from the three Michigan
schools.

494 MICHIGAN MEDICINE MAY 1972

• no interference with diabetic control . . . does not alter
carbohydrate metabolism.1

• conflicts have not been reported with diuretics,
corticosteroids, antihypertensives or miotics.

There are no known contraindications in recommended
oral doses other than it should not be given in the presence
of frank arterial bleeding or immediately postpartum.

IhSOdlAN

ISOXSUPRWE HC

the compatible vasodilator

,U.tH no, M Clin, Con, ape, on ,ke oC.eof °"

isoxsuprme. Effects have been demonstrated both by o jec . * diabetic vascular diseases thromboangiitis obliterans (Buerger’s disease),

lications: Cerebrovascular insufficiency, arteriosclerosis obliterans, d and ukers of ^hg extremities (arteriosclerotic, diabetic, throm-

ynaud’s disease, postphlebitic conditions, acroparesthesia, r y D , Oral— 10 to 20 mg. t.i.d. or q.i.d. Contraindications and

tic). Composition: VasodIlan tablets, isoxsuprme HC1 10 mg and 20 mg. Uosage . ut t immediatfly p0Stpartum 0r in the presence of

:eria”bleTding. Side^ffrot^'occasionaf^a^Wti^ ^n^dizziness can g° s^ancC Shafte^H? J^ndiana™^6*6 deta*'*

McadjUteii

) Horton, G. E., and Johnson, P.C., Jr.: Angiolo^ I5:7i>74 (Feb )1 -I J rymi , . , ’ laboratories

irr. Then Res. 4:124-128 (April) 1962. (5) Whittier, J. R. : Angiology 15 .82-87 (Feb.) 1964.

143 Michigan cities seek family doctors;
nearly 60 more need other specialists

Once again, as a service to physicians, Michigan
Medicine publishes the list of Michigan communi-
ties needing family practitioners and other special-
ists. The list is compiled by the Michigan Health
Council, which operates a free MD Placement Serv-
ice under MSMS guidance.

The Health Council’s list of communities needing
family physicians immediately follows this intro-
duction.

The specialty roster, which is available at all
times from the Health Council, lists the current op-
portunities by area, then alphabetically by city with-

Here's good news:
Michigan gains
206 MDs in 1971

A new set of figures from the Michigan Health
Council reveal that during the past year Michigan
gained 213 licensed physicians and 7,108 nurses.

According to the MHC’s 1972 Survery of Health
Manpower, licensed medical doctors increased by
206 and osteopaths by seven, for a record total of
2,124. The number of registered nurses jumped
4,728 to a record total of 45,942 and licensed prac-
tical nurses increased 2,380 to another record of
22,771.

Most Michigan counties gained one or more
doctors of medicine. Major increases occurred
in Genesee (17), Kalamazoo (16), Calhoun (9),
Macomb (25), Ingham (18), Kent (31), Washtenaw
(36) and Oakland (117). Counties with major losses
included Houghton (6), Midland (6) and Wayne
(102).

Michigan now has a ratio of one physician per
792 population compared to a U.S. ratio of one
physician per 631 population.

Within another two or three years, says John
A. Doherty, MHC executive vice president, officials
are hopeful that Michigan will be gaining at least
400 to 500 licensed physicians annually.

in the area. The Health Council uses a system of
local advisors, the immediate past presidents of
their component medical societies, to verify the
need for an MD in a particular area. Physicians
interested are invited to write the local advisors
directly for an appraisal of the need in that area.

Special bulletins are issued every 30 to 60 days
by the Health Council, and contain information
about new opportunities. All specialists registered
with the Placement Service receive the bulletin
automatically when an opening becomes available.

In addition to placement information, the Health
Council has a free list available to medical stu-
dents of approved residencies in Michigan. The list
may be obtained by writing to the Health Council,
712 Abbott Road, Box 1010, East Lansing, 48823.

The Michigan Health Council currently has 142
communities that are seeking general practitioners.
They are as follows:

UPPER PENINSULA — Baraga, Bessemer, Crystal
Falls, Escanaba, Ewen, Hancock-Houghton, Iron
Mountain-Kingsford, Iron River, Manistique, Mar-
quette, Menominee, Newberry, Norway, Rock, St.
Ignace, Sault Ste. Marie, Wakefield
NORTH CENTRAL — Alpena, Charlevoix, Frankfort,
Gaylord, Grayling, Hillman, Houghton Lake-Pru-
denville Area, Indian River, Lewiston, Lincoln,
Mackinaw City, Mancelona, Roscommon, St.
Helen, West Branch

WEST CENTRAL — Baldwin, Barryton, Belding, Big
Rapids, Edmore and Township, Eureka, Fremont,
Grand Haven, Hart, Holton, Kent City, Lakeview,
Lowell, Ludington, Manistee, Muskegon, Neway-
go, Onekama, Ovid, Ravenna, Reed City, St.
Johns, Scotville, Shelby, Whitehall, Zeeland
EAST CENTRAL — Almont, Bad Axe, Bay City, By-
ron, Caseville, Cass City, Columbiaville-Otter
Lake Area, Deckerville, Emmett, Flint, Hale, Har-
rison, Laingsburg, Lapeer, Marlette, Memphis,
Metamora, Millington, Morrice, Mt. Pleasant,
Perry, Saginaw, St. Clair, Sebewaing, Standish,
Yale

SOUTHWEST — Albion, Allegan, Battle Creek, Ben-
ton Harbor, Blissfield, Bridgman, Brooklyn, Bu-
chanan, Charlotte, Clinton, Coldwater, Coloma,
Douglas-Saugatuck-Fennville, Dowagiac, Grand
Ledge, Hastings, Hillsdale, Holt, Jackson, Jones-
ville, Lansing-East Lansing, Lawrence, Litchfield,
Marshall, Mason, Napoleon, Niles, Paw Paw,
Quincy, St. Joseph, Sister Lakes, South Haven,
Sturgis, Tecumseh, Three Rivers, Union City,
Vicksburg, Waldron, Wayland
SOUTHEAST — Ann Arbor, Armada, Chelsea, Davis-
burg, Detroit, Grosse Pointe Woods, Lake Orion,
Livingston County (Brighton, Howell, Hartland,
Pinckney and Fowlerville), Livonia, Milan, Mon-
roe, New Baltimore, Pontiac, Ypsilanti

496 MICHIGAN MEDICINE MAY 1972

Michigan Health Council
MD Placement Service

Breakdown of Specialty
Openings in Michigan

UPPER PENINSULA
Baraga
Crystal Falls
Escanaba

Hancock-Houghton
Iron Mountain
Ishpeming-Negaunee
Marquette
Sault.Ste. Marie
Wakefield
NORTH CENTRAL
Alpena
Cadillac
Charlevoix
Cheboygan
Gaylord

WEST CENTRAL

Edmore and Township

Grand Haven

Hart

Lowell

Ludington

Manistee

Muskegon

Onekama

St. Johns

Zeeland

EAST CENTRAL
Bad Axe
Bay City
Cass City
Harbor Beach
Harrison
Lapeer

Mount Pleasant
Owosso
Saginaw
SOUTHWEST
Allegan
Battle Creek
Benton Harbor
Buchanan
Coldwater

Dowagiac

Hastings

Hillsdale

Jackson

Kaiamazod

Lansing-East Lansing

Marshall

Niles

Paw Paw

St. Joseph

South Haven
Tecumseh

SOUTHEAST —

Centerline

Detroit

Howell

Livonia

Monroe
Pontiac
Royal Oak

Ypsilanti

STATEWIDE OPENINGS
TOTALS

<

O

■

§3

cr

MICHIGAN MEDICINE MAY 1972 497

Michigan Blue Shield sees need
to support private enterprise health care

Michigan Blue Shield must concentrate some
effort now on innovative techniques to enhance the
more classical system of health care delivery. There
are no apparent conflicts, notes John C. McCabe,
Blue Shield president, since the existence of a
pluralistic system is not only likely, it is desirable.

Discussing the future in the Michigan Blue Shield
Annual Report, released April 10, Mr. McCabe
noted that “our future plans must be predicated
on an awareness that, despite promotional efforts
to expand on the availability and use of alternative
forms of health care delivery, widespread and
immediate acceptance is unlikely.”

In the event that Congress would pass a Na-
tional Health Insurance Bill, said Mr. McCabe, “we
see a role for the private sector using an expertise
that government sorely lacks.”

“We know,” he noted, “numbers of claims and
benefit payout will continue to increase. Bene-
fits will also be expanded.”

The annual report reflected continued growth
in claims received and benefits paid in 1971.

Michigan Blue Shield received 13,385,000 claims
under private, underwritten programs in 1971, a
28% increase over 1970, and represented a pay-
out of $287.6 million, compared to $258.3 million
in 1970.

The federal Medicare program relating to per-
sons 65 years old and older received 15.4% more
claims in 1971 over the previous year and payout
was $65.7 million compared to $59.5 million in
1970.

The state Medicaid program experienced a
30.5% increase in claims and resulted in payout
to providers of $64.6 million in 1971 compared
to $44.5 million in 1970. During the same period,
however, the list of people eligible for benefits
increased from 597,435 to 723,217 or 22%.

Michigan Blue Shield’s Cost Control Program
which limited increases in physician fees and
preceded the federal freeze on physician fees
by seven months, resulted in a decrease of $1.1
million in fee increase requests.

Due to such cost containment efforts, coupled
with rate increases granted by the state insurance
commissioner, said Mr. McCabe, the company
ended the year with reserves equivalent to 1.7
months of income, after beginning the year with
a $4,153,500 deficit.

The improved financial situation has also re-
sulted in a recent rate filing with the insurance
bureau, which will have the effect of reducing
subscription charges, effective July 1, Mr. McCabe
revealed.

en/ice

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498 MICHIGAN MEDICINE MAY 1972

INTRODUCING

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°Iil memoiiam

Charles A. Cooper, MD
Stambaugh

Charles Arthur Cooper, MD, past president of the
Dickinson-Iron and Houghton county medical so-
cieties, died Feb. 18 at the age of 65.

Doctor Cooper served as physician and surgeon
for the Pickands-Mather Mining Company near
Stambaugh, where he maintained a private prac-
tice, also. He retired in 1959.

Doctor Cooper was a Minnesota native and was
graduated from the University of Michigan Medical
School. He was affiliated with the General Hospital
of the Iron River District in Stambaugh and was a
member of the American Academy of General Prac-
titioners and the industrial surgeons society.

John R. Heaton, MD
Largo, Fla.

John Richard Heaton, MD, Grand Rapids proc-
tologist, died March 22 at the age of 59.

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Doctor Heaton was affiliated with Ferguson,
Droste, Ferguson Hospital in Grand Rapids. He
was a graduate of the University of Illinois College
of Medicine and was a past president of the Ver-
milion County (Illinois) Medical Society.

Doctor Heaton was a member of the Michigan
State and American Proctologic Societies.

Thomas H. Miller, MD
Detroit

Thomas Harrop Miller, MD, long-time Detroit
dermatologist, died Feb. 22 at the age of 71.

Doctor Miller was on the medical staffs of Harper
and Deaconess hospitals and was a consultant at
Herman Kiefer Hospital before retiring in 1969. He
was on the Wayne State University School of Med-
icine faculty from 1933 to 1965.

Doctor Miller was past president of the Detroit
Dermatological Society, and belonged to the Amer-
ican Academy of Dermatology and Central States
Dermatological Association. He was graduated from
the University of Michigan Medical School.

James C. Mooney, MD
Saginaw

James C. Mooney, MD, Saginaw urologist, died
March 3 at the age of 42.

Doctor Mooney, a graduate of the Marquette Uni-
versity medical school, was a member of the staffs
of St. Mary’s, St. Luke’s and Saginaw General Hos-
pitals in Saginaw. He was a member of the Amer-
igan College of Urology and the Saginaw Surgical
Society.

Alfred A. Thompson, MD
Mt. Clemens

Alfred A. Thompson, MD, Mt. Clemens surgeon
and general practitioner, died March 5 at the age
of 74.

He was a past president of the Macomb County
Medical Society and a member of the St. Joseph
Hospital staff.

James A. Twing, MD
Lake Orion

James Arthur Twing, MD, a Lake Orion physician
who had recently given up his practice to become
a medical missionary in Tanzania, died in a light
plane crash Jan. 23.

Doctor Twing was serving with a Seventh-day
Adventist Church missionary team at Heri Hospital
in Tanzania. He previously had spent six months in
Tanzania in 1969.

A Vermont native, Doctor Twing was a graduate
of Autonoma University medical school of Jalisco,
Mexico. He had been affiliated with Wheelock Me-
morial Hospital in Goodrich, Pontiac General and
Crittendon Hospitals in Rochester.

500 MICHIGAN MEDICINE MAY 1972

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MICHIGAN MEDICINE MAY 1972 501

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ment plans, life insurance, disability, income, invest-
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the best in financial and practice counseling, phone
or write Phillip Fry and Associates, 14940 Plymouth
Road, Detroit, Michigan 48227. Phone (313) 499-9044.

CHILD PSYCHIATRY RESIDENCIES OFFERED:
MICHIGAN— ANN ARBOR, YPSILANTI: “Where
it’s at.” New Child Psychiatry residencies offered in
an innovative, established clinical program. Com-
munity Child Psychiatry, Day Treatment, Out-Patient
and Residential Treatment offer opportunities for a
variety of treatment techniques. Crisis intervention
(“life-space” interview) ; behavioral therapy, pharma-
cotherapy; individual, group and family treatment
methods; dynamic, social and developmental psychi-
atry taught. Learning by independent study, seminars,
supervised experiences. Multi-disciplinary staff in-
cluding: six child psychiatrists, pediatrician, pediatric
neurologist, psychologists, social workers, special edu-
cation teachers, speech therapists, occupational ther-
apist, recreational therapists, etc. Program affiliated
with the University of Michigan and a variety of
clinical settings including: community mental health
centers, guidance clinics, etc. Salaries negotiable. Con-
tact: Elissa P. Benedek, M.D., York Woods Center,
Box A, Ypsilanti, Michigan 48917. Phone (313)
434-3666. An Equal Opportunity Employer.

LOCUM TENENS WANTED for the months of July,
August and September, general practitioner, offices
in hospital, excellent X-ray and laboratory facilities,
summer resort area in southern Michigan. Should be
equipped for emergency service. Contact: B. H.

Growt, M.D., P.O. Box 128, Addison, Michigan
49220.

HEALTH DEPARTMENT DIRECTOR: Single County
Health Dept, has position available on July 1, 1972
for a Director of a 63,000 population County. Fringe
benefits; hospitalization; retirement program; paid va-
cation; sick leave; 10 annual holidays. Qualifications
require an M.D. or D.O. physician; Michigan licen-
sure. Address: Shiawassee County Health Dept., 120
E. Mack St., Corunna, Michigan 48817.

PHYSICIAN WANTED to join two man Family Prac-
tice Group. Kalamazoo, Michigan. Two large open
staff hospitals with active teaching programs located
within two mile radius of modern office building.
Area noted for its recreational facilities including
lakes and rolling hills. Excellent school system en-
hanced by one university and three colleges with stu-
dent enrollment exceeding 25,000. Guaranteed salary
with percentage. Equal time off including five weeks
paid vacation per year. Call Collect: Roger J. Smith,
M.D., (616) 381-4381.

IMMEDIATE OPENING for OB GYN, Internal Medi-
cine, and Orthopedic specialties to establish successful
practice with 14 man multi-specialty group. Excellent
group benefits; pension plan ; modern clinic facilities;
progressive community with excellent educational
system including two colleges; city population 35,000;
good recreational facilities; each specialty must be
board eligible or certified; young man with military
obligation completed. Contact: Business Manager,

The Manitowoc Clinic, 601 Reed Avenue, Manito-
woc, Wisconsin 54220.

MANAGEMENT POSITION WANTED: Young man
with masters in hospital administration and health
business background seeks position as manager in
small group practice or as assistant in large group.
Reply Box: 3, 120 W. Saginaw St., East Lansing,
Michigan 48823.

PSYCHIATRIST-CHALLENGING OPPORTUNITY
TO practice progressive and innovative treatment
to wide variety of mental disorders; excellent facili-
ties and ancillary staff; comfort of small town living
with nearby city conveniences; excellent school sys-
tem; good climate; regular hours, 30 day vacation,
exc. retirement, life, health ins. plans; can pay
moving expenses; salary range $23,424-$29,848; any
state or DC license required; equal opp. employer.
Write: Chief of Staff, VA Hospital, Salisbury, N.C.
28144.

PHYSICIAN SUMMER PLACEMENT in Beautiful
Upper Peninsula. Hospital sixty (60) miles east of
Mackinac Bridge is seeking a physician with Mich-
igan license to provide partial coverage in Emer-
gency Room during summer months. References re-
quested with terms to be negotiated. Call or write:
Helen Newberry Joy Hospital, Newberry, Michigan.
(906) 293-5181, Jack Vantassel, Administrator.

CUSTOMIZED NEW MEDICAL OFFICE SPACE
AVAILABLE. 6001 W. Outer Drive on the grounds
of Mt. Carmel Mercy Hospital, Detroit, Michigan.
Approximately 25 suites available ranging from 600
sq. ft. to 3,000 sq. ft. Landlord will customize space
for the doctors as required. 1500 car on site parking.
Call: (313) 864-3250. R. Cherne at the above

address.

MEDICAL DIRECTOR CORPORATE PARTNER.
Doctor interested in investing and directing in an
Industrial Medical Corporation. Excellent salary and
fringe benefits. Phone Collect (313) 791-3300.

LOCUM TENENS for qualified Internist for month of
July 1972, Michigan License required. Excellent
boating, fishing, swimming in area located on Lake
Michigan. Associateship or Partnership Potential.
Contact: D. R. Boyd, M.D., 1735 Peck Street, Mus-
kegon, Michigan 49441.

502 MICHIGAN MEDICINE MAY 1972

PSYCHIATRIC STAFF— Requirements of 3 years resi-
dency training to Board Certified. $26,000 to $36,300
depending on qualifications and experience. Excel-
lent Michigan Civil Service fringe benefits. Smog
free, peaceful, cultural summer-winter vacationland
community. College town, near Interlochen National
Music Camp. 1400 bed progressive psychiatric hos-
pital. J.C.A.H. approved. 3 year psychiatric residency
program. Contact M. Duane Sommerness, M.D.,
Room 323, Traverse City State Hospital, Traverse
City, Michigan 49684. An equal opportunity em-
ployer.

PHYSICIANS WANTED: Orthopedic Surgeon. Urolo-
gist. Internist and General Practitioners to establish
independent practices in upper midwest ski mecca,
famous summer resort community. Local college and
growing, year-around population of 40,000. New
acute care, general hospital will provide moving
stipend and one year's free rent on adjacent luxuri-
ous office suites. Milton D. Rasmussen, Administrator
Lockwood-MacDonald Hospital, Petoskey, Michigan
49770, Phone: (616) 347-3985.

RADIOLOGIST WANTED: Board certified or qual-
ified to associate with two other radiologists in an
office type practice. Offices in Ann Arbor and Ypsi-
lanti. No therapy. Professional corporation with ex-
cellent group benefits. Contact: W. R. Rekshan,
M.D., 425 E. Washington, Ann Arbor, Michigan.
(313) 665-4457.

FOR WEEKLY RENTAL— June through Labor Day;
Lovely two bedroom cottage on chain of four lakes
near Newaygo for boating, swimming, fishing and
canoeing; 100' private lakefront, boat, private dock,
commuting distance to Grand Rapids; Phone (616)
652-6929 for descriptive brochure.

Advertisers in MICHIGAN MEDICINE are
friends of the profession. By accepting their adver-
tising we show confidence in them, their services
and products. They help make the journal a qual-
ity publication. Please familiarize yourself with
their services and products and let them know
that you see their advertising in MICHIGAN
MEDICINE.

W HOSPITAL-MEDICAL 1

PROFESSIONAL

r PLANNING, INC. \

PERSONNEL RECRUITMENT

Alco Universal Building
[ East Lansing, Michigan <

FOR

^ 48823 i

HOSPITALS CLINICS UNIVERSITIES

517 332-1333 ^

Administrators, Physicians,

Dept. Heads

PHYSICIANS— ALL SPECIALTIES

At no financial obligation, send us your resume

if you would like a fine full-time position with

one of our Clients:

HOSPITALS: Full-time Chiefs of Services, Di-
rectors of Medical Education (General
and Specialty).

MULTI-SPECIALTY CLINICS: General Practice
and all Specialties.

SINGLE-SPECIALTY GROUPS. General Practice
and all Specialties.

MEDICAL SCHOOLS: Teaching and Research
appointments — all Disciplines.

DRUG FIRMS: Basic Science and Clinical Trials
Research

INDUSTRIAL FIRMS: Employee Health Care.

COLLEGES and UNIVERSITIES: Student Health

INDEX TO ADVERTISERS

Arch Laboratories 472

Barry Laboratories 477

Battle Creek Sanatorium 472

Beecham-Massengill Pharm 421

Bristol Laboratories 493

Brown Pharmaceuticals 465

Burroughs-Wellcome & Co 461, 485

Classified Advertising 502, 503

Cole Pharmacol Co., Inc 483, 484

Dow Chemical 453

Flint Laboratories 458, 459

Geigy Pharmaceuticals 413

Hayman Real Estate 500

Helen Newberry Joy Hospital 476

Hospital Planning, Inc 503

Import Motors, Inc 471, Cover III

Lederle 479, 480, 481, 482

Lilly, Eli and Co 422

Mead Johnson 495

Medical Protective Co 498

Mercywood Hospital 501

Michigan State Medical Society 491

Pharmaceutical Mfg. Association 467, 468, 469

Professional Management 501

Care.

In addition to our service to Client organizations, we
assist physicians in considering relative merits of a va-
riety of fine opportunities. No financial obligation at any
time to the candidate. Appointments can be made as
much as a year or more in advance. Send complete
resume plus your professional objectives and geographic
preferences in confidence to Arthur A. Lepinot.

Roche Laboratories . . .
Searle, G. D. & Co. . . .
Stratton, Ben P. Agency
Stuart Pharmaceuticals

Upjohn

U. S. V. Pharmaceutical

Warner-Chilcott

Winthrop Labs

. Cover II, 409, Cover IV

454, 455

504

456, 462, 463

418, 419, 486, 487, 488

499

474, 475

414, 415, 416

MICHIGAN MEDICINE MAY 1972 503

check these
umbrella
excess liability
premiums . . .

they could lead to savings

$1,000,000.00 Umbrella Excess Liability Policy — Our Schedule
* Physicians Class 1 & 2 . . . $121.00 Annual Premium*

^ Physicians Class 3, 4 & 5 . $205.00 Annual Premium*

The above premiums assume ownership or use of 2 residences, 2
automobiles, professional liability exposure (basically insured for
$100,000/ $300,000, except for physicians performing certain cos-
metic surgical procedures which require $200,000/ $600,000), and
professional office premises exposure. These premiums include
only excess Malpractice coverage. The Umbrella plan is spon-
sored by the Michigan State Medical Society for the benefit of
its members.

CALL US COLLECT (517) 393-7660

BEN P. STRATTON AGENCY, INC.

ESTABLISHED IN 1937

5848 EXECUTIVE DRIVE, P.O. BOX 547
LANSING, MICHIGAN 48903
(517) 393-7660

19400 WEST TEN MILE ROAD
SOUTHFIELD, MICHIGAN 48075
(313) 357-5083

504 MICHIGAN MEDICINE MAY 1972

G§ouyd Off

Doctor Masters
challenges MSMS
with exciting, new ideas

(Editor’s Note: Following is a portion
of the address made to the MSMS House
of Delegates March 20 in Detroit by
Brooker L. Masters , MD, Fremont ,
Chairman of The MSMS Council.

The speech was studied by a reference
committee which reported back to the
House stating in part: “Doctor Masters
has reported to us his recommendations
for a vigorous program for The Council
of MSMS in the coming year. He has
itemized concisely and articulately the
areas of high priority that he feels
should be emphasized. . . . This reference
committee feels that these are high
priority items not only for The Council
but also for all practicing physicians
and especially their elected representa-
tives in the MSMS House of Dele-
gates.”)

“I believe our members and potential members
are looking to us for dynamic leadership. Change
is being suggested. Change is really being demand-
ed, as evidenced by our willingness to discuss peer
review, and such concepts as bargaining, and by
our consideration of new MSMS priorities.

“Our base for a progressive future must be an
informed membership. MSMS leadership must have
a followship. Therefore, I recommend, and with The
Council’s approval, will appoint a membership com-
mittee whose primary purpose will be to promote
participation in all three levels of organized med-
icine.

“Further, I am going to recommend to The Coun-
cil that a separate Department of Membership and
Member Service be created within our staff struc-
ture. Mr. Tryloff assures me that such a Depart-
ment is essential to our success. Too long have we
neglected the nourishment of membership. We are
experimenting now with new things but they need
to be coordinated with visibility, accountability, and
responsibility.

“The proposed MSMS Membership Committee
and Department must work in at least four major

areas — recruitment of new members, orientation of
those members, involvement of members on MSMS
committees and in projects, and then retention of
the members.

“I am certain that we must listen in new system-
atic ways to our members. Therefore, I suggest we
create the office of a Membership ombudsman.
In addition to the listening and reporting by our
staff, I feel that we need a doctor who will be con-
cerned about their needs, their complaints, their
suggestions, their aspirations. I think specific re-
sponsibility must be given to an ombudsman whose
responsibility will be to monitor, listen and ascer-
tain the mood and over all desires of the member-
ship. The ombudsman (or ambassador) would chan-
nel these views to the MSMS leadership for con-
sideration. A field staff may be necessary to facili-
tate the new work of the proposed Membership
Committee and ombudsman.

“As we think about our membership and efforts
to make equal representation more meaningful, I
recommend that this House take the initial steps to
create a new Section on Academy Medicine to pro-
vide a voice for the many physicians at the three
medical schools. All segments and fields of med-
icine, I feel, must have a voice in our policy deci-
sions. The faculty members can make many unique
contributions.

“Our future as organized medicine certainly de-
pends too upon the medical students, who soon
will graduate, enter postgraduate training, and join
us in providing medical care. I recommend that
the House Committee on Constitution and Bylaws
consider ways that these students could be invited
to join MSMS as associate members with minimal
dues but eligible for our member benefits. Since

“We must be able to more effectively
tell our members, the medical students
and the public what MSMS believes in
and stands for.”

SOUND OFF/Continued

“Our base for a progressive future
must be an informed membership.

only three counties have medical schools within
their boundaries and because the paperwork for
student memberships would be an extreme burden
on these county staffs, I propose that the students
be able to obtain direct membership in MSMS.

“Hand-in-hand with this, I also believe that in-
terns and residents should be permitted to join
MSMS direct. MSMS could return to the county so-
cieties any dues income now derived by the coun-
ties from interns and residents.

“We all are glad to have student delegates in our
House of Delegates, to have students on various
MSMS committees, and to have a new active Liai-
son Committee with Medical Students. Related to
my concerns that students be encouraged to play
larger roles in MSMS, I believe that we must in-
volve more of our women doctors. I recommend
that MSMS follow the suggestions made in Resolu-
tion 21 adopted by the AMA last year that female
physicians be selected on their personal and pro-
fessional qualifications, be nominated, elected and
appointed to the committees and policy-making
bodies of state and component societies.

“Now permit me to shift to some challenges
facing MSMS.

“1. Expansion of the medical schools. MSMS
been working effectively in this area for more than
a decade and this House last fall reaffirmed our
position. And I know that we are telling this story
more effectively, as we all beat down the myth that
doctors have kept the supply of new physicians
down.

“2. Distribution of physicians. We know that just
increasing numbers will not solve the shortages in
many rural areas, some small towns, the inner
cities, etc. I do not know the answers — Forced
assignments? Special incentives? Satellite clinics?
But I am sure that the collective wisdom of our

members could develop some workable alterna-
tives.

“3. Area-Wide health planning. Physicians have
been urged to be more active on such planning
bodies. The problems seem insurmountable. But
we do know that physicians must accept leadership
responsibilities to solve some of the problems. Doc-
tors can do a great deal to help solve the conflicts
in our communities, the understandable hurdles of
institutional pride, etc.

“4. Delivery of health care. Would you please
review the work of our MSMS committees and the
resolutions adopted last fall, and then consider how
MSMS might assume some better ways to study
problems of the delivery of health care in Mich-
igan. Many of our committees appropriately deal
with internal operations. Over the years, other com-
mittees have focused on cardiac disease, maternal
health, etc. Such work is part of the whole subject.
How can we better study the complex problems
concerning the delivery of health care to all the
residents of Michigan? Send me your suggestions,
please.

“5. Health education. What is the responsibility
of individual physicians and their organizations for
health education? Should MSMS conduct work-
shops for teachers and school counselors? Should
MSMS develop study guides? Should MSMS pro-
mote the fine AMA materials? And what priority
does this type of activity deserve today?

“I can easily add more challenges; and probably
each of you would have a special subject to add.
This short list of five challenges facing medicine
today is certainly incomplete. There are solutions,
but they do require the attention of all doctors —
and particularly of each delegate.

“You delegates are the ‘Statesmen of Medicine
in Michigan.’ Webster defines a statesman, as ‘one
who shows unusual wisdom in treating or directing
great public matters.’

“As statesmen you must define our positions and
chart a course.

“Repeatedly I am asked, ‘What does the Mich-
igan State Medical Society stand for?’

“How do you answer this question when it is
raised by your associates?

“It is your role as delegates to identify and de-
fine the broad policies which MSMS can work for
and live under. We must be able to more effective-
ly tell our members, the medical students and the
public what MSMS believes in and stands for.

“You have a good Council now and I urge you
to leave the day-to-day direction up to The Coun-
cil. They can make the administrative decisions
based on broad policies set down by this House of
Delegates.

“We must unite our forces.

“We must deal with vital issues in a positive
way.

“And I know this is possible.”

506 MICHIGAN MEDICINE MAY 1972

More accolades
for Kent doctors

(This article is reprinted, with permission, from
the March 12 edition of the GRAND RAPIDS
PRESS.)

Private citizens occasionally complain that doc-
tors make too much money, and the doctors occa-
sionally complain that all the public knows about
them is how much they charge. That local physi-
cians contribute importantly to the welfare of this
community without any idea of receiving monetary
compensation for their efforts is a fact, we think,
that is widely recognized, although not by every-
one. But rarely are the doctors’ contributions ac-
knowledged in a formal way.

All of this is by way of saluting the Fraternal
Order of Police for having honored 21 Grand Rap-
ids area doctors for the time and effort they have
put into the police emergency unit program. The
FOP’s gesture follows that of the Women’s Aux-
iliary, the policemen’s wives, in formally thanking
the doctors for the same services. Perhaps no one
except the policemen themselves know better how
important those contributions have been than do
their wives.

But in any event, we think the honoring of the
doctors by both organizations was very much in
order. We wish to add only that the doctors went
into the program — designed and set up by them, in
fact — because they saw a need and decided to
remedy it. The impetus for the program came from
the doctors themselves, not from the police or the
community at large.

It seems pertinent to remark also that many of
these same doctors, as well as many others, have
donated equally important services to the Commu-
nity Action Program and welfare agencies, both
public and private, that don’t show up on anyone’s
doctor bill, either the individual’s or the public’s.

"The American doctor
. . . has no equaT

A great deal has been said about the shortcom-
ings of American medicine. Yet rarely does a doc-
tor take time off from his man-killing schedule to
defend the performance of his profession.

It might be helpful if doctors posted on their
waiting room walls the following figures compiled
by the National Center for Health Statistics and the
U. S. Department of Health, Education and Welfare.
The figures cover the 20-year period 1949 to 1968.
They show that in just 20 years advances in med-
ical science have brought the following reductions
in death rates in the U.S.: Polio nearly 100 percent;
whooping cough nearly 100 percent; dysentery

nearly 100 percent; syphilis 95 percent; tuberculosis
88 percent; hypertensive heart disease 78 percent;
nephrosis and nephritis (kidney diseases) 76 per-
cent; maternal mortality in childbirth 73 percent;
appendicitis 72 percent; asthma 58 percent; acute
rheumatic fever, chronic rheumatic heart disease
46 percent; meningitis 36 percent and infant mortal-
ity 31 percent. These figures of course barely touch
the surface. They tell nothing of the advances of
“nuclear medicine,” advances in heart surgery,
transplantation of human organs and the continuing
development of wonder drugs and other break-
throughs in what has been called by a leading pub-
lication “A medical revolution.”

The medical revolution could only have been
possible in a land where combination of free in-
quiry and technology is encouraged. The American
doctor with his superior skills has no equal, and
the public is the chief benefactor of the freedom
that produces his kind.

(This article is reprinted, with permission, from
the March 2 issue of the CRAWFORD COUNTY
AVALANCHE of Grayling.)

. .a time for
rolling up our sleeves
and fighting. .

By James H. Sammons, MD, President,

Texas Medical Association

Having observed the activities of organized med-
icine for a number of years — and, simultaneously,
having seen encroachments by government, hos-
pitals, nonprofessional corporations, and continued
apathy of many members toward these dangers —
it always renews my faith in the profession to ob-
serve the dedication, the effort, and the total com-
mitment of our colleagues who make up the mem-
bership of committees and councils of this Associa-
tion.

In these times, and for the indefinite future, I am
convinced that organizations of medicine must re-
direct their activities. Whether we like it or not,
medicine must become more oriented to socio-
economics, compilation of data profiles, data banks,
and computerization of activities of medicine. Fur-
thermore, we must be willing to expand our staffs
to whatever size and scope is necessary to monitor
these intrusions, to disseminate this information
and, yes, ultimately to be hard-nosed in negotia-
tions for the preservation of our freedoms.

Your Association has reached this point, and re-
quires a commitment from each of us: Not only
must we lend our moral support, but we must be
willing to pay the freight both physically and finan-
cially, if indeed we believe that these freedoms are
worth saving.

MICHIGAN MEDICINE MAY 1972 507

YOUR OPIN I ON /Continued

Doctor Sammons

I suggest to you, as a colleague, that you advise
your county society of your belief and of your will-
ingness to support these efforts. The time no longer
exists, it seems to me, for us to indulge in the lux-
ury of semantics in the misguided belief that right
always survives, and that our position by virtue of
such rightness will prevail. Rather, it is a time when
we must roll up our sleeves and fight for these
rights, adopt the tactics of the opposition, and in
fact be willing to out-think, outfight and outspend
them.

No physician who truly ' values the freedom to
treat his patients to the best of his ability can be-
lieve less or do less.

I know that we can count on each of you.

Unity must be the order of the day.

(Doctor Sammons’ editorial from the February
issue of TEXAS MEDICINE is reprinted here with
permission. Doctor Sammons was in Detroit on
Dec. 19 as a guest of Detroit TV interviewer Lou
Gordon. The topic of discussion then was the pur-
poses and activities of the AMA. Doctor Sammons
is on the AMA Board of Trustees.)

Doctor ,

have you filled out and returned
your copy of the

1972 MSMS Survey
on the Overhead Costs
of Medical Practice?

The survey was mailed to you about April 18,
designed to assemble facts on the economics of
medical practice in Michigan. These facts are
used to help committees of the society, in MSMS
policy deliberations and to refute allegations about
levels of physicians’ fees and income. The first
MSMS costs study was made in 1971.

Doctor Blue Spruce
says U.S. needs more
minorities in health care

The patient — the nation’s health manpower situ-
ation— is sick, says George Blue Spruce, DDS,
director, Office of Health Manpower Opportunity,
Bureau of Health Manpower Education, National
Institutes of Health.

And although the “patient” shows signs of im-
provement, its continuing betterment depends on
our willingness to continue the “treatment” — ade-
quate funding of programs designed to bring more
minorities into the health care field.

Doctor Blue Spruce, who keynoted the Great
Lakes Health Manpower Conference April 12 at
Michigan State University, observed that almost
all Americans encounter high prices, shortages and
long waiting lines in trying to obtain health care.

“But the most striking evidence that something
is wrong can be seen in the plight of minorities,”
he said. “The less attractive inner-city and rural
areas, where impoverished minorities tend to
cluster, are being abandoned by health profes-
sionals who tend to concentrate in attractive, high-
income districts.

“Health services are least adequate where the
need is greatest,” he said, citing statistics showing
that non-whites in the U.S. die seven years earlier,
their infants nearly twice as often, their mothers
in childbirth four times more often.

“Few minority children can even think of them-
selves as health professionals — they have no role
models,” he said. Doctor Blue Spruce (a Pueblo
from Santa Fe, N.M.) is himself the only full-
blooded American Indian dentist in the country.

“But probably the biggest obstacle to minority
students seeking careers in the health professions
is money — the high cost of education and the lack
of financial resources,” said Doctor Blue Spruce.

For that reason, he praised the programs set
up to encourage and finance minority students in
the health careers — among them the task force of
the AMA, the National Medical Association, the
American Hospital Association and the American
Association of Medical Colleges, whose long-term
goal is to achieve representation of minorities in
the physician population equal to the total popu-
lation.

Doctor Blue Spruce finds encouragement in
figures which show that Black first-year medical
school students increased from four to seven per-
cent of the total between 1969 and 1971, while
the percentage of Spanish-Americans and Ameri-
can Indians tripled.

508 MICHIGAN MEDICINE MAY 1972

IEDIGRAMS

\TE NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

U.

n

SAN

FRANCISCO

MEDiCAI. OEM

it i:d i

1 HR ARY

JUN 71972

May 19, 1972, Volume 71, Number 15
Michigan State Medical Society
Reading Time: 2 Minutes, 20 Seconds

B5305 TO AUTHORIZE UNIFORM FEE SCHEDULE for Medicaid payments by the
epartment of Social Services has moved into position for passage by the
ichigan House of Representatives. An amendment sought by MSMS , requiring
nnual review and adjustment of the schedule, was changed to "periodic"
eview and adjustment and added to the bill. It now is scheduled for
inal House action and then must face action in the Senate. The bill
ould change the system of payments under Medicaid from "reasonable
harges" to "uniform fees" and further states, "A uniform fee schedule
hall be determined by the state department (social services)."

In non-legislative areas, medicine won two of three points it had
lsisted upon for the state-operated Medicaid fiscal operation. A sub-
Dmmittee of medical and osteopathic physicians had recommended to the
all Medical Advisory Committee to the Medicaid program (1) use of a
iiform fee schedule, (2) use of the 1971 MSMS Relative Value Scale, and
3) use of the 5-digit CPT. The larger committee accepted the first two
^commendations , but opted for the 4-digit National Blue Shield coding
fstem.

Substitute Resolution 6 adopted by the fall MSMS House of Delegates
^solved "that the Council do everything in its power to establish a
svised Medicaid payment system which would include a Uniform Fee Schedule
or all services and procedures." At the spring session, the House adopted
ne 1971 version of RVS .

STATE SENATE APPROPRIATIONS COMMITTEE members met with constituent doctors
in MSMS building May 9 to discuss various medical economic factors. Guests
and physicians were Sen. Garland Lane of Flint and James Gibbons, MD , Flint;
Sen. Joseph Mack of Ironwood and Donald T. Anderson, MD, Kingsford; Sen.

Gary Byker of Holland and George J. Smit , MD , Holland; Sen. John Toepp of
Cadillac and Charles Oppy, MD, Roscommon; Sen. Jerry Hart of Saginaw and
Robert Jardinico, MD, Saginaw; and Sen. Carl Pursell of Plymouth and Ray R.
Barber, MD , Plymouth. Also in attendance were Aaron K. Warren, MD, of
Cassopolis, who was Doctor-of-the-week, and James H. Grove, MD, Niles, pres-
ident of the Berrien County Medical Society. Main discussion centered on
cost and growth of medical schools in Michigan, and how Michigan can retain
more of its trained physicians. Senators urged further meetings.

ISMS HAS ASKED THE AMA to investigate the credentials of the Japanese
>hysician who has appeared in Michigan to demonstrate acupuncture to
chiropractors. The AMA and the Michigan Department of Licensing and
regulation are studying acupuncture.

JOHNSON AND HIGGINS firm has requested a 90-day extension of their author-
ization from the MSMS Council to investigate on an exclusive basis a possible
professional liability insurance program for MSMS. If the extension is
granted, the firm plans to present a proposal to The Council August 4.

IN A NEW EFFORT TO PLAN public relations activities, the MSMS PR Committee
has invited MSMS committee chairmen, medical specialty leaders, and others
to present proposals for 1973 at a committee hearing May 24 at MSMS.

i

MSMS HEADQUARTERS continues as the busy hub for MSMS committees and many
medical groups — The Michigan Academy of Family Physicians Board will
confer May 21; American Cancer Society Service and Rehabilitation Committee
May 23; Michigan Society of Neurosurgeons, May 24; Michigan Society of
Internal Medicine, June 4, etc. The Michigan Council of Specialty Societie
held its regular meeting at MSMS May 17.

"FOR MANY YEARS, the Michigan State Medical Society has worked diligently
for the expansion of the medical schools at Wayne, the University of
Michigan and Michigan State University. Together we must work to produce
more well-trained young physicians to provide quality medical care for
the people of Michigan."

Those statements were part of a cooperative MSMS and Wayne County
Medical Society advertisement in the Detroit News special section May 7
about the dedication of WSU Scott Hall. The ad helped implement Resolution
64 adopted by the MSMS House last fall "to inform the public of its goals
of obtaining adequate numbers of well-trained physicians in Michigan."

The ad reached the 700,000 subscribers of the Detroit News .

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IF YOU HAVEN'T returned the 1972 MSMS Overhead Cost Study Questionnaire to
MSMS as yet, please do so immediately. Early returns are being tabulated.

MORE MICHIGAN MEDICAL school graduates will remain in Michigan for their
internships than last year. WSU reports that 77 of 127 graduates will
remain, 49 will intern in other states, and one is undecided. MSU reports
that 15 of its first graduating class of 30 will remain in Michigan and
15 will go to other states. U-M reports 82 of 190 graduates will intern
in Michigan, 99 will go out of state, four will join the Armed Forces;
and 5 have not completed arrangements. See July Michigan Medicine for
details .

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May 19, 1972 Vol. 71, No. 15

JfeMgGDDD

MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

UNIVERSITY OF CAL
LIBRARY SCH CF MED
THIRD t PARNASSUS AVE
SAN FRANCISCO CAL 94122

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tlie

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ty

EDITOR: HERBERT A. AUER

IEDIGRAMS

ME NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

May 30, 1972, Volume 71, Number 16
Michigan State Medical Society
Reading Time: 2 Minutes, 30 Seconds

HE VIEWS OF YOUNGER PHYSICIANS were solicited at a special meeting in
alamazoo May 25 when MSMS President-Elect John J, Coury, MD, held an open
orum with 27 doctors under 45. Doctor Coury told the March meeting of
tie MSMS Council and the Spring session of the House of Delegates that he
ants to invite questions and suggestions from younger doctors and also
rom hospital staffs; and to make a strong appeal for united profession,
homas R. Berglund, MD , MSMS PR Committee chairman, presided and explained
his pilot meeting was another attempt to further improve MSMS communications.

INCREASES IN PREMIUMS effective June 1 have been announced by the Medical
Protective Company, which provides professional liability insurance for an
estimated 4,500 MSMS members.

Increases in the five specialty classifications for physicians in Wayne,
Genesee, and Oakland will range from $18 to $242 a year. In all the counties
the increases will range from $36 to $325. In the three counties, the new
premiums for $100,000/$300,000 will be $194 for Class I up to $2,676 for
Class V. In the other counties, the new premiums will be $212 for Class I
up to $1,950 for Class V.

IICHIGAN PHYSICIANS ARE reminded to take their AMA membership card with them
rhen they go to the AMA convention in San Francisco in June. A registration
:ee will be charged non-members.

"PHYSICIAN OF THE YEAR" honors were bestowed by the Detroit Medical Society
and the Wolverine State Medical Society upon Charles Vincent, MD, Detroit,
May 24 at the annual Clinic Day. Doctor Vincent was hailed for his medical
leadership, excellent teaching, and advancement of obstetrical-gynecological
science. Herman J. Glass was honored as "Citizen of the Year" for his work
as a hospital administrator and community leader.

LIVINGSTON COUNTY Medical Society members will meet the MSMS staff and visit
the MSMS headquarters June 6 when the society holds its monthly dinner meeting
in East Lansing. Similar meetings were held this spring at the MSMS building
:>y the nearby Eaton and Shiawassee County Medical Societies. This idea will
De expanded in the fall.

IN A SURVEY of Lansing-MSU area residents re national health insurance, U.S.
Rep. Charles E. Chamberlain found that more favored "a program to help meet
costs of catastrophic illness" than any other alternative on the question-
naire. Respondents were asked to check one or more of six choices. These
were the replies: 42% approved a program to help meet costs of catastrophic

illness; 34% would require employers to provide health insurance for em-
ployees; 33% wanted additional tax credits for premiums for private insurance
27% favored a new program of health care for the poor to replace Medicaid;

26% favored complete nationalization of health insurance; and 15% urged no
new legislation. Rep. Chamberlain received more than 17,000 questionnaires
back.

KALAMAZOO AND HALE (in Iosco County) have been included by HEW among 122
USA urban and rural areas as medical poverty pockets qualifying for phy-
sicians assigned by the National Health Services Corps. The two Michigan
requests were approved by the two component medical societies and MSMS,
following guidelines adopted by the MSMS Council.

PLANS TO CONSTRUCT A WSU University Clinics Building and a new Detroit
General Hospital in the new Detroit Medical Center area have been anno
Construction plans and fund requests will be coordinated.

WAYS TO IMPROVE MD EFFECTIVENESS in the legislative process were discussed
May 19-21 at the first Legislative Seminar held in Lansing by the Michigan
Academy of Family Physicians. About 20 state legislators and state of-
ficials joined concerned Michigan family physicians. R. W. Oakes, MD,

Harbor Beach, MAFP legislative chairman, was in charge.

Maurice Reizen, MD , Director, state Department of Public Health, related
his personal "Do's and Don'ts" to a weekend MAFP legislation workshop. They
are:

1. Be Honest! All you need is one lie to destroy your credibility with
legislators .

2. Don ' t get so emotional you become irrational.

3. Don't threaten or bribe — it's stupid.

4. Don ' t bug legislators during the social hour. He deserves the courtesy
of enjoying a respite as would you.

5. D_o get to know the legislator's staff — aides, secretary, etc. They
can be very valuable to you in many w'ays .

6. Do learn the art of compromise.

7. Do listen to your legislator.

AN OBJECTION HAS BEEN FILED by the Michigan Hospital Association to HEW
Secretary Richardson's proposal that hospitals which receive Hill-Burton
money must provide more free care to the poor. Such a plan "would make
paying patients the victims of this involuntary charity," MHA declares.

May 30, 1972 Vol. 71, No. 16

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

MICHIGAN STATE MEDICAL SOCIETY

Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

EDITOR: HERBERT A. AUER

: i'-.'J • .o -r mi:

1-5

Hi

MICHIGAN STATE MEDICAL SOCIETY • VOLUME 71, NUMBER 17 • JUNE, 1972

m

Everybody experiences psychic tension.

if

Most people can handle this tension.

Some people develop excessive psychic tension and need your counseling,

and a few may need counseling
and the psychotropic action of Valium® (diazepam).

Before deciding to make Valium
(diazepam) part of your treatment
plan, check on whether or not the
patient is presently taking drugs
and, if so, what his response has
been. Along w ith the medical and
social history, this information can
help you determine initial dosage,
the possibility of side effects and
the ultimate prospects of success
or failure.

While Valium can be a most
helpful adjunct to your counseling,
it should be prescribed only as long
as excessive psychic tension per-
sists and should be discontinued
w hen you decide it has accom-
plished its therapeutic task. In
general, w hen dosage guidelines
are followed, Valium is well
tolerated (see Dosage). For con-
venience it is available in 2-mg, 5-mg
and 10-mg tablets.

Drowsiness, fatigue and ataxia
have been the most commonly re-
ported side effects.

Until response is determined,
patients receiving Valium should
be cautioned against engaging in
hazardous occupations requiring
complete mental alertness, such
as driving or operating machinery.

■

/nnrtiir\ Roche Laboratories

X HULHl / Division of Hoffmann-La Roche Inc.

\ / Nutley. NJ. 07110

Before prescribing, please consult complete product
information, a summary of which follows:

Indications: Tension and anxiety states; somatic com-
plaints which are concomitants of emotional factors; psycho-
neurotic states manifested by tension, anxiety, apprehension,
fatigue, depressive symptoms or agitation; symptomatic relief
of acute agitation, tremor, delirium tremens and hallucinosis
due to acute alcohol withdrawal; adjunctively in skeletal
muscle spasm due to reflex spasm to local pathology, spasticity
caused by upper motor neuron disorders, athetosis, stiff-man
syndrome, convulsive disorders (not for sole therapy).

Contraindicated: Known hypersensitivity to the drug.
Children under 6 months of age. Acute narrow angle glau-
coma; may be used in patients with open angle glaucoma who
are receiving appropriate therapy.

Warnings: Not of value in psychotic patients. Caution
against hazardous occupations requiring complete mental
alertness. When used adjunctively in convulsive disorders,
possibility of increase in frequency and/or severity of grand
mal seizures may require increased dosage of standard anti-
convulsant medication; abrupt withdrawal may be associated
with temporary increase in frequency and/or severity of
seizures. Advise against simultaneous ingestion of alcohol and
other CNS depressants. Withdrawal symptoms (similar to
those with barbiturates and alcohol) have occurred following
abrupt discontinuance (convulsions, tremor, abdominal and
muscle cramps, vomiting and sweating). Keep addiction-prone
individuals under careful surveillance because of their pre-
disposition to habituation and dependence. In pregnancy,
lactation or women of childbearing age, weigh potential
benefit against possible hazard.

Precautions: If combined with other psychotropics or
anticonvulsants, consider carefully pharmacology of agents
employed; drugs such as phenothiazines, narcotics, barbi-
turates, MAO inhibitors and other antidepressants may poten-
tiate its action. Usual precautions indicated in patients
severely depressed, or with latent depression, or with suicidal
tendencies. Observe usual precautions in impaired renal or
hepatic function. Limit dosage to smallest effective amount in
elderly and debilitated to preclude ataxia or oversedation.

Side Effects: Drowsiness, confusion, diplopia, hypoten-
sion, changes in libido, nausea, fatigue, depression, dysarthria,
jaundice, skin rash, ataxia, constipation, headache, incon-
tinence, changes in salivation, slurred speech, tremor, vertigo,
urinary retention, blurred vision. Paradoxical reactions such
as acute hyperexcited states, anxiety, hallucinations, increased
muscle spasticity, insomnia, rage, sleep disturbances, stimula-
tion have been reported; should these occur, discontinue drug.
Isolated reports of neutropenia, jaundice; periodic blood
counts and liver function tests advisable during long-term
therapy.

Dosage: Individualize for maximum beneficial effect.
Adults: Tension, anxiety and psychoneurotic states, 2 to 10 mg
b.i.d. to q.i.d.; alcoholism, 10 mg t.i.d. or q.i.d. in first 24 hours,
then 5 mg t.i.d. or q.i.d. as neeefed; adjunctively in skeletal
muscle spasm, 2 to 10 mg t.i.d. or q.i.d.; adjunctively in
convulsive disorders, 2 to 10 mg b.i.d. to q.i.d. Geriatric or
debilitated patients: 2 to 2V2 mg, 1 or 2 times daily initially,
increasing as needed and tolerated. (See Precautions.) Children:
1 to 2V2 mg t.i.d. or q.i.d. initially, increasing as needed and
tolerated (not for use under 6 months).

Supplied: Valium® (diazepam) Tablets, 2 mg, 5 mg and
10 mg; bottles of 100 and 500. All strengths also available in
Tel-E-Dose® packages of 1000.

Valium:

(diazepam)

To help you manage excessive psychic tension

Our leaders

MSMS Officers and Councilors

PRESIDENT

PRESIDENT-ELECT

SECRETARY

TREASURER

ASS T SECRETARY

ASS T TREASURER

SPEAKER

VICE SPEAKER

PAST PRESIDENT

AMA DELEGATION CHAIRMAN

COUNCIL CHAIRMAN

COUNCIL VICE CHAIRMAN . . .

Sidney Adler, MD Detroit

John J. Coury, MD Port Huron

Kenneth H. Johnson, MD Lansing

John R. Ylvisaker, MD Pontiac

Ross V. Taylor, MD Jackson

Ernest P. Griffin, MD Flint

Vernon V. Bass, MD Saginaw

James D. Fryfogle, MD Detroit

Harold H. Hiscock, MD Flint

Donald N. Sweeny, Jr., MD Detroit

Brooker L. Masters, MD Fremont

Robert M. Leitch, MD Battle Creek

COUNCILOR

First District Councilors: (Wayne County) DISTRICT MAP

Edward J. Tallant, MD, Detroit
Ralph R. Cooper, MD, Detroit
Frank G. Bicknell, MD, Detroit
Brock E. Brush, MD, Detroit
Louis R. Zako, MD, Allen Park
Second District Councilor: Ross V. Taylor, MD, Jackson
Counties: Clinton, Eaton, Hillsdale, Ingham, Jackson
Third District Councilor: Robert M. Leitch, MD, Battle Creek
Counties: Branch, Calhoun, St. Joseph
Fourth District Councilor: W. Kaye Locklin, MD, Kalamazoo
Counties: Allegan, Berrien, Cass, Kalamazoo, Van Buren
Fifth District Councilor: Noyes L. Avery, MD, Grand Rapids
Counties: Barry, Ionia-Montcalm, Kent, Ottawa
Sixth District Councilor: Ernest P. Griffin, Jr., MD, Flint
Counties: Genesee, Shiawassee

Seventh District Councilor: James H. Tisdel, MD, Port Huron
Counties: Huron, Sanilac, Lapeer, St. Clair
Eighth District Councilor: William A. DeYoung, MD, Saginaw
Counties: Gratiot-Isabella-Clare, Midland, Saginaw, Tuscola
Ninth District Councilor: Adam C. McClay, MD, Traverse City

Counties: Grand Traverse-Leelanau-Benzie, Manistee, Northern Michigan (Antrim, Charlevoix,
Cheboygan and Emmet combined), Wexford-Missaukee
Tenth District Councilor: Robert C. Prophater, MD, Bay City

Counties: Alpena-Alcona-Presque Isle, Bay-Arenac-Iosco, North Central Counties, (Otsego, Mont-
morency, Crawford, Oscoda, Roscommon, Ogemaw, Gladwin and Kalkaska, combined)

Eleventh District Councilor: Brooker L. Masters, MD, Fremont

Counties: Mason, Mecosta-Osceola-Lake, Muskegon, Newaygo, Oceana
Twelfth District Councilor: Raymond Hockstad, MD, Escanaba

Counties: Chippewa-Mackinac, Delta-Schoolcraft, Luce, Marquette-Alger
Thirteenth District Councilor: Donald T. Anderson, MD, Wakefield

Counties: Dickinson-Iron, Gogebic, Houghton-Baraga-Keweenaw, Menominee, Ontonagon
Fourteenth District Councilor: Donato F. Sarapo, MD, Adrian
Counties: Lenawee, Livingston, Monroe, Washtenaw
Fifteenth District Councilor: Sydney Scher, MD, Mount Clemens
Counties: Macomb, Oakland

DIRECTOR

GENERAL COUNSEL

LEGAL COUNSEL

ECONOMIC CONSULTANT
SCIENTIFIC EDITOR

Warren F. Tryloff East Lansing

Lester P. Dodd Detroit

A. Stewart Kerr Detroit

Clyde T. Hardwick, PhD Houghton

John W. Moses, MD Detroit

510 MICHIGAN MEDICINE JUNE 1972

cpifesideqts page

I am commonly told (unfairly, of course), that I
have a “short fuse.” It isn’t true. My accusers sim-
ply don’t understand the provocations to which I
am subjected.

One of the duties of the president of the society
is to examine the literature which comes across
his deck virtute officii. Two pieces, released in
April, 1972, occasion this explosion.

One is the keynote address of the president of
one of our national professional associations, ex-
coriating HMOs. If I weren't so stubborn, he might
even make me favor them.

They are, he says, “the product of years of heav-
ily financed maneuvering by promoters of labor
union monopoly power,” — politically motivated. And
politics, we learn, “deal in deception, exaggerating
problems that are best left to individuals, then
promising utopia in exchange for power . . . Pol-
itics is arbitrarily cruel and unscientific.” He goes
on to attack, by name, many important figures in
national and state government.

In heaven’s name, why? The address pleads for
public understanding of physicians’ problems. Such
intemperate attacks on those holding responsible
positions in government and in the community
make it much more difficult to gain that under-
standing. I don’t like HMOs, but this kind of stuff
upsets my digestion.

The second is a report on a regional medical
program conducted by a nonprofit educational in-
stitution, with government money. Its annual budget
exceeds $200,000. Existing mechanisms for “pro-
duction and distribution of health services in most
large cities,” are inadequate, it says, because of
“highly bureaucratic, political and administrative
environments, unimaginative management of the
urban machinery and rapid social and economic
transformation”; it then tells why its full-time staff
of seven, and parttime staff of another seven, can

Sidney Adler, MD
MSMS president

overcome the shortcomings of government.

Nonsense! Like many Americans, I mistrust big
government, but I mistrust even more the assump-
tion of our educational institutions that their per-
sonnel provide an intellectual elite capable of and
entitled to supersede elected officials in supplying
governmental functions.

There is a renaissance in the manner in which
we practice medicine. The distribution and delivery
of health care is changing. Some advocate trade
unionism and collective bargaining in our profes-
sion. The greater the federal involvement, the
greater the controls. Consumers demand more par-
ticipation or they will gain it through legislation.

Experimentation in health care and health care
facilities is the order of the day. Money alone will
not solve the medical problem.

These two organizations come at us from oppo-
site poles, but they pose equally serious threats to
our society. We must recognize and resist those
threats even if we can sympathize, philosophically,
with those who pose them. Our problems cannot
be solved either by anarchy or by elitism; we must
scorn them.

If we won’t support our government and our so-
ciety, who will?

MICHIGAN MEDICINE JUNE 1972 511

Goqteqts

SCIENTIFIC ARTICLES

523 Aseptic Meningitis associated with Echo Virus Type 3:
an outbreak in Flint, Michigan; F. Elamrousy Hassan,
MD, PhD

529 A case of necrotizing nocardial pneumonitis; Zwi Stei-
ger, MD; Barbara A. DeFever, MD; Edward G. Nedwicki,
MD; Nicholas M. Jackiw, MD

533 A new fourth year at the University of Michigan Med-
ical School; Thomas J. Herrmann, MD

539 Tumors of the liver in early infancy: Hepatoblastoma;

S. S. Vang, MD; A. J. Brough, MD, and Jay Bernstein,
MD

SPECIAL FEATURES

515 How does Michigan rank in internship-residency pro-
grams?

558 Lists of county medical society presidents and secre-
taries

572 MSMS evaluating its PR program; Thomas R. Berglund,
MD

578 How physicians are affected by price stabilization reg-
ulations

518, 574, 576 Picture pages

OTHER FEATURES

510 Our leaders

511 President’s page
528 Perinatal Tips

544 Your opinion please

546 Monthly surveillance report

554 County in the spotlight

559 County scenes

569 MSMS Council minutes

570 Michigan mediscene

571 MSMS in action
577 In small doses
580 In memoriam
589 Sound Off

Publication of Michigan Medicine is under the direction
of the Publication Committee, Michigan State Medical So-
ciety. The scientific editor is responsible for the scientific
content. The managing editor is responsible for the pro-
duction, correspondence and contents of the journal. He
and the executive editor share final responsibility of the
entire publication.

Neither the editors nor the state medical society will
accept responsibility for statements made or opinions ex-
pressed by any contributor in any article or feature pub-
lished in the pages of the journal. In editorials, the views
expressed are those of the writer and not necessarily offi-
cial positions of the society.

SCIENTIFIC EDITOR

John W. Moses, MD

EXECUTIVE EDITOR

Herbert A. Auer

MANAGING EDITOR

Judith Marr

PUBLICATION COMMITTEE
Edward J. Tallant, MD
Detroit
Chairman

Robert M. Leitch, MD
Battle Creek
Donato F. Sarapo, MD
Adrian

(fMichigati (fMediciqe

Devoted to the interests of the medical profession and
public health in Michigan.

INFORMATION FOR CONTRIBUTORS

1. Address scientific manuscripts to the Publication Com-
mittee, Michigan State Medical Society, 120 West Saginaw
Street, East Lansing, Michigan 48823. Submit original, double-
spaced typewritten copy and two carbon copies or photo copies
on letter size (8V2 x 11 inch) paper. On page one, include
title, authors, degrees, academic titles, and any institutional or
other credits.

2. Authors are responsible for all statements, methods, and
conclusions. These may or may not be in harmony with the
views of the Editorial Staff. It is hoped that authors may have
as wide a latitude as space available and general policy will
permit. The Publication Committee expressly reserves the right
to alter or reject any manuscript, or any contribution, whether
solicited or not.

3. Illustrations should be submitted in the form of glossy
prints or original sketches from which reproductions will be
made by Michigan Medicine.

4. Articles should ordinarily be less than four printed pages
in length (3000 words).

5. References should conform to Cumulative Index Medicus,
including, in order: Author, title, journal, volume number,
page, and year. Book references should include editors, edition,
publisher, and place of publication, as well.

6. The editors welcome, and will consider for publication,
letters containing information of interest to Michigan physi-
cians, or presenting constructive comment on current contro-
versial issues. News items and notes are welcome.

7. It is understood that material is submitted for exclusive
publication in Michigan Medicine.

MICHIGAN MEDICINE is the official organ of the Michigan
State Medical Society, published under the direction of the
Publication Committee. Published three times a month, ex-
cept four times in December and January, 38 issues, by the
Michigan State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at additional
mailing offices. Yearly subscription rate, $9.00; single copies,
80 cents. Additional postage: Canada, $1.00 per year; Pan-
American Union, $2.50 per year; Foreign, $2.50 per year.
Printed in USA. All communications relative to manuscripts,
advertising, news, exchanges, etc., should be addressed to
Judith Marr, Michigan State Medical Society, 120 West Sag-
inaw Street, East Lansing, Michigan 48823. Phone Area Code
517, 337-1351. © 1972 Michigan State Medical Society.

512 MICHIGAN MEDICINE JUNE 1972

rheumatoid arthritic blowup...
Tandearil Geigy

oxyphenbutazone nf tablets of 100 mg.

1 Important Note: This drug is not a simple analgesic.

Do not administer casually. Carefully evaluate patients
before starting treatment and keep them under close
| supervision. Obtain a detailed history, and complete
physical and laboratory examination (complete
hemogram, urinalysis, etc.) before prescribing and at
frequent intervals thereafter. Carefully select patients,
avoiding those responsive to routine measures, con-
traindicated patients or those who cannot be observed
frequently. Warn patients not to exceed recommended
dosage. Short-term relief of severe symptoms with
the smallest possible dosage is the goal of therapy.
Dosage should be taken with meals or a full glass of
milk. Patients should discontinue the drug and report
immediately any sign of: fever, sore throat, oral
. lesions (symptoms of blood dyscrasia); dyspepsia,
epigastric pain, symptoms of anemia, black or tarry
, stools or other evidence of intestinal ulceration or
hemorrhage, skin reactions, significant weight gain or
edema. A one-week trial period is adequate. Discon-
tinue in the absence of a favorable response. Restrict
• treatment periods to one week in patients over sixty,
i Indications: Acute gouty arthritis, rheumatoid arthritis,
; rheumatoid spondylitis.

■ Contraindications: Children 14 years or less; senile
patients; history or symptoms of G.l. inflammation or
ulceration including severe, recurrent or persistent
; dyspepsia; history or presence of drug allergy; blood
dyscrasias; renal, hepatic or cardiac dysfunction;
hypertension; thyroid disease; systemic edema;
stomatitis and salivary gland enlargement due to the
drug; polymyalgia rheumatica and temporal arteritis;
patients receiving other potent chemotherapeutic
I agents, or long-term anticoagulant therapy.

Warnings: Age, weight, dosage, duration of therapy,
existence of concomitant diseases, and concurrent
potent chemotherapy affect incidence of toxic reac-
tions. Carefully instruct and observe the individual
patient, especially the aging (forty years and over)
i who have increased susceptibility to the toxicity of the
drug. Use lowest effective dosage. Weigh initially
I unpredictable benefits against potential risk of severe,
even fatal, reactions. The disease condition itself is

unaltered by the drug. Use with caution in first trimes-
ter of pregnancy and in nursing mothers. Drug may
appear in cord blood and breast milk. Serious, even
fatal, blood dyscrasias, including aplastic anemia,
may occur suddenly despite regular hemograms, and
may become manifest days or weeks after cessation
of drug. Any significant change in total white count,
relative decrease in granulocytes, appearance of
immature forms, or fall in hematocrit should signal
immediate cessation of therapy and complete hema-
tologic investigation. Unexplained bleeding involving
CNS, adrenals, and G.l. tract has occurred. The drug
may potentiate action of insulin, sulfonylurea, and
sulfonamide-type agents. Carefully observe patients
taking these agents. Nontoxic and toxic goiters and
myxedema have been reported (the drug reduces
iodine uptake by the thyroid). Blurred vision can be
a significant toxic symptom worthy of a complete
ophthalmological examination. Swelling of ankles or
face in patients under sixty may be prevented by
reducing dosage. If edema occurs in patients over
sixty, discontinue drug.

Precautions: The following should be accomplished at
regular intervals: Careful detailed history for disease
being treated and detection of earliest signs of
adverse reactions; complete physical examination
including check of patient’s weight; complete weekly
(especially for the aging) or an every two week blood
check; pertinent laboratory studies. Caution patients
about participating in activity requiring alertness and
coordination, as driving a car, etc. Cases of leukemia
have been reported in patients with a history of short-
and long-term therapy. The majority of these patients
were over forty. Remember that arthritic-type pains
can be the presenting symptom of leukemia.

Adverse Reactions: This is a potent drug; its misuse
can lead to serious results. Review detailed informa-
tion before beginning therapy. Ulcerative esophagitis,
acute and reactivated gastric and duodenal ulcer
with perforation and hemorrhage, ulceration and per-
foration of large bowel, occult G.l. bleeding with
anemia, gastritis, epigastric pain, hematemesis, dys-
pepsia, nausea, vomiting and diarrhea, abdominal

distention, agranulocytosis, aplastic anemia, hemo-
lytic anemia, anemia due to blood loss including
occult G.l. bleeding, thrombocytopenia, pancytopenia,
leukemia, leukopenia, bone marrow depression, so-
dium and chloride retention, water retention and edema,
plasma dilution, respiratory alkalosis, metabolic
acidosis, fatal and nonfatal hepatitis (cholestasis may
or may not be prominent), petechiae, purpura without
thrombocytopenia, toxic pruritus, erythema nodosum,
erythema multiforme, Stevens-Johnson syndrome,
Lyell’s syndrome (toxic necrotizing epidermolysis),
exfoliative dermatitis, serum sickness, hypersensitivity
angiitis (polyarteritis), anaphylactic shock, urticaria,
arthralgia, fever, rashes (all allergic reactions require
prompt and permanent withdrawal of the drug), pro-
teinuria, hematuria, oliguria, anuria, renal failure with
azotemia, glomerulonephritis, acute tubular necrosis,
nephrotic syndrome, bilateral renal cortical necrosis,
renal stones, ureteral obstruction with uric acid crys-
tals due to uricosuric action of drug, impaired renal
function, cardiac decompensation, hypertension,
pericarditis, diffuse interstitial myocarditis with mus-
cle necrosis, perivascular granulomata, aggravation of
temporal arteritis in patients with polymyalgia rheu-
matica, optic neuritis, blurred vision, retinal hemor-
rhage, toxic amblyopia, retinal detachment, hearing
loss, hyperglycemia, thyroid hyperplasia, toxic goiter
association of hyperthyroidism and hypothyroidism
(causal relationship not established), agitation, con-
fusional states, lethargy; CNS reactions associated
with overdosage, including convulsions, euphoria,
psychosis, depression, headaches, hallucinations,
giddiness, vertigo, coma, hyperventilation, insomnia;
ulcerative stomatitis, salivary gland enlargement.

(B) 98-146-800-E

For complete details, including dosage, please see
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Each gram contains: Aerosporin® brand polymyxin B sulfate, 5000 units;
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neomycin base); special white petrolatum q. s.

In tubes of 1 oz. and V2 oz. for topical use only.

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Neosporin-G Cream

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Each gram contains: Aerosporin® brand polymyxin B sulfate, 10,000
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gramicidin, 0.25 mg., in a smooth, white, water-washable vanishing
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Contraindications: Not for use in the external ear canal if the eardrum is ,
perforated. These products are contraindicated in those individuals who
have shown hypersensitivity to any of the components.

Complete literature available on request from Professional Services
Dept. PML. 1 Hi

The following statistical information about internships and residencies
in Michigan and the nation is the latest. The 1971 information has not been
released as yet, and the 1972 medical school graduates are just now be-
ginning their internship programs.

This information is from the most recent Annual Report of the American
Medical Association Council on Medical Education.

Considerable interest is being shown in such figures by the MSMS
House of Delegates, the Michigan legislature, and others.

The MSMS House authorized the appointment of a committee to study
why Michigan graduates go to other states for internships and residencies
and to report to The MSMS Council and 1972 House. Speaker Vernon V.
Bass, MD, has asked the Liaison Committee with Medical Students and the
Education Liaison Committee to work together as a task force to make the
study. Two meetings have been held already and considerable research is
underway.

The following statistical reports as of Sept. 1, 1970 provide information
about the 1970 graduates of the medical schools in Michigan and the
nation:

A member of the first
graduating class from the
M5U College of Human
Medicine, Richard E. Hodg-
man, MD, of Bangor now
joins the ranks of Michi-
gan interns.

How does Michigan rank
in internship — residency programs?

AM A figures tell:

Michigan offered 627 positions as of Sept. 1,
1970 at 43 hospitals for the sixth largest number
of internships in the nation.

Michigan, with 464 positions filled, had the eighth
largest number of interns in the USA.

The Michigan batting percentage of 74% of posi-
tions filled ranks well with the bigger states. New
York had 2,014 of 2,433 positions filled for 83%.
California had 1,264 of 1,443 positions filled for
88%.

Pennsylvania had 786 of 1,131 positions filled for
69%. Illinois had 749 of 1,026 filled for 73%. Ohio
had 634 of 943 filled for 67%. Texas had 474 of
621 filled for 76%. Massachusetts had 511 of 575
filled for 89%, the best of the states with the larger
number of internships. Some of the smaller states
with 30 or fewer positions fared better than Massa-
chusetts’ 89%.

There were 319 graduates of U-M and WSU as
interns in the USA in 1970.

The University of Michigan led all other medical
schools in the number of interns and residents in
the USA as of Dec. 31, 1970 with 190 interns and
649 residents for a total of 839.

The Faculty of Medicine and Surgery, University

of Santo Tomes, Manila, led all foreign schools
with 129 interns and 1,251 residents for a total of
1,380 in the USA; far above the 579 total from the
Institute of Medicine, Far Eastern University, also
at Manila.

In Michigan there were 17 women in internships
as of Sept. 1, 1970 from US and Canadian schools.

In Michigan there were 7 black interns as of
Sept. 1, 1970 and 30 in residencies.

There were 36 osteopaths serving on hospital
attending staffs in 14 hospitals as of Sept. 1, 1970.
In the nation there were 53 hospitals with 117
osteopaths on attending staffs as of Sept. 1, 1970,
a gain from 11 hospitals with 23 osteopaths on duty
in 1969.

In Michigan in 1970 there was a total of 88 AMA-
approved paramedical education programs. The
largest numbers were 38 to train medical technol-
ogists, and 33 for radiologic technologists.

Michigan reported a total of 46 directors of med-
ical education, with 30 full-time, salaried; 12 part-
time salaried; 2 full-time non-salaried, and 2 part-
time non-salaried. In the nation there were 908 with
580 full-time salaried. The specialty of internal med-
icine contributed the largest single group with 34
percent of the total.

MICHIGAN MEDICINE JUNE 1972 515

Doctor Hodgman and another MSU graduate,
Marshall S. Spencer, MD, Port Huron, check
in at the nurses station in the Cardiac Care
Unit at Sparrow Hospital, Lansing. Doctor
Hodgman will remain in Lansing to intern,
while Doctor Spencer will continue his train-
ing in New York.

MICHIGAN INTERNSHIPS/Continued

Origin of Medical Education
of Interns in Michigan 9/1/70

296 from US or Canadian schools
168 from foreign schools
464 total in state

Michigan Internships

43 Number of hospitals
181 Number of approved internship programs
627 Total positions offered 9/1/70*

464 Total positions filled 9/1/70**

163 Positions vacant 9/1/70
74% Percent filled***

296 Interns, graduates of US, Canada 9/1/70
68 Interns, foreign graduates 9/1/70
36% Percent foreign filled

664 Total Internship positions offered in affiliated and
non-affiliated hospitals 1972-73

*The 627 positions in Michigan ranked sixth in the nation
behind New York, California, Pennsylvania, Illinois and Ohio,
in that order. Texas was a close seventh with 621.

**The 464 Michigan positions filled ranks eighth in the
nation behind New York, California, Pennsylvania, Illinois,
Ohio, Massachusetts, and Texas, in that order.

***ln the nation, 75% of the total of 15,354 positions
offered or 11,552 positions were filled as of Sept. 1, 1970.

Michigan Residencies

66 Number of hospitals
192 Number of approved residency programs
2,072 Total positions offered 9/1/70*

1,714 Total positions filled 9/1/70
358 Positions vacant 9/1/70
83% Percent filled**

922 Residents, graduates of US, Canada 9/1/70
792 Residents foreign graduates 9/1/70
46% Percent foreign filled
2,299 Total Residency positions offered 1972-73

*The 2,072 positions in Michigan ranked sixth in the na-
tion behind New York, California, Pennsylvania, Illinois, Ohio,
in that order.

**ln the nation, 88% of the total number of 46,005 places

offered or 39,220 positions were filled as of Sept. 1, 1970.

Here are 1972 results
for Michigan students
in intern matching

Officials at Michigan’s three medical schools re-
port they are “generally pleased” with the results
of the 1972 National Intern-Resident Matching Pro-
gram.

At the University of Michigan, 121 of the 190
young doctors in this year’s graduating class re-
ceived internships or residencies at their first-
choice training hospitals, an even higher propor-
tion than last year.

Wayne State medical graduates total 127 this
year, and of them, 89 received their first choice
in the internship matching program.

And at Michigan State, where the College of
Human Medicine is graduating its first class of
seniors, 23 of the 30 graduates were selected by
their first choices in the national computerized
program in which they list their preferences.

Thirty-five of the U-M graduates received their
second choice of hospital, and an additional 14
received their third choice.

Eighty-two U-M graduates will serve first-year in-
ternships or residencies in Michigan hospitals,
while 99 will go out of state and four will intern
in the Armed Forces. Fifty-five of the class chose
rotating internships, while 130 chose straight intern-
ships.

The U-M graduates chose specialties in the fol-
lowing numbers: internal medicine — 47; surgery —
34; pediatrics — 12; family medicine — 11; obstetrics
and gynecology — 10; pathology — 6; psychiatry — 6;
anesthesiology — 2; urology — 1; physical medicine
and rehabilitation — 1.

Seventy-seven of the WSU School of Medicine
graduates are planning to intern in Michigan, for
a percentage of over 60%, the highest of all the
medical schools. The percentage of U-M graduates
staying in Michigan is 43%, while the MSU per-
centage is 50%.

Forty-nine WSU medical graduates are going
out-of-state.

Three-quarters of the MSU class will be remain-
ing in the Great Lakes area for internships and
exactly half will remain in Michigan. Ten of the
students will be interning in community hospitals
in which they trained.

“When a first class is being trained in innovative
ways, it is not possible to know now well they will
be accepted,” remarks James Conklin, PhD, asso-
ciate dean for student affairs in the MSU medical
school. “Results of the intern matching give us
added confidence that we have been doing the
right things and that our students are well re-
ceived.”

516 MICHIGAN MEDICINE JUNE 1972

TE 5TDF !IVE

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The Cadillac Eldorado
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The Audi has had it since 1933.

The Audi gets

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The Audi has the same

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The same kind of system
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The Porsche 917 racing car
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OVERSEAS DELIVERY AVAILABLE

Health
Manpower
Week, 1972

An immunology ex-
hibit was staffed by
medical technology
students.

The first annual Health Manpower Week in
Michigan began with a highly successful
Health Careers Day at Michigan State Univer-
sity, pictured on this page. Sponsors were the
MSU Organization of Health Profession Stu-
dents, and the Michigan Health Council.

Over 5,000 high school students, counselors,
parents and others toured the MSU medical
education facilities, including colleges and de-

Some fabulous charting on the poly-
graph drew smiles from nursing stu-
dent Sue Schlosser and Howard
Brody, first-year student in the Col-
lege of Human Medicine, who was
in charge of all exhibits in the
MSU Life Sciences Building.

partments of dietetics, health education, med-
ical technology, medicine, music therapy, nurs-
ing, osteopathic medicine, social work, speech
and hearing, psychology and veterinary med-
icine.

Other events of the iveek, proclaimed offi-
cially by Lt. Gov. James H. Brickley, included
the Great Lakes Health Manpower Conference
in East Lansing, and the Metropolitan Detroit
Science and Career Fair at Cobo Hall. Over
120,000 Detroit-area students and counselors
viewed exhibits arranged by the Michigan
Health Council there.

Lt. Gov. James Brickley officially proclaims
Health Manpower Week in Michigan. From
left, standing, are David Black, veterinary
medicine student; Sue Schlosser, MSU nurs-
ing student; Robert Schuetz, PhD, director,
MSU Institute of Biology and Medicine; Rob-
ert Trepp, MSU osteopathic student; Howard
Brody, MSU medical student; John A. Doher-
ty, executive vice president, Michigan Health
Council.

518 MICHIGAN MEDICINE JUNE 1972

Advertisement

“The history of science, and in
particular the history of medicine ...is...

the history of man’s reactions to the
truth, the history of the gradual revelation
of truth, the history of the gradual
liberation of our minds from darkness
and prejudice.”

— George Sarton, from “The History

of Medicine Versus the History of Art”

o

6

Would it be useful

Would it be useful in clinical practice
to have government predetermine

drugs of choice?

Doctor of Medicine

Walter Modell, M.D.,
Professor of Pharmacology,
Cornell University
Medical College,
Editor,

Clinical Pharmacology
& Therapeutics,
Drugs of Choice,
Rational Drug Therapy

The proposition that gov-
ernment should determine
one or two “drugs of
choice’’ within a given
therapeutic class reflects
the belief that a similarity
in molecular structure in-
sures a close similarity in
pharmacologic effect. But
this is by no means the
rule. An obvious example
would be in the field of diu-
retics, where a small change
in chemical structure ac-
counts for substantial dif-

ferences in concomitant
effects such as potassium
excretion.

Any attempt to dictate
the “drug of choice” would
be complicated by the fact
that some populations dem-
onstrate a bimodal distribu-
tion in their reaction to
drugs. If the data on drug
response are mixed for the
total population, one drug
will appear to be as useful
as the other. But if drug
response is reported sepa-
rately for different seg-
ments of the population,
drug A will be found to be
better for one group and
drug B for the other.

It may, of course, be pos-
sible to determine drugs of
choice in particular cate-
gories on a broad statistical
basis. But there are always
certain patients in whom a
drug produces odd, unpre-
dictable or idiosyncratic re-
actions. So, though a drug
might statistically be the
most useful one in a given
situation, individual varia-
tions in response might
make it the incorrect one.

The point I wish to make
is that if two, three, four or
more drugs in one class are
of approximately equal
merit, that in itself is justi-
fication for their avail-
ability. Exceptional cases
do arise in which one drug
would be useful to a certain

segment of the population
and another drug would be
of no use at all. In the
practice of medicine, the
physician must be prepared
to treat the routine as well
as the unusual case.

Another objection to the
determination of a drug of
choice is that precise state-
ments of relative efficacy
are very difficult to make-
much more difficult than
statements of efficacy. For
example, in testing drug ef-
ficacy, it is easy to deter-
mine the difference be-
tween a drug that is effec-
tive in treating a condition
and one that is not at all
effective. Thus, it is fairly
easy to determine whether
a drug is more effective
than a placebo. But if you
compare one drug that is
effective with another drug
that is also effective, and
the relative differences be-
tween them are very slight,
statements of relative effi-
cacy may be very difficult
to make with assurance.

I do not mean to imply
that relative efficacy state-
ments are not useful or can
never be made. With some
groups of drugs (e.g., anal-
gesics), extensive study and
precise methodology have
yielded useful information
on relative efficacy. But in
most situations, such infor-
mation can be acquired only
through studies encompass-
ing three to five years of
use in many more patients
than are used to compare
drugs with a placebo for
the introduction of a drug
into commerce. It is really
only after practitioners use
a drug extensively that
relative safety and efficacy

in practice can really b
determined.

The Bureau of Drugs ha:
suggested the package in
sert as a possible means ol"
communicating informatioi
on relative efficacy of drugs
to the physician. I find this
objectionable, since I dc
not believe the physicia
should have to rely on this)
source for final scientific
truth. There is also a prac
tical objection: Since few!
physicians actually dis
pense drugs, they seldom
see the package insert. In
any event, I would main-1
tain that the physician
should know what drug ha
wants and why without de-|
pending on the governmem
or the manufacturer to telll
him.

Undoubtedly, physicians'
are swamped by excessive
numbers of drugs in some
therapeutic categories. And
I am well aware that many
drugs within such cate-
gories could be eliminated
without any loss, or per-
haps even some profit, to
the practice of medicine.
But, in my opinion, neither
the FDA nor any other
single group has the exper-
tise and the wisdom neces-
sary to determine the one
“drug of choice” in all
areas of medical practice.

It

ivertisement

One of a series

Maker of Medicine

nneth G. Kohlstaedt,M.D.,
Vice President,
Medical Research,

Eli Lilly and Company

[n my opinion, it is not
! function of any govern-
■nt or private regulatory
;ncy to designate a “drug
:hoice.” This determina-
n should be made by the
ysician after he has re-
ved full information on
; properties of a drug,
3 then it will be based on
i experience with this
lg and his knowledge of
: individual patient who
seeking treatment,
if an evaluation of com-
rative efficacy were to be
ide, particularly by gov-
lment, at the time a new
lg is being approved for
irketing, it would be a
eat disservice to medi-
e and thus to the patient
le consumer. For exam-
, when a new therapeu-
agent is introduced, on
: basis of limited knowl-
;e, it may be considered
be more potent, more
ective, or safer than
pducts already on the
irket. Conceivably, at
is time the new drug
lid be labeled “the drug
choice.” But as addi-
nal clinical experience is
cumulated, new evidence
iy become available,
ter, it may be apparent

that the established prod-
ucts should not be so easily
dismissed.

Variation in patient re-
sponse to drugs constitutes
one of the major obstacles
to the determination of
“drugs of choice.” We are
just beginning to open the
door on pharmacogenetics,
but it is evident that genetic
differences cause wide var-
iations in the way drugs are
absorbed, metabolized, etc.
This fact alone is sufficient
to make unrealistic the
idea that there is one drug
in each class to be used for
every human being.

The problem of deter-
mining relative drug effi-
cacy is an extremely com-
plicated one. Comparison
with other drugs of the
same class should not be
a prerequisite for market-
ing a new substance. In
some therapeutic areas, it
may be difficult to make ac-
curate comparisons. For
example, in the treatment
of infections it is not possi-
ble to conduct crossover
studies. Recovery may be
influenced by factors which
cannot be controlled or
measured, i.e., natural host
resistance and virulence of
infective agents. A drug’s
acceptability must often be
judged on the basis of its
own performance, and this
may be limited to experi-
ence in a relatively small
patient population. If the
introduction of a new drug
must await the adequate
establishment of relative ef-
ficacy, the duration of clini-
cal trial and extent of
studies would be greatly
prolonged, particularly for
rare or unusual conditions.
The availability of a new
drug would be delayed.
Many patients might suf-
fer needlessly and lives
might be lost.

Relative efficacy can best
be established by experi-
ence in a general patient
population through regular
channels of clinical prac-
tice. The physician consid-
ers the patient as a whole,
which means the patient
often has multiple prob-
lems and drugs must be
selected with this in mind.
Hence, a “drug of choice”
in an uncomplicated case
may not be the best drug
for a patient with associ-
ated problems. Publica-
tion of well-controlled
studies in medical journals
may provide comparative
evidence; discussions at
medical meetings, presen-
tations at postgraduate
courses, and the new audio-
visual technology may
bring evidence to physi-
cians on comparative ther-
apy. In a free medical
marketplace, a drug that
does not measure up will
fall into disuse. For exam-
ple, broad clinical experi-
ence has established
vitamin Bis as the “drug of
choice” for the treatment
of primary pernicious ane-
mia. No amount of adver-
tising or promotional effort
by the manufacturer could
increase the use of liver ex-
tract for this anemia. How-

ever, a physician may wish
to employ parenteral liver
preparations for a special
purpose.

In the field of surgery,
peer review in the hospi-
tal has brought significant
improvement in the use of
new techniques and proce-
dures. Something of this
nature would be useful
in the area of drug ther-
apy. However, it should be
developed by the medical
profession itself and would
necessitate, for its proper
function, an improvement
in the dissemination of re-
liable data on clinical phar-
macology of drugs under
consideration.

Ideally, information on
the relative efficacy of
drugs should be gathered
and assessed by the physi-
cians who actually admin-
ister the specific agents to
a specific patient popula-
tion. To do this, they will
need even more informa-
tion on the drugs they use
— information that the
pharmaceutical manufac-
turers must begin to pro-
vide if government regula-
tion of “drugs of choice ” is
to be avoided.

Opinion ^Dialogue

What is your opinion, doctor?

Send us your comments on the above issue.

The Pharmaceutical Manufacturers Association
1155 Fifteenth Street, N.W., Washington, D.C. 20005

One of
the familiar
line of
Cardran

flurandrenolide

products

Eli Lilly and Company
Indianapolis, Indiana 46206

Additional information
available to the
profession on request.

Scientific papers

Aseptic meningitis associated with echo virus
type 3: an outbreak in Flint

By Fikria Elamrousy Hassan, MD, PhD
Flint

The ECHO viruses were first implicated as a
cause of aseptic meningitis in the mid 1950’s.13
Since then, several reports of the association of
ECHO virus, types four,3 six,4-11 nine,1-2-7-17’18 and
eleven0-16 with the epidemic form of this disease
have appeared. ECHO virus type three is known
at present to be capable of producing sporadic
cases of aseptic meningitis. The present report de-
scribes an outbreak of aseptic meningitis due to
ECHO virus type three, which occurred in Flint,
Michigan during the summer of 1970.

Materials and Methods

Study Group

During the summer of 1970 we received in the
research laboratory at the Mott Children’s Health
Center, specimens from 49 patients with the diag-
nosis of aseptic meningitis. All patients were hos-
pitalized at Hurley Hospital, Flint, Michigan. We
reviewed in retrospect the clinical records of 47 of
these patients. History, clinical findings, and lab-
oratory data were tabulated, analyzed, and corre-
lated with virus isolation studies.

Virus Isolations

Specimens for virus isolations were obtained
from 49 patients. A total of 29 rectal swabs, 34
throat swabs, 37 cerebrospinal fluid (CSF) spec-
imens, and five paired sera were obtained. Spec-
imens were inoculated into three cell culture tubes
from the following cell culture systems: primary
human embryonic kidney (HEK) , a continuous
cell line Hep-2, and human embryonic lung fibro-
blasts (HEL) . They were then observed for cyto-
pathic effect for eight to 15 days at which time, if
negative, a second passage was performed. Fluids
from tubes showing definite or questionable CPE

Doctor Hassan is director of laboratories at
the Mott Children’s Health Center. She also is
a consultant in infectious diseases at Hurley
Hospital, Flint.

_ASEFTC MENINGITIS
FLIN l, MICH GAN - SUMMER, 1970
CASES EY WEEK OF ONSET

14 -
13 -
12 -
II -

coio

Z9

LlJ

JJLT AUGUST SEPTEMBER OCTOBER

TIME CLINICAL CASES □

ECHO 3 EOLATION ■
ECHO 6 ISOLATDN §

were used for subculture and the harvest was used
for virus typing. Virus titration was done by the
Reed-Muench method15 and 100 TCID50 were
used for neutralization against antisera pools, and
subsequently against type specific antisera. Homo
typic neutralization tests with paired sera were
performed using 100 TCID50 of a local strain of
ECHO vims type three. Confirmation of virus
identification and antibody detennination was
done at the Virology Division of the State of
Michigan Public Health Laboratory.

Results

Occurrence of Illness

Specimens from 49 patients with the diagnosis
of aseptic meningitis were received from July
through October, 1970. The epidemic curve based

MICHIGAN MEDICINE JUNE 1972 523

ASEPTIC MENINGITIS/ Continued

Table 1

Aseptic, Meningitis
Flint, Michigan — Summer, 1970

Cases by Age

Age group (years)

Number

Percent of Total*

less than 1

20

43

1-5

10

21

6-10

6

13

11-15

5

11

16-20

3

6

21-29

1

2

30-39

2

4

47

100

‘Fractions are approximated

Table 2

Aseptic Meningitis

Flint,

Michigan — Summer,

1970

Age, Sex, and Race

Distribution

Age Group

White

Non White

Male Female

Male Female

less than one year 3

9

3

5

1-5

3

2

2

3

6-10

3

2

1

11 - 15

2

2

1

16-20

3

—

21-29

1

—

30-39

1

l

—

Total

16

16

6

9

Table 3

Aseptic Meningitis

Flint,

Michigan — Summer,

1970

Clinical Syndrome —

47 Patients

Number

Percent

Fever

39

83

Headache

20

43

Stiff neck

23

49

Nausea and vomiting

28

60

G.l. symptoms

10

21

Upper respiratory infection

14

30

Seizures

1

2

Rash

1

2

on the date of admission is depicted in Figure 1.
The peak of the epidemic occurred during August
and the first week of September. Only one case
was received in October.

The age distribution (Table 1) showed that the
disease occurred predominantly in children. Eighty-
eight percent of patients were children under 15
years of age. Forty-three percent were less than
one year old; this included three infants in their
second and third weeks of life.

Breakdown by race and sex (Table 2) showed
that the epidemic occurred more in whites (32:15).
Taking all age groups together, males were equally
affected as females in the whites, with a slight in-
creased incidence in females of the nonwhite
group. However, in infants less than one year old,
the number of females affected was more than
double that of males in the same age group.

Clinical Findings

Clinical data were available on 47 of the 49 pa-
tients studied for virus isolation. The composite
clinical picture is summarized in Table 3. Fever
(101 °F. or more) was present in 83% of patients.
Headache (43%), stiff neck (49%), nausea and
vomiting (60%) , were other cardinal features of
the disease. Symptoms related to the G.F tract
weie present in 10 patients from whom the virus
was recovered. This consisted of diarrhea in four
patients, abdominal pain in another four, and ab-
dominal distension in two patients. One patient
presented with seizures, and 14 had upper respira-
tory infection. Rash was reported only in one case.

Laboratory Results

Table 4 summarizes the laboratory data avail-
able for the 47 patients in the study. Peripheral
white blood counts were performed on 46 cases.
Although the majority (48%) had less than
10,000/cu.mm, there was a significant portion
(13%) with counts above 15,000 and (9%) with
counts of 20,000 and above. The remainder (30%)
were in the 10,000-15,000/cu.mm, range.

Lumbar punctures were performed on all 47
patients (Table 4). Although 47% had CSF leuco-
cyte counts of less than 100/cu.mm., 38% had
counts greater than 100, four individuals had
counts greater than 500, one had a count of more
than 1,000 and two had counts more than 2,000/
cu.mm. Similarly, although mononuclear cells pre-
dominated in the CSF in most cases (Table 4),
about one third (16/47) of the patients had great-
er than 60% polymorphonuclear leukocytes on
their initial spinal fluid examination. There were
18 of the 47 cases with CSF protein of more than
50 mgs% and one case with CSF protein of more
than 100 mgs%. Of the 46 CSF glucose determina-
tions, 5 (11%) were below 50 mgs% (Table 4).

524 MICHIGAN MEDICINE JUNE 1972

Table 4

Aseptic Meningitis
Flint, Michigan— Summer, 1970

Routine Laboratory Data

Peripheral White Blood Cell Counts— 46 Patients

WBC per mm3

5,000-9,999

10,000-14,999 15,000-19,999

20,000+

Total

No. of cases

22

14 6

4

46

% of total

48

30 13

9

100%

Cerebrospinal

Fluid Pleocytosis — 47 Patients

WBC per mm3

0-99 100-499 500-999 1000-1999

2000+

Total

No. of cases

22

18 4 1

2

47

% of total

47

38 9 2

4

100%

Percentage of Polymorphonuclears in CSF— 47 Patients

Percent interval

0-9 10-19

20-29 30-49 50-69

70-100

Total

No. of cases

8 4

1 7* 11*<

16

47

% of total

17 9

2 15 23

34

100%

Cerebrospinal Fluid Protein — 47 Patients

mg%

0-49

50-99 100-149

150+

Total

No. of cases

27

18 1

1

47

% of total

58

38 2

2

100%

Cerebrospinal Fluid Glucose — 46 Patients

mg%

0-49

50-99 100-150

Total

No. of cases

5

40

1

46

% of total

11

87

2

100%

*one case with only 3 WBC (2 monos,

1 poly)

**one case with only 2 WBC (1 mono,

1 poly)

Table 5

Aseptic Meningitis

Flint, Michigan — Summer, 1970

Virologic Results

Virus Throat

Fecal

Serum

Case#

Isolated Swab

Swab CSF Acute

Conv.

70

e3

+ +

1:8

1:128

73

E3 +

+ +

1:8

1:64

84

E3 +

+

1:8

1:64

89

E3

- +

1:8

1:64

80

E6

+

N.D.

1:256

92

Ee

+ +

N.D.

N.D.

95

E6 +

+ -

1:16

1:512

Virologic Results

A total of 100 specimens were processed for
virus isolation. Fourteen of 37 (38%) spinal fluids,
12 of 29 (41%) rectal swabs, and 10 of 34 (29%)
throat swabs were positive for ECHO virus type
three. Thus out of the 49 patients studied, 23 pa-
tients were positive for isolation of ECHO virus
three. Results of neutralization tests on paired
sera from four patients from whom the virus was
isolated are shown in Table 5. All four paired sera
showed evidence of infection with ECHO virus
type three. In addition, specimens from three other
patients (two CSF’s, one throat swab, and one

rectal swab) were positive for ECHO virus type
six. Paired sera from one patient, and convalescent
serum from another showed a considerable rise in
antibody titer against ECHO virus type six (Table
5). In no instance was more than one virus re-
covered from the same patient.

Discussion

The syndrome of aseptic meningitis is the most
common manifestation of involvement of the cen-
tral nervous system by an ECHO virus. Of the
thirty-three currently recognized ECHO virus sero-
types, at least 24 have been identified to varying

MICHIGAN MEDICINE JUNE 1972 525

ASEPTIC MENINGITIS/Continued

degrees as causes of aseptic meningitis. Six ECHO
virus types are known to cause epidemics of aseptic
meningitis in different parts of the world. These
are: type four,3 type six,4-11 type nine,1’2-7-1718 type
eleven,6-19 type sixteen,10 and type thirty.5 Recently
ECHO virus type thirty-three was reported as a
cause of epidemics of aseptic meningitis in Ger-
many.89 Sporadic forms of the disease were caused
by these types and by additional serotypes. ECHO
virus type three is among the types known at pres-
ent to be capable of producing sporadic cases of
aseptic meningitis. To our knowledge this is the
first report on the association of ECHO virus type
three with a community outbreak of aseptic men-
ingitis.

In this study, ECHO virus type three was re-
covered from 23 of the patients with the clinical
syndrome of aseptic meningitis. Fourteen of those
patients yielded virus from the CSF thus firmly
establishing the etiologic role of the virus in the
syndrome. In addition, more than a four fold rise
in serum antibody titer was seen in the patients
on whom convalescent serum was available.

In this epidemic, infection was primarily a dis-
ease of children, the peak incidence occurred in
summer and the laboratory findings generally re-
flected a low white count, and a mild degree of
spinal fluid lymphocytosis. However, a number of
patients presented with CSF findings typical of
bacterial meningitis. This is in general agreement
with epidemics due to other types of ECHO virus.
The virus was readily isolated from CSF, fecal
swabs gave the highest yield of virus recovery, and
throat swabs gave the least.

Some features of this epidemic deserve special
mention. The disease occurred predominantly in
children, with 43% below one year of age. There
was a higher incidence in females than males in
this age group in contrast to aseptic meningitis
due to other types of ECHO virus in which males
were more affected than females. Thirty precent
of the patients presented with upper respiratory
infection (URI) in addition to the aseptic men-
ingitis syndrome. Although ECHO virus type three
has been implicated as a cause of an outbreak of
mild febrile respiratory illness in infants and nur-
sery children,16 this high degree of association of
aseptic meningitis with URI is another unusual
feature of the epidemic and has not been reported

in descriptions of aseptic meningitis due to other
types of ECHO viruses.

In certain outbreaks of entroviral diseases spe-
cific rashes have been observed alone or in con-
junction with aseptic meningitis.12 In this epi-
demic, rash was not a part of the clinical picture.
Whether or not these features are characteristic of
aseptic meningitis due to ECHO virus type three
awaits description of more epidemics due to the
same type.

ECHO virus type six was isolated from three
patients during this epidemic. Infection is estab-
lished by virus isolation from CSF in two patients
and the rising antibody titer in one. The small
number of cases, its occurrence in different age
groups (four months, 10 years, 17 years), and its
presence only during a two week period are in
favor of the conclusion that ECHO virus type six
played a minor role during the epidemic period
which was primarily caused by ECHO virus type
three.

Summary

An outbreak of aseptic meningitis which oc-
curred in Flint, Michigan proved to be due to
ECHO virus type three. Features of the outbreak
included the young age of the majority of pa-
tients, a higher incidence in females, association
with upper respiratory symptoms, and absence of
rash. The virus was readily recovered from the
spinal fluid.

Acknowledgement

The author wishes to express her appreciation
to Doctor Arthur L. Tuuri, President of the Mott
Children’s Health Center for supporting the study.
Thanks are also due to Mrs. Phyllis Page for her
technical assistance, the attending physicians and
housestaff of Hurley Hospital for their interest
and cooperation in providing the clinical spec-
imens, and to Doctor Morris Becker, Chief of the
Virology Division in the State of Michigan De-
partment of Public Health Laboratories for con-
firmation of virus identification and antibody titra-
tion.

References

1. Baumann, T. von, Barben, M., Marti, R., Hassler,
A., and Krech, U., Erkrankungen durch ECHO-
Virus Typ 9. Eine epidemiologische, klinische und
virologisch-serologische Studie, Schweiz, med. Wschr.
87, 307-315, 1957.

2. Boissard, G.P.B., Macrae, A.D., Stokes, J.L., and
MacCallum, F.O., Isolation of viruses related to
ECHO virus type 9 from outbreaks of aseptic
meningitis, Lancet 1, 500, 1957.

3. Chin, T.D.Y., Beran, G.W., and Wenner, H.A., An
epidemic illness associated with a recently recog-
nized enteric virus (ECHO virus type 4) . II. Rec-

52G MICHIGAN MEDICINE JUNE 1972

ognition and identification of the etiologic agent,
Am. J. Hyg. 66, 76-84, 1957.

4. Davis, D.C., and Melnick, J.L., Association of echo
virus type 6 with aseptic meningitis, Proc. Soc. Exp.
Biol. Med. 92, 839-843, 1956.

5. Duncan, I.B.R., Biological and serological prop-
erties of Frater virus— a cytopathogenic agent asso-
ciated with aseptic meningitis, Arch. ges. Virus-
borsch. II, 248-257, 1961.

6. Elvin-Lewis, M., and Melnick, J.L., ECHO 11
virus associated with aseptic meningitis. Proc. Soc.
Exp. Biol. Med. 102, 647-649, 1959.

7. Godtfredsen, A., and von Magnus, M., Isolation of
ECHO virus type 9 from cerebrospinal fluids, Dan-
ish Med. Bull. 4, 233-236, 1957.

8. Henigst, W., Echo virus type 33 in Southern Ger-
many (Bavaria) . Epidemiologic studies after isola-
tion of the virus from cerebrospinal fluid. Zbl.
Bakt (Orig) 206:133-139, 1968.

9. Kapsenberg, J.G. Echo virus type 33 as a cause of
meningitis. Arch Ges Virusforsch 23:144-147, 1968.

10. Kibrick, S., Melendez, L., and Enders, J.F., Clinical
associations of enteric viruses with particular ref-
erence to agents exhibiting properties of the ECHO
group, Ann, N.Y. Acad. Sci. 67, 311-325, 1957.

11. Karzon, D.T., Winkelstein, W., and Cohen, S.:
Isolation of ECHO Virus Type 6 during Outbreak
of Seasonal Aseptic Meningitis. J.A.M.A., 162: 1298,
1956.

12. Lerner, A.M., Klein, J.O., Cherry, J.D., and Fin-

land, M., New viral exanthem New Eng. J. Med.
269, 678-685, 736-740, 1963.

13. Lyle, W.H. Lymphocytic meningoencephalitis with
myalgia and rash. A new exanthem? Lancet 2,
1042, 1043, 1956.

14. Nihoul, E., Quersin-Thiry, L., and Weynants, A.,
ECHO virus type 9 as the agent responsible for an
important outbreak of aseptic meningitis in Bel-
gium. Am. J. Hyg. 66, 102-118, 1957.

15. Reed, L.J. and Muench, H. A simple method of
estimating fifty percent endpoints. Amer. J. Hyg.
27:493-497, 1938.

16. Rosen, L., Kern, J., and Bell, J.A. An outbreak of
infection with ECHO virus type 3 associated with
a mild febrile illness, Am. ]. Hyg. 79, 163-169,
1964.

17. Sabin, A.B., Krumbiegel, E.R., and Wigand, R.,
ECHO type 9 virus disease. Virologically controlled
clinical and epidemiologic observations during 1957
epidemic in Milwaukee with notes on concurrent
similar diseases associated with Coxsackie and other
ECHO viruses, Am. J. Dis. Child. 96, 197-219, 1958.

18. Solomon, P., Weinstein, L., Chang, Te-W., Arten-
stein, M.S., and Ambrose, C.T. Epidemiologic,
clinical, and laboratory features of an epidemic of
type 9 ECHO virus meningitis, /. Pediat. 55, 609-
619, 1959.

19. von Zeipel, G., and Svedmyr, A. A study of the
association of ECHO viruses to aseptic meningitis.
Arch ges. Virusforsch. 7, 355-368, 1957.

MICHIGAN MEDICINE JUNE 1972 527

cPeriqatal ‘TTps

By Paul M. Zavell, MD
Detroit

The following case from the files of the Wayne
Coutity Medical Society Perinatal Mortality Com-
mittee is presented as an aid in continuing ed-
ucation.

Maternal

This was the fourth pregnancy of a Gravida IV,
Para I, 23-year-old, A negative, diabetic mother.
(Her husband is Rh-f ) . She had had diabetes
since age nine and presently was on 64 units of
Lente Insulin. She had gained from 132% lbs. to
143 lbs. Her blood pressure was 130/90 with +1 to
+ 2 albumin in urine on several occasions.

In 1966 she had a spontaneous abortion at six
weeks followed by a D and C. At the end of 1966
she had a one-month spontaneous abortion. In
1968 at 37 weeks gestation she had an elective C-
Section and delivered an 8 lb. male who is alive
and well at the present time.

This fourth pregnancy was complicated by diffi-
cult control of her diabetes. We have no further
information except that at 33 to 34 weeks she was
hospitalized for three days in another hospital for
control of her diabetes. Her L.M.P. was 9/9/69
with estimated day of confinement of 6/17/70.

Doctor Zavell is chairman, Neo-Natal and Hos-
pital Care Committee, Michigan Chapter, AAP;
and chairman, Perinatal Mortality Study Commit-
tee, Wayne County Medical Society.

She was seen regularly for her prenatal visits with
amniocentesis done on 4/13/70 when Rh anti-
bodies were negative. She was seen at 37 weeks
for a prenatal visit and all seemed to be going
well. The baby was thought to be small and it
was decided to wait one to two more weeks to do
her elective C-Section.

She was next seen on 6/5/70 with the story she
had felt no fetal movements for 4-5 days. This was
confirmed at physical examination when no fetal
heart tones were heard. Studies done were as fol-
lows: blood sugar 492 on 6/5/70, 202 on 6/6/70,
154 on 6/7/70', 140 on 6/8/70. Hgb. of 14.9 gm
on 6/6/70 and 13.1 gm on 6/9/70. VDRL neg. on
6/9/70. A.P. abdomen X-ray on 6/6/70 “Normal
fetus in breech with no sign of fetal death seen.”

Mother was hospitalized on 6/8/70, an elective
C-Section was done revealing a stillbirth female
infant weighing five pounds, 13% ounces. The
autopsy found only some early maceration of in-
fant believed to have been dead five to seven days.

Perinatal Committee Comments

1. Although an amniocentesis was done no
Coombs test was done. It is felt this may have
been of some value here in deciding the appro-
priate course to take.

2. It was felt that the presence of a small infant
in a diabetic mother at 37 weeks pregnancy
should not dissuade the obstetrician from do-
ing a C-Section. Especially is this true if there
has been prior infant loss or difficulty in any
way in control of her diabetes. Instead the
small infant should alert the obstetrician that
something might be wrong (especially in a
multipara) .

3. Properly hospital-collected estriol levels at 37
weeks (and perhaps later) could be of some
help in deciding upon the proper course to
take in a problem diabetic pregnancy.

528 MICHIGAN MEDICINE JUNE 1972

A case of necrotizing nocardial pneumonitis

By Zwi Steiger, MD
Barbara A. DeFever, MD
Edward G. Nedwicki, MD
Nicholas M. Jackiw, MD
Allen Park

Abstract:

We are presenting a case of nocardiosis that
resembled a non-resectable carcinoma of the lung.
The correct diagnosis was made only at the post-
morten examination. It is postulated that the out-
come of the case could have been different if the
diagnosis of nocardiosis had been made earlier and
proper therapy instituted.

A plea is made to include nocardia infection in
the differential diagnosis of lung diseases.

It is doubtful that any thoracic surgeon will see
more than one or two cases of nocardiosis in his
career, and therefore, we feel that a case report is
worthwhile. Recently we had a case of necrotizing
pneumonitis of the lung due to nocardia which
simulated an unresectable carcinoma.

Case Report:

A 39-year-old white male, E.H.B., was admitted
to APVAH on November 27, 1967, because of
cough and hemoptysis. A roentgenogram of the
chest revealed an infiltration in the apex of the
left lung. In the three weeks prior to his admis-
sion he had chills, fever, left chest pain and on
one occasion he coughed up about half a cupful of
bright red blood. He had lost about 20-25 lbs. in
the last year. He had smoked a pack of cigarettes
daily for 23 years and drank beer daily. The rest
of his history was non-contributory.

He was well developed and in no acute distress.
His physical examination was essentially within
normal limits. His temperature was 99.8°.

On admission his Hgb. was 10.7 gms., HCT
34%, WBC 16,000 with 82 neutrophils, 11 lymph-
ocytes, 6 monocytes and 1 eosinophile. VDRL was
negative. No acid-fast bacilli were found in the
sputum. Urine was normal. Tuberculin PPD inter-
mediate (5 T.U.) was negative and so were the
histoplasmin blastomycin and coccidioclin skin

Doctors Steiger, DeFever, Nedwicki and Jackiw
are with the departments of surgery, pathology,
chest medicine and radiology, respectively, of
the Allen Park VA Hospital. Doctor Steiger is
an assistant professor and Doctor Nedwicki is an
associate instructor, while Doctors DeFever and
Jackiw are instructors at Wayne State University.

Figure 1. X-ray on admission shows a dense
confluent and mottling infiltration in the left
apex and intra-clavicular region with streaky ex-
tension towards the left upper hilum.

tests. Sputum cultures were positive for neisseria
catarrhalis, Candida albicans, Streptococcus viri-
dams and Diplococcus pheumoniae. Prothrombin
time was off by three seconds. WBC eventually
rose to 29,500. Bronchoscopy showed a small
amount of purulent material coming from the left
upper lobe. No tumor cells were found in the
sputum.

Serial roentgenograms revealed no change in the
appearance of the lesion. Since the etiology could
not be determined and the possibility of malig-
nancy could not be ruled out, surgery was advised.

An exploratory thoracotomy was carried out on
February 8, 1968. At the surgery the left upper
lobe was indurated; necrotic tissue invaded the
second and third ribs and the vertebrae medially.
Because of the invasion of the adjacent vertebrae
and the ribs, the lesion was considered non-resect-
able. Several pieces of tissue were obtained for
histology. Frozen sections of these were reported
as, “acute and chronic inflammation of undeter-
mined etiology.” Stains for acid-fast organisms and
fungi were negative. It was assumed that the sec-
tions represented an inflammatory lesion distal to
malignancy.

MICHIGAN MEDICINE JUNE 1972 529

NOCARDIAL PNEUMONITIS/Continued

Figure 2. Lung: Inflammation with abscess. H&E x 65.

Postoperatively the patient ran a febrile course
and on the ninth post-operative day he developed
paraplegia which was felt to be secondary to inva-
sion of the spine, and he expired a few hours later.

At autopsy the right lung was normal. The left
lung weighed 650 gms. The pleura was thickened.
The apical region was necrotic. Several small
nodules were scattered in the lung parechyma. The
hilar nodes were enlarged. The first and second
thoracic vertebrae had punched out areas filled
with necrotic material. The spinal cord seemed to
have been compressed at the lower cervical and
upper thoracic levels.

On microscopic examination of the lung, chron-
ic and acute inflammation was seen with abscesses
and small cavities lined by fibrous tissue. Histi-
ocytes and occasional multinucleated giant cells
were present. In the areas of inflammation, gram
positive and weakly acid-fast branching filaments
of bacterial thickness compatible with nocardia
were seen. The inflammation extended into the
chest wall. Similar findings were present in micro-
scopic sections of vertebrae. Microscopic sections
from the central nervous system showed central
chromatolysis and axial swelling of the thoracic
and lumbar spinal cord, possible secondary to
compression and Wernicke’s policencephalopathy.

Discussion

Nocard in 188 described an acid fast fungus in
cattle having multiple abscesses, draining sinuses
and pulmonary involvement.1 The micro-organism
was later named Nocardia asteroides by Trevisan.2

Eppinger described the lesion in the human.
The disease is not transmittable from one person
to another. It is an exogenous infection contracted
from organisms which grew saprophytically in the
soil.3 It is rarely found to be a containant.4 There-
fore, demonstration of the organism can be con-
sidered proof of the disease.

In Nocardiosis, gram-positive and partially acid-
fast filaments of Nocardia asteroides are to be
found in areas of suppuration and necrosis. An-
imal pathogenicity tests help to verify the diag-
nosis. The difficulty in establishing a diagnosis of
Nocardiosis stems from the fact that the frag-
mented gram-positive filaments resemble gram-
positive streptococci and diptheroids, and are re-
ported as such. It on the smear fragmented acid-
fast filaments are seen and sent only for culture
of mycobacteria they are often destroyed by the
concentration methods with sodium hydroxid and
the cultures are then negative.5-0

The clinical features and course of this disease

530 MICHIGAN MEDICINE JUNE 1972

Figure 3. Bone: Acute inflammation with necrosis, H&E x 65.

m

7 "" " -

4

-

/ “

1 •

*

m

* 4* '«*

-*s # *■

-v* * * ,

*

— i

• *'* *#/ *• . ~i/. ^ ■ «;

*

- * - 4 - *

T <• #

■ #

V

/ , 4 9 ,

’ #

r, f I

r t

■ *y.' t*

’t#* a

r . 7 , ' ^ ■*-*. , /

« * a**"1" ‘ *• *_ v

»- - • ^ c

T '->• *-»

« " . V '*

* *-v\

■\ . ■

*^*y. >■

r > * &

• ■ t *<.

V “ 5: * m

#

*

a#

. Ml *

* -v % •» „

je?S : - *

> *

0 C

: # r *

0

* j*

# " •

•"Hi 1 | *■ m

*$ *■ * **, , * >

Jit

ate

•w «

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Figure 4. Bone: Delicate branching filaments. Gram stain x 385.

MICHIGAN MEDICINE JUNE 1972 531

NOCAR DIAL PNEUMONITIS/Continued

may closely simulate actinomycosis, but there is a
greater tendency for cerebral metastasis and for
multiple abscesses to develop. The clinical picture
may manifest itself as tracheitis, bronchitis, pleuro-
pulmonary fistula, pneumonia, peritonitis, menin-
gitis, ischiorectal abscess, keratoconjunctivitis, endo-
carditis, abscesses in the thyroid, liver, spleen,
lymph nodes, kidneys, adrenals, intestines and
skeletal muscles.7 The clinical manifestations are
non-specific and the diagnosis is made only when
suspected and proven by bacteriological means.

The radiological features of the lung lesions
mimic those of tuberculosis, pneumonia and can-
cer of the lung.

Nocardia asteroides is occasionally found in pa-
tients with a chronic debilitating disease such as
leukemia, carcinoma of the lung, Hodgkin’s dis-
ease, myelofibrosis, hemolytic anemia, or in pa-
tients on prolonged steroid therapy. In these cases
Nocardia asteroides is considered an opportunistic
organism.8-9

Treatment

The treatment of Nocardiosis is mainly medical.
The surgical part consists of incision and drainage
of abscesses and empyema cavities.

In vitro and in vivo studies show sulfadiazine
to be the agent of choice in the treatment of No-
cardiosis. Some studies showed in vitro resistance
of the organism to sulfadiazine. Despite this, it is
advisable to give the patient the drug as discrep-
ancies between in vitro and in vivo actions of
sulfadiazine on Nocardiosis were reported. Addi-
tion of a broad spectrum antibiotic is advisable.
The recommended dose is 6 to 10 gm. of sulfa-
diazine a day. This will give a blood concentration
between 10 to 20 mg. percent. The medication
should continue for several months after the man-
ifestations of the disease subsided. Kidney function
should be monitored for possible kidney dam-
age.7-10

Summary

A case of necrotizing nocardiosis imitating a
nonresectable carcinoma of the lung was pre-
sented. The disease entity was briefly reviewed. An
appeal to include the disease in the differential
diagnosis is made. The difficulties encountered in
making the diagnosis are illustrated. Sulfonamides
remain the drug of choice in treatment of No-
cardiosis. Surgery in this disease is ancillary.

Bibliography

1. Nocard, M.E.: Note sur la maladie des bocufs de la
guadeloupe connue sous le nom de Farcin. Ann.
lnstitut Pasteur, 1888, 1,293,302.

2. Waksman, S.A., and Henrici, A.T.: The Nomen-
clature and Classification of the Actinomycitis.
J. Bad. 46:337, 1943.

3. Eppinger, H.: “Ueber Eine Neue Pathogen Cla-
dothrix und Eine Durch Sie Herforgerufene Pseudo-
tuberculosis,” Wien, Klin. Wochschr. 3:321, 1890.

4. Raich, R.A., Casey, F., and Flass, W.H.: Pulmonary
and Cutaneous Nocardiosis, the significance of the
laboratory isolation of Nocardia. Amer. Rev. Resp.
Dis. 1961, 83, 505.

5. Miller, R.C., Feldman, Y.M.: Pemphigus Vulgaris
and Pulmonary Nocardiosis. Arch. Derm. Vol. 96,
Nov. 1967.

6. Nev, H.C., Silva, M., Flazen, E., Rosenheim, S.H.:
Necrotizing Nocardial Pneumonitis. Annals of Int.
Medicine. Vol. 66, No. 2, Feb. 1967.

7. Peabody, J.W., Jr. and Seabury, J.H.: Actinomyco-
sis and Nocardiosis. Am. J. Med., 29:99, 1960.

8. Murray, J.F., Finegold, S.M., Forman, S., Will,
D.W.: The Changing Spectrum of Nocardiosis, A
Review and Presentation of Nine Cases. Amer. Rev.
Resp. Dis. 83: 315, 1961.

9. Saltzman, H.A., Chick, E.W., Conant, N.F.: Nocar-
diosis and a Complication of Other Diseases. Lab.
Divest. 11:1110, 1962.

10. Weed, L.A., Andersen, H.A., Good, C. Allen, Bag-
enstoss, A. H.: Nocardiosis. The New England
Journal of Medicine. No. 62, Vol. 253

Please send reprint requests to Doctor Steiger,
VA Hospital, Allen Park, 48101.

532 MICHIGAN MEDICINE JUNE 1972

A new fourth year

at The University of Michigan

Medical School

By Thomas J. Herrmann, MD
Ann Arbor

Introduction

The subject of this report is the new “all elec-
tive” senior year at the University of Michigan
Medical School. This revision in the school’s cur-
riculum was first introduced during the 1970-71
academic year. Other medical schools have also
modified their fourth year in a somewhat similar
manner and some have reported on their expe-
rience.1-2

While a number of the more general aspects of
the school's new fourth year are covered in this
report, it is the elective process rather than the
year itself that is the area of primary considera-
tion. Having given students the opportunity to
design for themselves the entire tenninal year of
the curriculum, the results of this activity were
analyzed to determine the extent to which it
exerted an influence on their choice of a future
career in medicine. The “elective” process has a
number of potential by-products. Effect on career
goal selection was singled out for special attention
both because of its importance to students and the
entire health care profession and because the in-
formation available appeared to be more objective
than that associated with other alternatives.

The University of Michigan
Medical School Curriculum

In order to put Michigan’s fourth year into its
proper perspective, it is necessary to provide some
detail about the year itself and to briefly describe
the rest of the curricular modifications that were
introduced into the three years that precede it.
Starting with the freshman class in the fall of
1967, a major revision of the school’s curriculum
was begun and the first full cycle of this process
was completed four years later with the graduation
of the Class of 1971.

Thomas J. Herrmann, MD, is assistant dean,
assistant professor of surgery, and assistant pro-
fessor of postgraduate medicine at the Univer-
sity of Michigan Medical Center.

For the purposes of introducing more clinical
teaching into the first two years, 40% of the time
previously allocated to the basic sciences was elim-
inated. While reorganization of their teaching ef-
forts varied from one basic science department to
another, most responded to this challenge by af-
fecting a reduction in the laboratory component
of their medical student courses. The time thus
gained during the freshman and sophomore years
was to a large extent given over to two newly
created, clinically oriented, interdisciplinary, two
year vertical core courses; a clinical medicine se-
quence and a neural and behavioral sequence. The
net result was to increase interdisciplinary teach-
ing in the first two years to 38% in the first year
and 66% in the second year. The degree of partici-
pation on the part of the School’s clinical faculty
was also increased; to 31% in the first year and
45% in the second year.

The clinical clerkships previously taught in all
of the third year and half of the fourth were modi-
fied and relocated into the third year alone.

In the “all elective” fourth year, the student
was permitted to select that set of courses felt to
be most appropriate to a career goal already in
mind or, in the case of uncertainty, to aid in the
identification of such a goal. A special faculty
counseling system and formal institutional review
mechanism were established to assist the students
in the development of their fourth year curricula.
An entirely new group of senior elective opportu-
nities was created by the faculty in a variety of
areas including clinical, basic science and research.
A modest number of guidelines for the “all elec-
tive” year were established by the faculty. The
two most important were 1.) students were re-
quired to spend a quarter of their 40-week senior
year in a course that dealt with the clinical care
of patients in a broad-based and comprehensive
fashion, and 2.) unless a compelling reason to the
contrary was identified, three-fourths of the year
had to be spent at the University of Michigan
Medical Center or one of its core-affiliated group
of hospitals. These included the Veteran’s Hospital
and the St. Joseph Mercy Hospital in Ann Arbor,
the Wayne County General Hospital in Wayne
and the Henry Ford Hospital in Detroit.

MICHIGAN MEDICINE JUNE 1972 533

NEW FOURTH VEAR/Continued

Table 1

Comparison of Departmental Contributions
to

Senior Curriculum

Department % of 4th

Year

Anatomy 2.4

Anesthesia 1-2

Dermatology 2.0

Internal Medicine 42.4

Neurology 4.0

Obstetrics/Gynecology 5.8

Ophthalmology 3.5

Otorhinolaryngology 2.8

Pathology 1-9

Pediatrics 5.0

Pharmacology 2.6

Physical Medicine 0.2

Physiology 0-2

Psychiatry 5.3

Radiology 7.5

Surgery 10.2

Non-Departmental Electives 3.3

Total 100.0%

Table 2

Orientation of
Senior Elective Selections

Course

Orientation

% of 4th
Year

Clinical

88.5

Basic Science

4.9

Interdisciplinary
(Joint Clinical — Basic

Science)

2.0

Research

(Clinical and/or Basic Science)

3.2

Misc. Electives

1.3

Total

Table 3

100.0%

Location

of Senior Electives

Source

% of 4th
Year

University of Michigan

Medical Center

52.3

Core-Affiliated Hospitals

37.4

Non-Core Institutions

10.3

Total

100.0%

Methods

Medical school records for the 1970-71 senior
year were used to determine the extent to which
students chose electives in various disciplines (Table
1), the overall orientation of senior elective selec-
tions (Table 2), and the locations where these elec-
tives were taken (Table 3).

Other information used as the basis of this re-
port was obtained directly from the members of
the Class of 1971. During the latter half of their
junior year, this class engaged in the process of

choosing their senior electives. For the benefit of
the faculty counselors and to assist the school in
its institutional review of senior curricula, all stu-
dents were required to identify in writing the
status of their future plans and how these related
to the courses of study being proposed. In this
way, specific information on pre-senior year career
goals was obtained.

On the afternoon prior to their graduation, a
questionnaire was distributed to the Class of 1971
asking about the year just completed and some of
its more important components and characteristics.
Included were questions that related to the realiza-
tion of student expectations, the extent to which
the year had met a number of educational goals,
and the sufficiency of elective opportunities made
available by the school in a variety of areas. The
students were also asked to retrospectively identify
the format they preferred for their fourth year of
medical education.

In the final section of the questionnaire, the
soon-to-be-graduates were asked to again state their
plans for a future career and also to identify from
a list of options the types of influence their elec-
tive fourth year had exerted on the plans they had
made. In about a quarter of the cases, students’
perception of how the elective fourth year had in-
fluenced career goal selection differed from the
more objective data that was available; namely,
the before and after identification of career goals.
When this discrepancy occurred, the type of fourth
year influence referred to in Tables 10 and 11 was
adjusted to reflect the more objective, and thus
more reliable information.

From a total of 201 graduates, 180 completed
all sections of the questionnaire for a response
rate of 89.5%. Those 180 students about whom a
complete spectrum was obtained were used as the
study group for this report.

Findings

When given the opportunity to design for them-
selves an entire year of their medical education,
Michigan’s Class of 1971 responded as might be
predicted in many ways but still managed to gen-
erate a few surprises. Quite unexpected was the
degree to which this class chose electives oriented
in the direction of further clinical training, Table
2. With the strong emphasis on the “clinical” in
the first two years of the curriculum, the school
thought there would be a significant amount of
senior student interest in taking additional work
in the basic sciences and in other areas related
only indirectly to the care of patients.

When all was said and done, however, an av-
erage of almost 90% of the 1970-71 senior year
was spent in the clinical disciplines. Of even great-
er significance perhaps, was the extent to which

534 MICHIGAN MEDICINE JUNE 1972

Table 4

Realization of Student Expectations
During

“All

Elective”

Senior Year

None

Little

Partially

Mostly

Fully

% of Expectations
Fulfilled

0%

25%

50%

75%

100%

No. 1971
Graduates

0

6

37

119

20

11.0% of the Study Group realized all of their expectations.
76.3% realized most (75%) of their expectations.

96.7% realized at least half of their expectations.

senior electives were chosen in the field of internal
medicine. As shown in Table 1, the class averaged
over 40% of its senior year in that discipline with
surgery a distant second at slightly over 10%. With
only 21 members of the class naming internal med-
icine as their choice of a future career (Table 9),
it is apparent that a large number of students in-
terested in other careers still felt that the internist
had much to offer in the way of further education
at the senior level.

Although the guidelines specified that seniors
were permitted to spend up to a quarter of their
year in electives originating outside of the Medical
Center and its core-affiliated group of hospitals,
Table 3 shows that only slightly over 10% of the
year on the average was actually spent at outside
institutions. Of that 10%, about a third was spent
in foreign countries and two-thirds in this country.
Outside electives taken in this country were di-
vided about equally between the State of Mich-
igan (2.9%) and the other 49 states (3.6%) .

From the data obtained from the questionnaire,
it woukh seem that most members of Michigan’s
Class of 1971 were quite satisfied with the experi-
ence they had just concluded. As shown in Table 4,

11.0% stated that they had realized all of their
expectations and 76.3% realized most of what they
had hoped to accomplish. 85.3% said that they had
enjoyed the year to more than just a moderate de-
gree, Table 5. When given the opportunity to
choose in a retrospective fashion among a number
of curricular alternatives for the fourth year of
their medical education, both the “all elective”
fourth year and some form of rotating internship
format were either the first or second preference
for over 80% of the study group, Table 7.

When asked to quantitate the extent to which
the year had been helpful in reaching a variety of
educational goals, the students selected an increase
in general medical information and the filling-in
of knowledge and experience gaps left over from
the three previous years of the curriculum as the
two areas of greatest benefit. Table 5. It is some-
what disappointing to note that only a little over
half of the class were more than moderately
pleased with the practical training received or the
degree to which a better understanding of their
patients had been achieved. Even less felt that the
year had satisfactorily augmented their previous
training in the basic sciences. While generally sat-
isfied with the variety of electives made available

Table 5

Extent to Which Senior Year Met Educational Goals

% of 1971 Graduates

Categories

More than
Moderate

Moderate

Less than
Moderate

a)

Increased general
medical knowledge

70.4

27.4

2.2

b)

Filled in knowledge
or experience gaps

79.0

17.7

3.3

c)

Provided practical
help for patient care

53.9

29.4

16.7

d)

Improved understanding
of patients

54.5

33.3

12.2

e)

Augmented basic
science training

29.4

37.8

32.8

f)

Was Fun!

85.3

11.3

3.4

MICHIGAN MEDICINE JUNE 1972 535

NEW FOURTH YEAR/Continued

Table 6

Satisfaction with Availability
of Elective Opportunities

% of 1971 Graduates

Categories

Not

About

Too

Enough

Right

Much

Clinical Specialties/

Subspecialties
Primary /Comprehensive

5.8

93.6

0.6

Health Care

38.2

60.6

1.2

Contact with Physicians
in Private Practices

52.9

46.5

0.6

Combined Clinical -
Basic Science

29.3

70.7

0.0

Basic Science

15.0

83.2

1.8

Research

6.1

87.8

6.1

% of Senior Year at
Medical Center or Core-
Affiliated Hospitals

6.0

44.3

55.7

Table 7

Preference

for 4th

Year

of Medical Education

% of Graduates

Alternatives Indicating 1st or

2nd Choice

a. ) “All Elective” Format 83.4

b. ) Mixed Elective and Regular Courses 12.6

c. ) Rotating Internship Format 81.3

d. ) First Year of Residency 34.5

Table 8

Status of Career Goal Selection
Before and After Elective 4th Year

Status of

Before 4th Year

After 4th Year

Future Career

No. of

% of

No. of

% of

Planning

Students

Total

Graduates

Total

Identified

Single
Career Goal

91

50.6

157

87.2

Considering
Two or More
Alternatives

40

22.2

20

11.1

Totally

Undecided

49

27.2

3

1.7

Study Group

Totals

180

100.0%

180

100.0%

by the school in most areas, a significant number
of students felt that more opportunities should
have been provided in the field of primary com-
prehensive health care and even more felt that the -
amount of contact available with physicians in
private practice was not adequate, Table 6. It is of
interest that over half of the class felt that three-
quarters of the year spent at the Medical Center
and its core-affiliates was a bit too much.

When asked to identify their career goals prior
to the beginning of their fourth year, as shown in
Table 8, 50.6% of the 180 members of the study
group indicated that they were quite certain of
their future plans. However, the remainder for one
reason or another, were unable to be as specific.
These included 22.2% who could only narrow
their choices down to a list of alternatives and
27.2% who were too uncertain at that point in
their training to provide the school with any in-
formation about their future plans. When asked a
second time to identify their plans, now after hav-
ing completed the elective fourth year, a signif-
icantly higher percentage was able to settle on a
single career choice (87.2%) . Those continuing to
remain uncertain (1.7%) or still unable to elim-
inate one or more alternatives (11.1%), while by
no means insignificant in their numbers, were sub-
stantially reduced from the year before.

The types of career goals identifed by graduat-
ing seniors are shown in Table 9. Since both med-
icine and surgery really represent a grouping of
separable specialty interest, it is hardly surprising
that they were by far the most popular choices.
When the data is viewed in terms of individual
disciplines, it becomes apparent that the future
career choices of Michigan’s seniors cover a fairly
broad spectrum.

Table 10 shows the frequency with which var-
ious types of influence effected the career goal se-
lection process during the course of the elective
fourth year. When one subtracts from the total the
groups of students whose future planning was not
effected (Groups 1 and 2) or merely reinforced
(Group 3) , there is still a residual of 108 individ-
uals or 60.0% (Subgroup B) who indicated that
their experience over the past year had noticeably
influenced their choice of a future career. Of those
108, 38 had been able to find a career goal where
none had existed before, 36 selected a single goal
from a list of two or more previously considered
alternatives, 27 actually changed from one pre-
viously identified goal to another and seven pre-
viously certain of their career goals, became un-
certain during the year. When the same informa-
tion is viewed by way of a discipline by discipline
comparison, as was done in Table 11, one finds
some differences between disciplines but these do
not appear to be great.

536 MICHIGAN MEDICINE JUNE 1972

Comments

From the material just presented, it is apparent
that Michigan’s graduating Class of 1971 was 1.)
reasonably pleased with the “all elective” format
of its senior year, 2.) felt the need to take a signif-
icant amount of additional training during the
senior year in the clinical disciplines, most espe-
cially in internal medicine and 3.) chose to spend
the majority of its fourth year at the Medical Cen-
ter and its core-alfiliated hospitals. While undoubt-
edly successful in many of its aspects, the school’s
first attempt to mount an “all elective” senior year
was by no means a complete success. Some of the
problems that occurred have been pointed out in
earlier sections of this report.

A matter of particular significance was the
amount of movement in career goal selection that
occurred during the course of the elective fourth
year. When one looks only at those students who
were totally undecided in their choice of a future
career, the initial size of that group (27.2%) and
its subsequent reduction throughout the fourth
year (to 1.7%) is about what one might expect
given the pressures that currently exist to make a
firm career decision before the period of graduate
medical education begins. In actuality, movement
in career goal selection involved not only those
who were undecided but a number of others as
well and finally amounted to 60% of the 180
member study group. While it is true that some
degree of activity would have occurred in all of
the influenced categories cited in this report re-
gardless of the format used for the fourth year, it
is highly probable that the total magnitude of this
activity was significantly greater than what might
have occurred under a non-elective or minimally
elective fourth year format.

In addition to the combined size of the several
groups whose career goal selections were signif-
icantly influenced, the quality of the decision-
making process employed by students is also a fac-
tor that must be taken into consideration. The
class in question was not a group of students
whose exposure to clinical medicine prior to their
fourth year need be judged as inadequate. In addi-
tion to the clinical clerkships that occupied the
entire 48-week third year, this class also spent
nearly half of its first two years in courses oriented
to clinical medicine and taught to a significant
extent by the clinical faculty. In spite of this, a
high proportion of the class indicated that some to
most of their fourth year electives were chosen to
gain additional familiarity with disciplines either
already selected or being seriously considered as a
future career. Often, the experience that ensued
was either positive in nature, when a student spent
time in a discipline and it proved to be enjoyable
and satisfying, or negative, when a previously con-
sidered choice was found to be unsuitable for a

Table 9

Career Goal Selections of 1971 Graduates

Discipline

Graduates
Selecting Discipline

% of
Total

Anesthesiology

5

2.8

Dermatology

2

1.1

General Practice

14

7.8

Internal Medicine

37*

20.6

Neurology

2

1.1

Obstetrics & Gynecology

20

11.1

Ophthalmology

11

6.1

Otorhinolaryngology

8

4.4

Pathology

3

1.7

Pediatrics

7

3.9

Psychiatry

4

2.2

Radiology

8

4.4

Surgery

36**

20.0

Uncertain

23***

12.8

Study Group Totals

180

100.0%

* Includes General Internal Medicine (20) and Medicine
Subspecialties (17).

** Includes General Surgery (13), Orthopedic Surgery (9),
Urology (6), Thoracic Surgery (4), Neurosurgery (3),
and Plastic Surgery (1).

*** Includes Totally Undecided (3) and those considering
two or more alternatives (20).

Table 10

Elective 4th Year Influence
on Career Goal Selection

No. of % of

Type of Influence Graduates Total

Group 1: Uncertain and continued

uncertain.

16

8.9

Group 2: Previously identified,

unchanged and no effect.

5

2.8

Group 3: Previously identified,

unchanged but reinforced.

51

28.3

Subgroup A: No effect or minimal

effect on career goal selection

72

40.0

Group 4: Previously identified

and now uncertain.

7

3.9

Group 5: Previously identified

and now changed.

27

15.0

Group 6: Selected from two or more

previously considered alternatives.

36

20.0

Group 7: Identified where none

previously existed.

38

21.1

Subgroup B:
career goal

Significant effect on
selection.

108

60.0

Study Group

Totals

180

Graduates

100.0%

MICHIGAN MEDICINE JUNE 1972 537

NEW FOURTH YEAR/Continued

Table 11

Elective 4th Year’s Effect on Career Planning
Analyzed by Discipline Selection

No. of Graduates Selecting Discipline

Career

Goal

Selections

Total

No.

No Uneffected
or Minimally
Effected*

No. Significantly
Effected**

Anesthesiology

5

1

4

Dermatology

2

2

—

General Practice

14

7

7

Internal Medicine

37

9

28

Neurology

2

2

—

Ob/Gyn

20

8

12

Ophthalmology

11

6

5

Otorhinolaryngology

8

4

4

Pathology

3

—

3

Pediatrics

7

3

4

Psychiatry

4

1

3

Radiology

8

1

7

Surgery

36

12

24

* Coincides to Subgroup A, Table 10
** Coincides to Subgroup B, Table 10

life-time career. In both circumstances, it is likely
that more informed, and thus better decisions were
made than would have been the case without the
benefit of an “all elective” fourth year.

Conclusions

With the pressures being exerted by today’s so-
ciety for more and better health care, all facets of
medicine including its educational continuum are
being seriously re-evaluated. It has been recom-
mended by some that benefit can be gained by
reducing the time spent in medical school from
four to three years.3-4-5 Some medical schools across
the country already have or are planning to move
in this direction. 5-6-7 The Federal Government has
given a measure of support for this concept in the
past and new legislation is pending before Con-
gress that would serve to increase the level of this
support.

Evidence has been presented in this report to
show that Michigan’s fourth year in its current
format is popular with students, assists in the at-
tainment of certain educational objectives and
most significantly perhaps, appears to facilitate a
relatively large number of changes in career goal
selection. By and of itself, this information is ob-
viously insufficient to affirm or deny the continued
need for a fourth year in medical school or to sug-
gest that future changes should not be made in
this school’s fourth year curriculum; our present
system of undergraduate medical education is too
far from ideal to permit that luxury. It would

seem, however, that the “all elective” senior year
does serve a very useful purpose for a large num-
ber of students and should not be eliminated or
significantly modified until the substitute chosen
in its place has been adequately tested for a num-
ber of important characteristics, most specifically
for its ability to respond to a common medical
student need; information and experience to assist
in the choice of a future career.

References

1. Miller, J.Q., Weary, P.E., Five Years’ Experience
with a Completely Elective Fourth Year, J. Med.
Educ., 44:976, 1969.

2. Penrod, K.E., The Indiana Program for Compre-
hensive Medical Education, J.A.M.A., 210: 868-870,
1969.

3. Blumberg, M.S., Accelerated Programs of Medical
Education, ]. Med. Educ., 46:643-651, 1971.

4. The Carnegie Commission on Higher Education.
Higher Education and the Nation’s Health: Policies
for Medical and Dental Education, New York: Mc-
Graw-Hill, 1970.

5. Page, R.G., The Three Year Medical Curriculum,
J.A.M.A., 213:1012-1015, 1970.

6. Council on Medical Education of the American
Medical Association. Medical Education in the
United States: Some Recent Events of Special In-
terest to Medical Education, J.A.M.A., 214:1484-
1487, 1970.

7. Hubbard, W.N., Gronvall, J.A. and DeMuth, G.R.,
The Medical School Curriculum, J. Med. Educ., 45:
-38, 1970.

538 MICHIGAN MEDICINE JUNE 1972

Tumors of the liver in early infancy:

Hepatoblastoma

By S. S. Yang, MD
A. J. Brough, MD
Jay Bernstein, MD
Royal Oak

Abstract

Hepatoblastoma is a distinctive tumor predom-
inantly of early childhood that can be differentiat-
ed histologically from other hepatic tumors. The
microscopic appearance, marked by neoplastic epi-
thelium and connective tissue elements, is charac-
terized by a resemblance to embryonal and fetal
liver. The tumor can often be surgically resected,
and despite considerable operative risk the prog-
nosis is relatively good in contrast to that of hepa-
tocarcinoma, from which it must be differentiated
pathologically.

Introduction

Surgical resection of hepatic neoplasms has in
the last two decades become the customary and
expected form of therapy. With refinement of op-
erative techniques, generally good results can be
anticipated in treating benign tumors and mal-
formations. Hepatic carcinomas have also been re-
sected, and an increasing number of apparent
cures has led to a clearer understanding of the
behavior of malignant tumors in childhood. Re-
ports of long-tenn postoperative survivals have
shown that success is generally associated with one
of two types of hepatic carcinoma.

Willis1’2 is credited with the recognition that
embryonal carcinoma, comparable to the embry-
onal nephroblastoma or Wilms’ tumor of the
kidney, does occur in the liver, where it can be
differentiated histologically from primary carci-
noma of the adult type. Despite the common his-
tologic complexity of these tumors and the diffi-
culty in evaluating individual cases, malignant
hepatomas in childhood can be separated into 1)
fetal or embryonal cell types, called hepatoblas-
toma, and 2) differentiated or mature cell types,
called hepatocellular carcinoma or hepatocarci-
noma. Willis, writing before the results of surgical
treatment had been publicized and believing

The authors are with the Departments of Pa-
thology of William Beaumont Hospital, Royal
Oak, Michigan, Children’s Hospital of Michigan
and Wayne State University College of Medicine,
Detroit.

hepatoblastoma to be a highly malignant tumor,
actually questioned the validity of the distinction.
The recent clinical-pathological studies of Ishak
and Glunz3 and of Kasai and Watanabe,4 clearly
justify, however, the practicality of this classifica-
tion. It is apparent that hepatoblastoma carries
the better prognosis, individual results depending
to a great extent on resectability of the tumor and
possibly on the age at operation. Successful treat-
ment requires also early diagnosis and early surg-
ical intervention.

These views have been presented in recent path-
ological and surgical publications.3-6 The pur-
pose of this paper is to summarize them and to
review the experience at the Children’s Hospital
of Michigan.

Experience

at Children’s Hospital of Michigan

A review of hepatic tumors filed since 1940 re-
vealed 16 primary epithelial neoplasms, which
were classified histologically3-4 as anaplastic hepa-
toma (three cases) , hepatocellular carcinoma (four
cases) and hepatoblastoma (nine cases) . In ail
nine cases of hepatoblastoma (Table I) a laparo-
tomy was performed, and in two thought to have
bilateral hepatic involvement the procedure was
limited to a biopsy. Subsequent postmorten exam-
ination, after unsuccessful irradiation and chemo-
therapy, in one (Case 8) showed that the hepatic
tumor was indeed a single mass limited to the
right lobe. There were, however, occasional small
pulmonary and vertebral marrow metastases one
month after biopsy.

Each of the other tumors was a single mass,
four in the right lobe and one in the left, varying
in size between 9.5 and 13 cm. The age range was
two weeks to 10 years. Three children died on the
operating table, two in 1960 and since then only
one other, a two-week-olcl. The successftd opera-
tions included three lobectomies and one partial
hepatectomy. The four children surviving surgical
resection of the tumor are all alive and free of
disease for periods of 21 months, two and a half
years, three years and eight years. No cases of
hepatocellular or anaplastic carcinoma survive;
one of each had undergone surgical resection.

The tumor was in each case delimited from the
adjacent hepatic parenchyma, sometimes encaps-
ulated by a layer of greyish-white, membranous
connective tissue. The cut surfaces were nodular

MICHIGAN MEDICINE JUNE 1972 539

HEPATOBLASTOMA/ Continued

Fig. 1. Fetal type of hepatoblastoma containing
relatively well differentiated, vacuolated and
clear cells, generally arranged in cords and
trabeculae; the tumor is separated from com-
pressed non-neoplastic liver tissue by a thin
fibrous capsule. Case 4. Alive and well eight
years after right partial hepatectomy. H&E stain.
Magn. 160X.

Fig. 2. Histologic pattern of hepatocarcinoma
for comparison with Fig. 1. Cells are pleomor-
phic; the nuclei are large and vesicular; often
containing prominent nucleoli. The pattern does
not resemble embryonal or fetal liver. 22-month-
old boy with evidence of metastatic disease
shortly after biopsy. H&E stain. Magn. 350X.

and variegated, displaying focal areas of hemor-
rhage, necrosis and bile-staining in generally soft,
fleshy, pale tumor masses.

Histologic evaluation in most instances provided
easy differentiation of hepatoblastoma from hepa-
tocarcinoma (Fig. 1 & 2); two specimens were rela-
tively difficult, although the three authors were in
complete agreement on reviewing the slides. Tu-
mor cells resembled fetal (Fig. 1) and embryonal
(Fig. 3) cell types in the nine hepatoblastomas, five
fetal and four mixed. The fetal cells were uni-
form, small, and polygonal or cuboidal, con-

Fig. 3. Hepatoblastoma of mixed cell type with
fetal epithelial elements, a sarcomatous stromal
component, and osteoid metaplasia. Case 6.
Four-month-old child alive and well two and a
half years after right hepatic lobectomy. H&E
stain. Magn. 150X.

Fig. 4. Hepatoblastoma in a six-month-old in-
fant. Apparent vascular invasion in a fibrotic
portal area at margin of tumor. Case 5. Alive and
well three years after wedge resection. H&E
stain. Magn. 40X.

540 MICHIGAN MEDICINE JUNE 1972

Table 1

Cases of Hepatoblastoma Treated at
Children's Hospital of Michigan

Case

Year

Name

Age

Race

Sex

Location

Size

Surgery

Outcome

1.

1952

W.P.

41/2 Y

W

M

Bilat.

Bx

Presumed dead (discharged in terminal

state)

2.

1960

T.K.

3 Y

N

F

R

11cm

RHL

Died during surgery. Operation delayed

3% month after biopsy

3.

1960

L.L.

IV2 Y

N

F

R

12cm

RPH

Died during surgery

4.

1962

J.W.

10 Y

W

M

R

13cm

RPH

Alive without disease 8 years

5.

1967

W.E.

6 M

W

F

L

10cm

Wedge

resect.

Alive without disease 3 years

6.

1968

J.T.

4 M

W

F

R

9.5cm

RHL

Alive without disease 2V2 years

7.

1968

L.S.

1/2 M

W

F

R

9.5cm

RHL

Died during surgery

8.

1969

S.J.

9 M

W

M

R

12cm

Bx

Died 1 month after biopsy with

metastasis

9.

1969

N.P.

6 M

W

M

R

RHL

Alive without disease after 21 months

RHL — right hepatic lobectomy
RPH — right partial hepatectomy
Bx — biopsy

Table 2

Survey of Recent Literature
Surgically Treated Cases of Hepatoblastoma

Surgical

OP

Late

Resection

Death

Death

Survived

Comment

1.

Clatworthy et al, 19611

12

5

2

3*

0

*One with septicemia

2.

Nixon, 1965s

—

5

2*

2 **

l(ly)

*One due to IVC thrombosis;

the other to pulmonary
infarcts

**Due to recurrence &

metastasis

3.

Fish & McCary, 196611

4

1

1 (44m)

Reported as embryonal

hepatomas

4.

Ishak & Glunz, 19673

35

18

4

5*

9 (4-13y)

*Died l-34m (av. 10.8m); 4 had

metastasis

5.

Ito & Johnson, 19695

5

3

3 (12m, 20m, 29m)

6.

Kasai & Watanabe, 19704

31 Fet.

15

4

2*

9 (18m x2, 3-6y x7)

*Died 11m & 2y6m with

recurrence

16 Emb.

8

5*

3 (8m, 4y, 3m died of

*Recurrence 5-18m

unrelated disease)

7.

Schiodt, 1970°

7

4

2

2 (24m, 29m)

8.

CHM, 1970

9

7

3

4 (21m, 21/zy, 3y, 8y)

Total

66

17

17

32 (20 surviving more than 3 yrs)

taining oval to round nuclei and distinct nu-
cleoli. The cells often contained clear or vacu-
olated cytoplasma, in which both fat and gly-
cogen were demonstrated. The tumor cells were
arranged in cords or trabeculae, usually two cells
thick, which were separated by sinusoids. Hema-
topoietic cells were present in all but one case.
Bilestasis was present in fetal cells. The mixed
tumors contained, in addition, embryonal cells
resembling those seen in extremely immature liver
tissue (Fig. 3). These cells were less differentiated
and appeared to be less mature than the fetal type.
They were more elongated and often less cohesive,
being arranged in irregular sheets and ribbons.
Acinar, pseudorosette, and papillary formations
were commonly present. Bile-stasis was not asso-

ciated with immature, embryonal cells. In com-
parison with the fetal type, mitoses were more
common; hemotopoiesis was lacking. Foci of hem-
orrhage, necrosis and calcium deposition were pres-
ent in association with both types of cells. Appar-
ent vascular invasion was seen at the tumor mar-
gins in both types, but was not a reliable indica-
tion of prognosis (Fig. 4).

Primitive mesenchymal tissue in various propor-
tions was also noted in association with both cell
types (Fig. 3). Islands of osteoid were present in
two instances. Clusters of keratinized squamous

Please address reprint requests to Department
of Pathology, William Beaumont Hospital, Royal
Oak, Michigan 48072.

MICHIGAN MEDICINE JUNE 1972 541

HEPATOBLASTOMA/Continued

epithelial cells were seen in three, and pigmented
granules similar to melanin were present in epi-
thelial and mesenchymal cells of one case.

Discussion

Several series3-9 and our own material, summar-
ized in Table II, total 66 cases in which the tumor,
identified as hepatoblastoma, was surgically re-
sected. The operative mortality has been high
(26%) ; perhaps figures for only the last five years
would be less formidable, reflecting better surgical
technique. Nonetheless, favorable outcomes have
been described in almost half of the 66, and of the
49 cases undergoing successful resection, 32 (65%)
were listed as surviving, 20 of them for more than
three years. To these figures may be added sev-
eral reports of individual cases,10-16 but complete
tabulations are impaired by inadequate histopath-
ologic documentation or a failure in some recent
papers to distinguish between hepatoblastoma and
hepatocarcinoma.17-21 The prognosis in hepatocar-
cinoma is in contrast unquestionably poor; Ishak
and Glunz3 cite only five published reports of long-
term survivals.

The important point is that these data indicate
a relatively good prognosis for hepatoblastoma in
operable cases. The survival in unoperated cases
seldom exceeds 12 months.3 Chemotherapy and
irradiation have thus far been of no value,3"4-9 and
an aggressive surgical approach is, therefore, just-
ified. The tumors are, despite their bulk, most
often single masses, and bilobar involvement is
relatively infrequent. Therefore, the resectability
rate is potentially high. In the series of Ishak and
Glunz,3 28 of 35 tumors formed single masses, and
25 were strictly localized to one lobe of the liver.
Other series have indicated a greater than 50%
rate of resectability. Our own series carries a
theoretical resectability of 90% (eight out of
nine) . In one case resection was not carried out
because there was mistakenly thought to be bi-
lateral hepatic involvement. The surgeon may be
faced with a difficult task, requiring greater than
usual operative finesse and delicate postoperative
care, but he has small chance otherwise for success.

We wish to emphasize that the data in Table II
show a survival for more than three years in ap-
proximately one-third of the tabulated cases. The
proportion increases significantly, of course, in
successfully operated cases. Patients with post-
operative recurrences, on the other hand, expired
prior to 34 months, and metastases had become
evident earlier than that. Those patients alive and
well three years after surgery, might, therefore,
anticipate permanent relief.

The tabulated data show that hepatoblastomas
are predominantly tumors of early childhood, al-
though exceptions have been noted. The series re-
ported by Kasai and Watanabe4 included patients

of five, six and eight years, and Ito and Johnson5
had a patient 12 years of age. One of ours, now
surviving eight years after resection of the tumor,
was 10 years old. It seems unreasonable, therefore,
to classify hepatic tumors according to age at on-
set, as suggested by Misugi et al.,22 for the prog-
nosis relates to the histologic structure rather than
the age. The younger patients in the series of
Misugi and colleagues22 appear all to have had
hepatoblastoma.

Willis,12 in recognizing that hepatoblastomas
can be differentiated from hepatocarcinomas, di-
vided the former into those epithelial tumors re-
sembling embryonal or fetal liver parenchyma and
those mixed tumors containing also sarcomatous
mesenchymal elements, including cartilage and
bone. He also recognized a rhabdomyoblastic sar-
coma that subsequent authors have tended to class-
ify in a separate group with sarcoma botryoides of
the extrahepatic bile ducts. Ishak and Glunz3 pre-
served the distinction between epithelial and
mixed tumors, although no clinical differences
emerged from their study. Kasai and Watanabe4
emphasized the classification of hepatoblastomas
into anaplastic, embryonal and fetal types. It ap-
pears, however, that the anaplastic pattern may be
associated with aggressive growth and early metas-
tases, warranting separation from other types of
hepatoblastoma. We have not been able to pre-
serve a strict differentiation of fetal and embryonal
types, nor have clinical differences been apparent.

Willis1-2 admitted the difficulty of always dis-
tinguishing between fetal hepatoblastomas appear-
ing late in infancy and adult-type hepatocarci-
nomas appearing early in childhood. Contempo-
rary pathologists are, however, constrained to make
that distinction, keeping in mind the predom-
inance of hepatoblastoma in early childhood.

Ultrastructural studies5-22 have shown hepato-
blastomas to contain undifferentiated cells; the
paucity of cytoplasmic organelles is in sharp con-
trast to their abundance in hepatocellular carci-
noma.

Of special interest are the concurrences with
hepatocellular tumors of several anomalies and
metabolic disturbances, among them hemihyper-
trophy, osteoporosis, and hypercholesterolemia. We
have not encountered a specific association with
either type of tumor, except that virilization is
apparently more often associated with hepatoblas-
toma. Increased serum concentration of alpha-I
fetoglobulin has occurred in association with hepa-
toblastoma,23 as well as with hepatocarcinoma, and
does not serve to differentiate between the two.

Summary

Hepatocellular tumors in childhood can be dif-
ferentiated into hepatoblastoma and hepatocarci-

542 MICHIGAN MEDICINE JUNE 1972

noma. The former, composed of cells resembling
embryonal and fetal liver, often admixed with
sarcomatous mesenchymal elements, can, if surg-
ically resectable, be accorded a relatively good
prognosis. A tabulation of reported cases indicates
a survival of three years or longer approaching
50% in successfully operated cases. A majority of
tumors is anatomically resectable. Despite charac-
teristic age distribution, the recognition of this
type of hepatoma rests on histologic criteria. Indi-
vidual cases require prompt and aggressive surgical
management.

References

1. Willis, R.A.: Pathology of Tumours, 2nd ed. St.
Louis, C.V. Mosby Co., 1953.

2. Willis, R.A.: The Pathology of Tumours of Chil-
dren. Springfield, 111., Charles C. Thomas, 1962.

3. Ishak, K.G. & Glunz, P.R.: Hepatoblastoma and
hepatocarcinoma in infancy and childhood: Report
of 47 cases. Cancer 20:396, 1967.

4. Kasai, M. 8c Watanabe, I.: Histologic classification
of liver-cell carcinoma in infancy and childhood
and its clinical evaluation: A study of 70 cases
collected in Japan. Cancer 25:551, 1970.

5. Ito, J. 8c Johnson, W.W.: Hepatoblastoma and
hepatoma in infancy and childhood. Arch. Path.
87:259, 1969.

6. Schiodt, T.: Hepatoblastoma and hepatocarcinoma
in infancy and childhood. Acta path, microbiol.
Scand. Suppl. 212:181. 1970.

7. Clatworthy, H.W., Jr., Boles, E.T., Jr. 8c Kott-
meier, P.K.: Liver tumors in infancy and child-
hood. Ann. Surg. 154:475, 1961.

8. Nixon, H.H.: Hepatic tumors in childhood and
Child. 40:169, 1965.

their treatment by major resection. Arch. Dis.

9. Fish, J.C. 8c McCary, R.G.: Primary cancer of the
liver in childhood. Arch. Surg. 93:355, 1966.

10. Debre, R., Mozziconacci, E. 8c Habib, R.: L’hepato-
blastome. Arch. Franc. Pediat. 11:1013, 1954.

11. Knox, W.G., Zintel, H. 8c Begg, C.F.: Partial hepat
ectomy for primary carcinoma of the liver in
childhood. Cancer 11:1044, 1958.

12. Koop, C.E.: Abdominal tumors in infants and
children. Arch. Dis. Child. 35:1, 1960.

13. Borman, J.B., Harbott, A.J. 8c Morris, D.: Hepatic
lobectomy in infancy for hepatoblastoma. Brit. J.
Surg. 49:11, 1961.

14. Peterson, R.D.A., Varco, R.L. 8c Good, R.A.: A 5-
year survival of an infant after surgical excision of
an embryonal hepatoma. Pediatrics 27: 474, 1961.

15. Haller, J.A. Sc Stowens, D.: Right hepatic lobec-
tomy in infancy. Surgery 53:368, 1963.

16. Gans, H„ Koh, S.K. 8c Aust, J.B.: Hepatic resec-
tion. Arch. Surg. 93:523, 1966.

17. Foster, J.H., Lawler, M.R., Welborn, M.B., Jr.,
Holcomb, G.W. 8c Sawyers, J.L.: Recent experience
with major hepatic resection. Ann. Surg. 167:651,
1968.

18. Taylor, P.H., Filler, R.M., Nebesar, R.A. 8c Tefft,
M.: Experience with hepatic resection in child-
hood. Amer. J. Surg. 117:435, 1969.

19. Martin, L.W. 8c Woodman, K.S.: Hepatic lobec-
tomy for hepatoblastoma in infants and children.
Arch. Surg. 98:1, 1969.

20. Cohn, R.: Right hepatic lobectomy in children.
Amer. J. Surg. 118:512, 1969.

21. Lin, T. Y.: Primary cancer of the liver. Scand. J.
Gastroent. Suppl. 6:223, 1970.

22. Misugi, K., Okajima, H., Misugi, N. 8c Newton,
W.A., Jr.: Classification of primary malignant tu-
mors of liver in infancy and childhood. Cancer
20:1760, 1967.

23. Alpert, M.E. 8c Seeler, R.A.: Alpha fetoprotein in
embryonal hepatoblastoma. J. Pediat. 77:1058, 1970.

MICHIGAN MEDICINE JUNE 1972 543

GYout~' opii\ioii please

MSMS asked the question:

What are your opinions on continuing med-
ical education for physicians? Should it be
required for relicensure? How much should
be required? How would you set standards?
How would you suggest that Michigan physi-
cians best obtain further education during
their careers?

(The MSMS Committee on Continuing Phy-
sician Education has recommended a pro-
gram of requirements for re-registration, and
a new task force, led by former MSMS Presi-
dent Robert J. Mason, MD, Birmingham, has
been charged with submitting a detailed se-
ries of recommendations to the 1972 MSMS
House of Delegates.)

These doctors replied :

Henry T. Forsyth, MD
Chesaning

When it comes time to set down my thoughts in
writing with regard to continuing medical education
as a requirement for relicensure, I find that it is not
a simple task.

In this day and age of rapid advancements, im-
provements in knowledge and skills in the medical
field appear at such a rate that any practitioner of
any specialty cannot hope to be maximally effec-
tive in caring for patients if he does not participate
in continuing medical education on a reasonably
regular basis. We also tend to forget to some de-
gree many of the basics with which we were once
familiar if we do not use them regularly in our
practices. Therefore I feel that continuing medical
education is an extremely desirable goal and is
necessary for one to be the best provider of the
best medical care that he is capable of.

How best to obtain needed postgraduate med-
ical education is a big question. I have found that
courses given at or under the direction of universi-
ties are most valuable to me in terms of useful

knowledge. However, there are many seminars, sym-
posia, “clinic days,” which are also valuable. Audio
Digest and other taped materials are very worth-
while. Reading journals is a valuable day-to-day
activity but many articles are of little value and
much time can be lost unless one is selective.

I personally would recommend courses given by
universities as being the best and easiest and most
enjoyable, but the journals and the tapes are es-
sential, also. Programs at hospital staff meetings
and at county medical society meetings also are
helpful.

Now I would like to set forth my views on how
much should be required, how to set standards,
and whether or not continuing medical education
should be a requirement for relicensure.

I will begin by saying that although I believe and
have stated that continuing medical education is
extremely desirable and is necessary if one is to
be maximally effective in providing the best in med-
ical care, I do not feel that it should be a require-
ment for relicensure.

I am a member of the American Academy of Fam-
ily Practice. In order to remain a member I must
acquire 150 hours of postgraduate credit in each
three-year period. This is not difficult to do if one
plans ahead. The American Board of Family Prac-
tice, the newest specialty board, requires that one
pass examinations before certification just as all
specialty boards do. It also requires re-examina-
tion every six or eight years to maintain that cer-
tification— a practice that other boards have con-
sidered and may follow.

The county medical societies, the hospital staffs,
and the various specialty boards have been and
will continue to be the most effective instruments
to maintain high standards of medical practice. The
standards they demand are far more stringent than
the state could require for relicensure and I fear
that such a requirement might lead to some deteri-
oration in standards rather than the improvement
that would be hoped for.

A physician will be a better physician not be-
cause he has attended a post-graduate course, but
because he wants to be a better physician. You
cannot legislate desire, and I sincerely believe that
the voluntary methods now being utilized by physi-
cians to improve their knowledge are far more ef-
fective than meeting a specified basic requirement
for relicensure.

In closing, I would like to point out that in my
experience it is a rare thing to meet a physician
who has not attended some meeting, seminar or
symposium in the recent past. I therefore do not
believe that making continuing education a re-
quirement for relicensure would result in a hard-

544 MICHIGAN MEDICINE JUNE 1972

ship or in any difficulty for the vast majority of
doctors. My fear would be that meeting the require-
ment for relicensure might tend to become the end-
point which would replace the voluntary search for
excellence which now prevails.

John J. Rick
Coldwater

In this present area of medicine characterized
by rapid changes in technology and basic medical
knowledge, it is imperative that the practicing phy-
sician keep abreast of all new developments. The
question no longer is whether or not post-graduate
education is needed, but rather how to deliver this
education and then how to insure that the physi-
cian fulfills certain basic requirements in this area
of continuing education.

The most immediate need is in the area of de-
veloping a suitable educational program. This must
be accomplished before any rigid enforcement rules
can be formulated. The best program would be one
that could be delivered at the local level so that
the physician could receive his training without
leaving the community.

In order to establish this type of local teaching
program certain resources would have to be de-
veloped.

1. A cadre of teaching-physicians who would be
accepted by their peers and have the time to
develop a program APPROPRIATE TO EACH
COMMUNITY.

2. Teaching resources such as slides and tapes
to provide the proper visual and auditory aids.

3. Resource consultants that could be brought
into the community as needed to supplement
any teaching program.

Once this type of program is operational, then
the local physician could better decide his interests
and deficiencies. With this knowledge the physi-
cian could then choose various regional or national
meetings to supplement his specific needs.

If and when such a program is made operational
the next logical step is developing certain minimal
criteria of post-graduate education for all physi-
cians. Until the educational facilities are available
on a continuing basis, rules to enforce such educ-
tion are superfluous. What we really need is some
objective method of evaluating the worth of post-
graduate education so that effective methods of
presentation and application could be developed.
Pre-teaching and post-teaching levels of effective
medical care will have to be developed in order
to decide if the teaching is worthwhile.

To arbitrarily state that each physician should
attend so many hours of meetings, read so many
journals, and listen to so many tapes is not the
answer. Until teacher effectiveness and pupil moti-
vation are measured, no honest, equitable stand-
ards will ever be established. First, let us start
educating at a local level where the teacher-physi-
cian can best determine the needs. Then let the

Doctor Rick Doctor Vanselow

physician develop his new skills and knowledge
both locally and with well-chosen meetings.

Lastly, let us evaluate the effectiveness of this
training in the only way possible — by improved pa-
tient care.

Neal A. Vanselow, MD
Ann Arbor

There recently has been increasing pressure from
the government and the public to assure that qual-
ity medical care is available to all citizens.

One result has been the development or advo-
cacy of programs to assure the competence of the
individual practitioner. New York, for example, re-
quires that its physicians meet certain continuing
medical education requirements for participation
in the state Medicaid program. In Michigan a high
official of the State Health Department has said
that the matter of quality control of physicians is
simple, adding that our state government is already
programming a computer to provide questions
which form the basis for a mandatory relicensure
examination!

In view of the above, there has been vigorous
debate within our profession regarding the best
method of assuring physician competence without
being arbitrary or unduly restrictive. A number of
innovative methods have been introduced. The
American Academy of Family Practice has con-
tinuing education requirements for membership, the
American Board of Family Practice requires period-
ic re-examination for certification, and over 20 vol-
untary self-assessment examinations are being of-
fered by medical specialty societies. In addition,
the American Medical Association has developed a
Physician's Recognition Award program and some
hospitals have developed programs of medical
audit and peer review.

All of the above techniques contain at least one
of the following two weaknesses — either they are
purely voluntary or they apply to only a small frac-
tion of the physician population. Few hospitals have
comprehensive medical audit or peer review pro-
grams. In most states a physician can continue to
practice without belonging to a specialty society,
undergoing examination by a specialty board, par-
ticipating in a self-assessment examination, or en-
gaging in any sort of continuing medical education
activity.

MICHIGAN MEDICINE JUNE 1972 545

YOUR OPINION /Continued

Other proposals include the suggestion that each
physician be required to take a written examination
every three to five years as a prerequisite to re-
licensure. Medical educators have generally op-
posed this approach since written examinations
emphasize measurement of factual knowledge
alone, and are a poor method of determining com-
petence to practice medicine. More interest has
been shown in compulsory programs of medical
audit in which a physician’s performance is meas-
ured by reviewing the medical records of patients
he has treated. At the present time, however, these
programs are time-consuming, expensive, and are
usually applicable only to hospitalized patients.

A number of state medical societies have taken
steps to promote competence by requiring partici-
pation in postgraduate education for continued so-
ciety membership. Such programs are operative
in Oregon, Pennsylvania, Arizona, and Massachu-
setts, but obviously do not apply to non-members.
New Mexico has gone one step further and has re-
quired all physicians to show proof of participation
in continuing medical education for relicensure.

The Postgraduate Education Committee of the
Michigan State Medical Society has considered the
alternatives listed above and has rejected the pro-
posal that participation in postgraduate education
be tied to M.S.M.S. membership. Non-members of
M.S.M.S. would not be affected by such a plan,
and members who did not meet the requirements
would be forced to leave the society. The latter
move would not prevent them from practicing but

would place them beyond the influence of organ-
ized medicine.

It seems more logical to tie participation in con-
tinuing education to reregistration or relicensure,
a move recommended by the Postgraduate Educa-
tion Committee and now under study by a Task
Force of the House of Delegates. While it can be
argued that participation in postgraduate education
does not absolutely assure competence, at least all
physicians in Michigan would be required to ex-
pose themselves to educational activities through-
out the duration of their active practice.

I believe that every three to five years each phy-
sician in Michigan should be required, as a pre-
requisite for reregistration, to provide the State
Board of Registration in Medicine with evidence of
participation in continuing medical education. A
number of state societies have developed criteria
for such participation and these could be modified
as necessary for use in Michigan. In general, cred-
it would be given for a wide variety of educational
activities ranging from formal postgraduate courses
and hospital meetings to journal reading and resi-
dent teaching. As an alternative, physicians who
wished could submit to an audit of their medical
records by an appropriate M.S.M.S. committee.

While the above approach may be a departure
from our traditional methods, it appears to be the
fairest and most flexible of the alternatives avail-
able. It seems high time that we take the initiative
in this area of great public interest before those
who are less qualified take it for us.

£

MICHIGAN
DEPARTMENT
OF PUBLIC
HEALTH

Monthly Surveillance Report

Cases of Certain Diseases Reported
To the Michigan Department of Public Health
For the Four-Week Period Ending April 28, 1972

1972

1971

1972

1971

Total

This

Same

Total

Total

Cases

4-Week

4-Week

To Above

Same

for

Period

Period

Date

Date

1971

Rubella

192

477

775

1,379

2,955

Congenital Rubella Syndrome

0

0

0

1

1

Measles

329

390

1,039

765

2,659

Whooping Cough

5

6

40

33

140

Diphtheria

1

0

1

0

1

Mumps

Scarlet Fever &

425

1,481

1,726

6,337

10,748

Strep Sore Throat

819

1,019

5,105

5,673

11,244

Tetanus

0

0

0

0

7

Poliomyelitis (paralytic)

0

0

0

0

0

Hepatitis

Salmonellosis

300

380

1,553

1,743

4,828

(other than S. typhi)

53

54

226

207

691

Typhoid Fever (S. typhi)

2

1

3

2

10

Shigellosis

24

9

159

66

295

Aseptic Meningitis

3

10

23

39

239

Encephalitis

5

11

25

43

108

Meningococcic Meningitis

5

7

20

32

64

H. Influenza Meningitis

7

6

27

26

82

Tuberculosis

169

164

608

626

1,824

Syphilis

364

293

1,666

1,283

4,689

Gonorrhea

1,674

1,557

7,073

6,307

22,115

Information can be supplied by the local health department on the local incidence of disease.

Maurice Reizen, M.D., Director
Michigan Department of Public Health

546 MICHIGAN MEDICINE JUNE 1972

There’s a soup

for almost every patient and diet
...for every meal
and, its made by

PROTEIN CONTENT/ 1 Cup Prepared Soup*

Bean with Bacon

7.7

Beef

9.1

Chicken Broth

8.4

Chicken 'N Dumplings

6.6

Chili Beef

7.0

Consomme

5.6

Green Pea

7.8

Hot Dog Bean

8.6

Oyster Stew

6.0

Pepper Pot

6.9

Split Pea with Ham

11.6

Vegetable Beef

5.7

When protein is the focal point in your patients’
special diets, Campbell’s Soups can be a convenient
supplementary source of that essential nutrient.

* From “Nutritive Composition of Campbell’s Products”
which gives values of important nutritive constituents of all
Campbell’s Products. For your copy, write to Campbell Soup
Company, Dept. 365, Camden, New Jersey 08101.

the Ovulen phase

Most women* with a balanced hormone profile and
normal menses do best on a middle-of-the-road pill
that is neither estrogen dominant nor strongly
progestogen dominant.

(*Typical clues— normal body build and breasts,
feminine appearance, healthy skin and hair. Vaginal
cytology slide— balanced “pink and blue!’)

Some women having problems on other O.C.s
might do well on Ovulen.

Ovulen has a distinctive hormonal balance that
combines moderate estrogenic activity with a slight
progestogen dominance. It has an excellent record
of patient acceptance.

Ovulen

Each white tablet contains: ethynodiol diacetate 1 mg./mestranol 0.1 mg.

All women are not equal in their endogenous
hormonal output. And, while all oral
are fundamentally effective, they exhibit differences
in their activity levels and estrogen-progestogen
ratios that affect different women differently— in
both short and long-term use. Some brands
may be insufficient for the woman’s needs or else
may exceed them.

Searle offers a family of O.C. products that covers
the range of women’s needs to help you provide
the right pill for the right woman at the right time.

References 1. Editorial Oral Contraceptives Which Pill for Which Patient7 Patient Care 3:90-115
(Feb.) 1969 and 4135-145 (June 15) 1970. 2. Greenblatt, R B. Progestational Agents in Clinical
Practice, Wed. Sci. 18: 37-49 (May) 1967 3. Kistner, R W Gynecology Principles and Practice, ed. 2.
Chicago, Year Book Medical Publishers, 1971 4. Kistner R. W: The Pill: Facts and Fallacies About
Today’s Oral Contraceptives, New York, Delacorte Press, 1968 5. Nelson, J H, Clinical Evaluation of
Side Effects of Current Oral Contraceptives,! Reprod Med 6:5055 (Feb) 1971 6. Orr.G W Oral
Progestational Agents: Therapy and Complications, S Dakota J Med. 2211-17 (Jan ) 1969

SEARLE

For brief summary of prescribing information
see following page.

the Demulen phase

Many women* who secrete more estrogen than most
do well on a pill with lower estrogen activity and an
increased progestogen overbalance.

("Typical clues— shorter, plumper, full-breasted,
with glowing skin and no wrinkles. Vaginal cytology
slide "pink’.’)

Some women with special conditions that may
be aggravated by higher estrogen-activity products
may do better on this ratio.

Demulen combines minimal estrogenic activity
with a moderate ratio of progestogen overbalance.

It is particularly well suited to the young when
low-dose (activity) is preferred. Demulen offers
little risk of the most potent progestogen side
Mpeffects; early breakthrough bleeding is often
p Transient.

Demulen

Each white tablet contains: ethynodiol diacetate 1 mg./ethinyl estradiol 50 meg
Each pink tablet in Ovulen-28'and Demulen® 28 is a placebo,
containing no active ingredients.

Both Ovulen and Demulen are available in 21- and 28-pill schedules.

the Enovid-E phase

Some women* who secrete less estrogen than mosl
do best on a pill with a moderate estrogen
overbalance.

("Typical clues— oily complexion, acne, hirsutism,
masculinity, flat chest. Vaginal cytology slide —
“blue;’)

Patients with estrogen deficiency may show:
premenopausal syndrome intermittent depressior
early-cycle bleeding increased appetite

scanty menses steady weight gain

vaginal candidiasis

Enovid-E not only provides increased estrogenic
activity with low progestogen activity, but also
contains the only progestogen that is not
antiestrogenic. Therefore it offers less risk of high-
dose progestogen side effects.

Enovid-E

Each tablet contains: norethynodrel 2.5 mg./mestranol 0.1 mg.

Oral contraceptives are complex medications and, after
reference to the prescribing information, should be prescribed
with discriminating care.

for the 3 phases of Eve:

a family of O.C. products

Ovulen* Demulen

Each white tablet contains: Each white tablet contains:

ethynodiol diacetate 1 mg./mestranol 0.1 mg. ethynodiol diacetate 1 mg./ethinyl estradiol 50 meg.

Each pink tablet in Ovulen-28®and Demulen®-28 is a placebo, containing no active ingredients.

Actions -Ovulen and Demulen act to prevent ovulation by inhibitingthe out-
put of gonadotropins from the pituitary gland. Ovulen and Demulen depress
the output of both the follicle-stimulating hormone (FSH) and the luteinizing
hormone (LH).

Special note-Oral contraceptives have been marketed in the United
States since 1960. Reported pregnancy rates vary from product to product.
The effectiveness of the sequential products appears to be somewhat lower
than that of the combination products, Both types provide almost completely
effective contraception.

An increased risk of thromboembolic disease associated with the use of
hormonal contraceptives has now been shown in studies conducted in both
Great Britain and the United States. Other risks, such as those of elevated blood
pressure, liver disease and reduced tolerance to carbohydrates, have not been
quantitated with precision.

Long-term administration of both natural and synthetic estrogens in sub-
primate animal species in multiples of the human dose increases the frequency
of some animal carcinomas. These data cannot be transposed directly to man.
The possible carcinogenicity due to the estrogens can be neither affirmed nor
refuted at this time. Close clinical surveillance of all women taking oral contra-
ceptives must be continued.

I ndication -Ovulen and Demulen are indicated for oral contraception,

Contraindications-Patients with thrombophlebitis, thromboembolic
disorders, cerebral apoplexy or a past history of these conditions, markedly im-
paired liver function, known or suspected carcinoma of the breast, known or
suspected estrogen-dependent neoplasia and undiagnosed abnormal genital
bleeding.

Warnings-The physician should be alert to the earliest manifestations of
thrombotic disorders (thrombophlebitis, cerebrovascular disorders, pulmonary
embolism and retinal thrombosis). Should any of these occur or be suspected
the drug should be discontinued immediately.

Retrospective studies of morbidity and mortality conducted in Great Britain
and studiesof morbidity in the United States have shown a statistically significant
association between thrombophlebitis, pulmonary embolism, and cerebral
thrombosis and embolism and the use of oral contraceptives. There have been
three principal studies in Britain1'3 leading to this conclusion, and one4 in this
country. The estimate of the relative risk of thromboembolism in the study by
Vessey and Doll3 was about sevenfold, while Sartwell and associates4 in the
United States found a relative risk of 4.4, meaning that the users are several
times as likely to undergo thromboembolic disease without evident cause as
nonusers. The American study also indicated that the risk did not persist after
discontinuation of administration and that it was not enhanced by long-
continued administration. The American study was not designed to evaluate
a difference between products. However, the study suggested that there might
be an increased risk of thromboembolic disease in users of sequential prod-
ucts. This risk cannot be quantitated, and further studies to confirm this finding
are desirable.

Discontinue medication pending examination if there is sudden partial or
cqmpjete loss of vision, or if there is a sudden onset of proptosis, diplopia or
migraine. If examination reveals papilledema or retinal vascular lesions medica-
tion should be withdrawn.

Since the safety of Ovulen and Demulen in pregnancy has not been demon-
strated, it is recommended that for any patient who has missed two consecutive
periods pregnancy should be ruled out before continuing the contraceptive
regimen. If the patient has not adhered to the prescribed schedule the possi-
bility of pregnancy should be considered at the time of the first missed period.

A small fraction of the hormonal agents in oral contraceptives has been
identified in the milk of mothers receiving these drugs. The long-range effect to
the nursing infant cannot be determined at this time.

Precautions-The pretreatment and periodic physical examinations
should include special reference to the breasts and pelvic organs, including a
Papanicolaou smear since estrogens have been known to produce tumors,
some of them malignant, in five species of subprimate animals. Endocrine and
possibly liver function tests may be affected by treatment with Ovulen or Demu-
len. Therefore, if such tests are abnormal in a patient taking Ovulen or Demulen,
it is recommended that they be repeated after the d rug has been withd rawn for
two months. Under the influence of progestogen-estrogen preparations pre-
existing uterine fibromyomas may increase in size. Because these agents may
cause some degree of fluid retention, conditions which might be influenced by
this factor, such as epilepsy, migraine, asthma, cardiac or renal dysfunction,
requirecarefulobservation. In breakthrough bleeding, and inallcasesof irregular
bleeding per vaginam, nonfunctional causes should be borne in mind. In un-
diagnosed bleeding per vaginam adequate diagnostic measures are indicated.
Patients with a history of psychic depression should be carefully observed and

thedrugdiscontinued if thedepression recurs to a serious degree. Any possible
influence of prolonged Ovulen or Demulen therapy on pituitary, ovarian, adrenal,
hepatic or uterine function awaits further study. A decrease in glucose tolerance
has been observed in a significant percentage of patients on oral contracep-
tives. The mechanism of this decrease is obscure. For this reason, diabetic pa-
tients should be carefully observed while receiving Ovulen or Demulen therapy.
Theageof the patient constitutes no absolute limitingfactor, although treatment
with Ovulen or Demulen may mask the onset of the climacteric. The pathologist
should be advised of Ovulen or Demulen therapy when relevant specimens are
submitted. Susceptible women may experience an increase in blood pressure
following administration of contraceptive steroids.

Adverse reactionsobserved in patients receiving oral contracep-
tives-A statistically significant association has been demonstrated between
use of oral contraceptives and the following serious adverse reactions: thrombo-
phlebitis, pulmonary embolism and cerebral thrombosis.

Although available evidence is suggestive of an association, such a relation-
ship has been neither confirmed nor refuted for the following serious adverse
reactions: neuro-ocular lesions, e.g., retinal thrombosis and optic neuritis.

The following adverse reactions are known to occur in patients receiving oral
contraceptives: nausea, vomiting, gastrointestinal symptoms (such as abdom-
inal crampsand bloating), breakthrough bleeding, spotting, change in menstrual
flow, amenorrhea during and after treatment, edema, chloasma or melasma,
breast changes (tenderness, enlargement and secretion), change in weight
(increase or decrease), changes in cervical erosion and cervical secretions, sup-
pression of lactation when given immediately post partum, cholestatic jaundice,
migraine, rash (allergic), rise in blood pressure in susceptible individuals and
mental depression.

Although the following adverse reactions have been reported in users of
oral contraceptives, an association has been neither confirmed nor refuted:
anovulation post treatment, premenstrual-like syndrome, changes in libido,
changes in appetite, cystitis-like syndrome, headache, nervousness, dizzi-
ness, fatigue, backache, hirsutism, loss of scalp hair, erythema multiforme,
erythema nodosum, hemorrhagic eruption and itching.

The following laboratory results may be altered by the use of oral contra-
ceptives: hepatic function: increased sulfobromophthalein retention and other
tests: coagulation tests: increase in prothrombin, Factors VII, VIII, IX and X;
thyroid function: increase in PBI and butanol extractable protein bound iodine,
and decrease in T3 uptake values; metyrapone test and pregnanediol deter-
mination.

References: 1. Royal College of General Practitioners: Oral Contracep-
tion and Thrombo-Embolic Disease, J. Coll. Gen. Pract. 13: 267-279 (May) 1967.
2. Inman, W. H. W„ and Vessey, M. P. Investigation of Deaths from Pulmonary,
Coronary, and Cerebral Thrombosis and Embolism in Women of Child-Bearing
Age, Brit. Med. J. 2:193-199 (April 27) 1968. 3. Vessey, M. P, and Doll, R.: Investi-
gation of Relation Between Use of Oral Contraceptives and Thromboembolic
Disease. A Further Report, Brit. Med. J. 2651-65/ (June 14) 1969. 4. Sartwell,
P. E.: Masi, A. T.; Arthes, F. G.; Greene, G. R„ and Smith, H. E.: Thromboem-
bolism and Oral Contraceptives: An Epidemiologic Case-Control Study, Amer.
J. Epidem. 90:365-380(Nov.) 1969.

Products of SEARLE & CO.

San Juan, Puerto Rico 00936

Enovid-E*

norethynodrel 2.5 mg./mestranol 0.1 mg.

Actions -Enovid-E acts to prevent ovulation by inhibiting the output of
gonadotropins from the pituitary gland. Enovid-E depresses the output of both
the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH).

Indication -Enovid-E is indicated for oral contraception

The Special Note, Contraindications, Warnings, Precautions and Adverse
Reactions listed above for Ovulen and Demulen are applicable to Enovid-E and
should be observed when prescribing Enovid-E.

Enovid-E

brand of norethynodrel with mestranol

Product of G. D. Searle & Co.

PO. Box 5110, Chicago, Illinois 60680
Where "The Pill" Began

SEARLE

SEARLE

Prompt relief of pain is a lot of what the practice of
medicine is all about... East or West.

In much of the Far East, the analgesic efficacy of
Empirin® Compound with Codeine would prob-
ably be measured against acupuncture, an ancient
and traditional therapeutic system.

In America, codeine sets such a high standard
for oral analgesia, that it has become a criterion in
terms of which other major oral analgesics are most
often measured.

Synthetic and other oral analgesics may
offer some of the properties of codeine, but
not one can provide both its benefits
and potency. And codeine provides
an antitussive bonus.

Empirin Compound with Codeine

is the most widely used,

jf/k and probably the most
f sfjj pharmaceutically ele-
C gant analgesic

prepara-
tion providing codeine.

It’s the time-tested combi-
nation for predictable pain
relief . . . whether the pain is
visceral or musculoskeletal;

JIBIm acute or chronic.

(UH New prescription flexibility. At your dis-
cretion, and where state law permits, a pre-
scription for Empirin Compound with
Codeine may now be refilled up to five
times in six months.

Empirin Compound with Codeine
No. 3 contains codeine phosphate*

(32.4 mg.) gr. i/2. No. 4 contains codeine
phosphate* (64.8 mg.) gr. 1. *(Warning—
may be habit-forming.) Each tablet also

contains: aspirin

A w ^^^m,gr'3V2,phen'

ace tin gr.

2Vz>caf- /A

fcinegr. (A.

Bottles of

lOOandlOQO.

But for relief of Western pai

Burroughs Wellcome Co., Research Triangle Park, North Carolina 27709

When irritable colon feels like this

. . .in the presence of spasm or hypermotility,
gas distension and discomfort, KINESED*
provides more complete relief :

CH belladonna alkaloids— for the hyperactive bowel
D simethicone— for accompanying distension and pain due to gas
□ phenobarbital— for associated anxiety and tension

Composition: Each chewable, fruit-flavored, scored tab-
let contains: 16 mg. phenobarbital (warning: may be
habit-forming); 0.1 mg. hyoscyamine sulfate; 0.02 mg.
atropine sulfate; 0.007 mg. scopolamine hydrobromide;
40 mg. simethicone.

Contraindications: Hypersensitivity to barbiturates or
belladonna alkaloids, glaucoma, advanced renal or he-
patic disease.

Precautions: Administer with caution to patients with
incipient glaucoma, bladder neck obstruction or uri-

nary bladder atony. Prolonged use of barbiturates may
be habit-forming.

Side effects: Blurred vision, dry mouth, dysuria, and
other atropine-like side effects may occur at high doses,
but are only rarely noted at recommended dosages.
Dosage: Adults: One or two tablets three or four times
daily. Dosage can be adjusted depending on diagnosis
and severity of symptoms. Children 2 to 12 years: One
half or one tablet three or four times daily. Tablets may
be chewed or swallowed with liquids.

STUART PHARMACEUTICALS I Pasadena, California 91109 | Division of ATLAS CHEMICAL INDUSTRIES, INC.

(from the Greek kinetikos,
to move,

and the Latin sedatus,
to calm)

KINESED®

antispasmodic/sedative/antiflatulent

Spring peeper (tree frog, Hyla crucifer):
this small amphibian can expand
its throat membrane with air until it is
twice the size of its head.

MICHIGAN MEDICINE JUNE 1972 553

County in the spotlight

Ingham doctors take the initiative
to meet, talk with their legislators

By Judith Marr
Managing Editor

At noon on the fourth Thursday of each month
this year, legislators from the Ingham, Clinton and
Eaton County areas have made the short walk
across the street from their Capitol Building offices
to Lansing’s Olds Plaza Hotel.

There, in a small third floor meeting room,
they’ve shared a buffet luncheon of cold cuts, soup
and salad with Ingham County doctors who extend
the standing invitation.

As the meetings progress, one specially-invited
legislator, usually from another area of the state,
outlines bills pending on a particular subject of
medical interest. That legislator is usually the bills’
sponsor or chairman of the committee which will
lead discussion.

Thus, the Ingham doctors this year have heard
Rep. J. Robert Traxler (D-Bay City) on malpractice
legislation; Rep. James Farnsworth (R-Plainwell),
Rep. Raymond Kehres (D-Monroe) on uniform fee

Here are Doctor Payne’s sugges-
tions for other county medical
societies which might initiate a
series of meetings with their local
legislators :

1) It is most important to make personal
contacts and telephone calls to the legislators
you invite to your meetings. (Each month the
Ingham physicians send letters which are
followed up with personal telephone calls.)

2) If possible, work with local physicians
who have served as Doctors of the Week in
Lansing, as their first-hand acquaintance with
legislators is a decided advantage.

3) Arrange the meetings around the legis-
lative schedule and sessions and on a regular
basis.

4) Keep the meetings informal but struc-
tured (at least have a subject for each meet-
ing, though that subject doesn’t always have
to be medical).

5) Lean heavily on the MSMS Govern-
ment Relations staff and your county execu-
tive secretary, if you have one. “Without
them, such a program is impossible,” says
Doctor Payne.

schedules and Rep. Jackie Vaughn III (D-Detroit)
on physicians’ assistants.

Other topics have included Medicaid fees, the
Medical Practice Act and vaccination requirements.

Following a 10-minute presentation, open discus-
sion prevails, and conversation flows into other
legislative and medical areas of concern. The meet-
ings break up about 1:30 p.m. and the legislators
make their way back to the Capitol.

These monthly meetings are the project of
Thomas Payne, MD, Lansing, legislative chairman
for the Ingham County Medical Society. And they
represent one of the most successful and worth-
while activities being carried out around the state
by county medical societies.

Doctor Payne explains that his idea grew out of
his 1970 experience with the MSMS program to
bring Michigan physicians to Lansing for a week
of meeting and talking with legislators. Doctor
Payne also took ideas from the Kent County Med-
ical Society’s similar activity of monthly meetings
with local legislators.

“I got to know most of our local lawmakers dur-
ing my Doctor of the Week experience,” says Doc-
tor Payne. “I thought it would be nice to work on a
regular basis with them.”

He sent letters to Ingham, Eaton and Clinton
county legislators inviting them to the first meeting
in January, 1971, and personally went down to the
Capitol to introduce himself to those he hadn’t met
and to invite them to attend. The luncheon sessions
were held seven times during 1971 and resumed
again this January. They will recess during the
summer months and there probably will be one
more this year in the fall, says Doctor Payne.

Local legislators involved on a regular basis in-
clude two senators and six representatives. Doctor
Payne’s legislative committee equals that number,
and the group swells with interested county society
members, legislators from other areas and MSMS
staff members.

“I wish every county society in the state would
do this,” says Bruce Ambrose, manager, MSMS
Government Affairs Department, who has given his
staff’s support to the Ingham program. He and Doc-
tor Payne sit down before each monthly meeting
to select the topic.

“The Ingham program has been very successful
and it represents a minimum of imposition on the
legislator’s time,” Mr. Ambrose says.

554 MICHIGAN MEDICINE JUNE 1972

The lawmakers appreciate the opportunity to
meet with the doctors, Mr. Ambrose reports. “Rep.
Douglas Trezise (R-Owosso), tells me he goes to
the meetings for information and because he
doesn’t see his doctor-constituents at home.”

Rep. Earl Nelson (D-Lansing), in a letter to Doc-
tor Payne May 9, said, “The opportunity to ex-
change information at the monthly meetings which
you have convened has been very helpful to me.

I believe this kind of political action is in the best
spirit of a proper relationship between organiza-
tions and legislators.”

Doctor Payne emphasizes that the purpose is to
gather and disseminate information.

“I never thought before meeting the legislators
that these guys have to be experts not only in med-
ical affairs, but in such things as drainage systems
and taxes — the whole scope of social affairs,” Doc-
tor Payne continues.

“And not only do the legislators not know of our
medical concerns, but I know many of my commit-
tee members are hopelessly ignorant of what’s in
the legislative hopper downtown.

“I think our meetings have made the legislators
more aware of how their decisions can affect the
practice of medicine,” he adds.

And another effect has been that members of the
Ingham County Medical Society, drawn to the meet-
ings over particular subjects, have become inter-
ested new members of Doctor Payne’s committee.

Northern physicians
give financial support
to environmental projects

An active part in the fight to protect our environ-
ment is being taken by members of the Northern
Michigan Medical Society. The society recently
made a contribution of $200 from membership dues
to support a suit being waged by John Tanton,
MD, Petoskey, against the Michigan Department of
Natural Resources.

Doctor Tanton’s suit has stopped building of a
dam across Monroe Creek near Charlevoix to
create a man-made lake as the center of a large
development. The $200 went to the Michigan En-
vironmental Protection Foundation, a northern
Michigan organization created specifically to fund
lawsuits on environmental issues.

Doctor Tanton expects a decision late in May
from the Charlevoix Circuit Court.

The Northern Michigan society also contributed
$500 to help bring Stewart Udall, former U.S. Sec-
retary of the Interior, to a two-day community-wide
Earth Fair April 26-27 in Petoskey. Mr. Udall spoke
the evening of the 26th in the Petoskey Junior High
School Auditorium.

Established 1924

MERCYWOOD HOSPITAL

4038 Jackson Road

Conducted by Sisters of Mercy Ann Arbor, Michigan

Telephone — 313 663-8571

Mercywood Hospital is a private neuropsychiatric hospital
licensed by the Michigan Department of Mental Health.
Mercywood specializes in intensive, multi-disciplinary
treatment for emotional and mental disorders.

Accredited by the Joint Commission on Accreditation of
Hospitals and the National League of Nursing. A full Blue
Cross participating hospital.

Certified for: Medicare and M.A.A. programs

Robert J. Bahra, M.D.

Dean P. Carron, M.D.
Francis M. Daignault, M.D.
Gordon C. Dieterich, M.D.
James R. Driver, M.D.

(Active & Associate)

Robert L. Fransway, M.D.
Stuart M. Gould, Jr., M.D.
Sydney Joseph, M.D.
Hubert Miller, M.D.

Jacob J. Miller, M.D.
Rudolf E. Nobel, M.D.

Gerard M. Schmit, M.D.
Joseph J. Tiziani, M.D.
Prehlad S. Vachher, M.D.
Richard D. Watkins, M.D.
Robert M. Zimmerman, M.D.

MICHIGAN MEDICINE JUNE 1972 555

VASODlLAN

the compatible vasodilator

• has not been reported to complicate the
treatment of hypertension.

• conflicts have not been reported with con-
currently administered antihypertensives,
diuretics, corticosteroids or miotics.

• complications in the treatment of diabetes,
peptic ulcer, coronary insufficiency, glaucoma
or liver disease have not been reported.

In fact, there are no known contraindications
in recommended oral doses other than it should
not be given in the presence of frank arterial
bleeding or immediately postpartum.

Although not all clinicians agree on the value of vasodilators in vascular disease, several
investigators1'1' have reported favorably on the effects of isoxsuprine. Effects have been
demonstrated both by objective measurement2’* and observation of clinical improvement.1,3
Composition: VasodIlan tablets, isoxsuprine HC1, 10 mg. and 20 mg. VasodIlan syrup,
isoxsuprine HCI, 10 mg. per 5 ml. teaspoonful. Indications: In cerebral vascular dis-
orders, for relief of symptoms due to vascular insufficiency associated with various con-
ditions such as arteriosclerosis and hypertension. In peripheral vascular disorders, for
relief of symptoms such as intermittent claudication, coldness, numbness, pain and cramp-
ing of the extremities — in the management of arteriosclerosis obliterans, diabetic vascular
diseases, thromboangiitis obliterans (Buerger’s disease), Raynaud's disease, postphle-
bitic conditions, acroparesthesia, frostbite syndrome and ulcers of the extremities
(arteriosclerotic, diabetic, thrombotic). Dosage and Administration: In peripheral and
cerebral vascular disorders — 10 to 20 mg. three or four times daily. Contraindications and
Cautions: There are no known contraindications to oral use when administered in recom-
mended doses. Should not be given immediately postpartum or in the presence of arterial
bleeding. Adverse Reactions: On rare occasions, oral administration of the drug has been
associated in time with the occurrence of severe rash. When rash appears, the drug
should be discontinued. Occasional overdosage effects such as transient palpitation or
dizziness are usually controlled by reducing the dose. Supplied: Tablets, 10 mg. — bottles
of 100 and 1000, and Unit Dose;20 mg. — bottles of 100 and 500. Syrup, 10 mg. per 5 ml.
teaspoonful — bottles of 1 pint. References: 1. Clarkson, I. S., and LePere, D. M. : Angi-
ology 77:190-192 (June) 1960. 2. Horton, G. E., and Johnson, P. C., Jr.: Angiology
75:70-74 (Feb.) 1964. 3. Dhrymiotis, A. D., and Whittier,

J. R.: Curr. Ther. Res. •7:124-128 (April) 1962. 4. Whittier,

J. R.: Angiology 75:82-87 (Feb.) 1964.

1971 MEAD JOHNSON S COM PA NY

ANSVILLE. INDU

47721 U.S.

LAB O R AT O RIBS

County Presidents & Secretaries

COUNTY

PRESIDENT

Allegan

Janis Pone, MD

Alpena-Alcona-Presque Isle

Charles T. Egli, MD

Barry

Robert J. Heubner, MD

Bay-Arenac-losco

John W. Grigg, MD

Berrien

James H. Grove, MD

Branch

Jack D. Gift, MD

Calhoun

Keith S. Wemmer, MD

Cass

Aaron K. Warren, MD

Chippewa-Mackinac

Anton G. Venier, MD

Clinton

W. F. Stephenson, MD

Delta-Schoolcraft

John R. LeMire, MD

Dickinson-Iron

Hugh D. McEachran, MD

Eaton

Herman F. Van Ark, MD

Genesee

Richard L. Rapport, MD

Gogebic

John R. Franck, MD

Grand Traverse-Leelanau-Benzie

Oswald V. Clark, MD

Gratiot-lsabella-Clare

Robert B. Johnson, MD

Hillsdale

Ward O. Powers, MD

Houghton-Baraga-Keweenaw

David H. Gilbert, MD

Huron

Ralph C. Dixon, MD

Ingham

Jerome F. Cordes, MD

lonia-Montcalm

John L. London, MD

Jackson

Harold L. Oster, MD

Kalamazoo

Donald G. May, MD

Kent

Reinard P. Nanzig, MD

Lapeer

Anthony M. Abruzzo, MD

Lenawee

Richard H. Gascoigne, MD

Livingston

Roscoe V. Stuber, MD

Luce

R. P. Hicks, MD

Macomb

Donald G. Blain, MD

Manistee

Roger D. Paterson, MD

Marquette-Alger

Thomas B. Bolitho, MD

Mason

Ruth V. C. Carney, MD

Mecosta-Osceola-Lake

Edward W. Van Auken, MD

Menominee

John R. Heidenreich, MD

Midland

James Reif, MD

Monroe

M. N. Ozdaglar, MD

Muskegon

Douglas H. Giese, MD

Newaygo

Robert E. Paxton, MD

North Central

W. E. Bontrager, MD

Northern Michigan

Gustav A. Uhlich, MD

Oakland

Bruce D. Bauer, MD

Oceana

Willis A. Hasty, MD

Ontonagon

James P. Strong, MD

Ottawa

Peter J. VerKiak, MD

Saginaw

Aaron C. Stander, MD

St. Clair

Wm. S. Bowden, MD

St. Joseph

Charles R. Zimont, MD

Sanilac

Michael H. Jayson, MD

Shiawassee

John E. Morovitz, MD

Tuscola

E. N. Elmendorf, II, MD

Van Buren

Adelbert L. Stagg, MD

Washtenaw

Dean P. Carron, MD

Wayne

Homer M. Smathers, MD

Wexford-Missaukee

Kenneth A. Kleyn, MD

SECRETARY

Van 0. Keeler, MD, 304 Dix St., Otsego 49078

Peter Aliferis, MD, Alpena General Hospital, Alpena 49707

James E. Atkinson, MD, 1005 W. Green St., Hastings 49058

James L. Fenton, MD, 701 N. Grant St., Bay City 48706

K. Robert Lang, MD, Andrews Univ. Med. Ctr., Berrien Springs 49103

Malcolm D. Steider, MD, Route 7, Box 248, Coldwater 49036

Charles L. Seifert, MD, 632 North Ave., Battle Creek 49017

Lowell D. Smith, 109 School St., Cassopolis 49031

Earl S. Rhind, MD, Sault Polyclinic, Sault Ste. Marie 49783

Bruno C. Cook, MD, Westphalia 48894

Mary L. Cretens, MD, Delta County Bldg., Escanaba 49829

Dale R. Shampo, MD, Dickinson Co. Mem. Hosp., Iron Mt. 49801

Thomas A. Kelly, MD, 141 S. Washington, Charlotte 48813

Fredk. W. VanDuyne, MD, 2849 Miller Rd., Flint 48503

Florian J. Santini, MD, 109 E. Aurora, lronwood 49938

Arthur F. Dundon, MD, 1100 Sixth St., Traverse City 49684

Wm. F. Fishbaugh, MD, 245 Warwick Dr., Alma 48801

Charles T. Vear, MD, 252 S. Howell, Hillsdale 49242

John C. Rowe, MD, 212 Florida St., Laurium 49913

Robert A. Willits, MD, 193 N. Main St., Elkton 48731

Robert G. Combs, MD, P.O. Box 770, East Lansing 48823

Charles E. Stevens, MD, 513 N. Lafayette St., Greenville 48838

Bruce F. Knoll, MD, 766 W. Michigan, Jackson 49201

Thomas R. Berglund, MD, 325 E. Centre St., Portage 49081

Erwin L. Fitzgerald, MD, 50 College Ave., SE, Grand Rapids 49503

Leon R. Boruch, MD, 834 Liberty St., Lapeer 48446

Richard L. Taylor, MD, Emma L. Bixby Hospital, Adrian 49221

Stanley L. Hoffman, MD, 1200 Byron Rd., Howell 48843

Robert E. Gibson, MD, 207 W. John St., Newberry 49868

Leland C. Brown, MD, 21536 Parkway, St. Clair Shores 48082

Karl K. Kellawan, MD, 490 Fourth St., Manistee 49660

James R. Acocks, MD, Morgan Heights, Marquette 49855

James E. Waun, MD, 1011 N. Sherman, Ludington 49431

Harry Mohammed, MD, 809 Ives Ave., Big Rapids 49307

Wm. S. Jones, MD, 1146 10th Ave., Menominee 49858

H. C. Scharnweber, MD, P.O. Box 1693, Midland 48640

Amir H. Mehregan, MD, P.O. Box 360, Monroe 48161

Howard V. Sanden, MD, 1643 Peck St., Muskegon 49441

Robert W. Emerick, MD, P.O. Box 147, Fremont 49412

Donald D. Burkley, MD, P.O. Box 428, Grayling 49738

Robert A. Mengebier, MD, Burns Clinic Med. Ctr., Petoskey 49770

Arnold L. Brown, MD, 35 S. Johnson, Pontiac 48053

Willis A. Hasty, MD, 204 N. Michigan, Shelby 49455

Karl E. Hill, MD, 9 Hemlock St., White Pine 49971

Mary F. S. Kitchel, MD, P.O. Box 521, Grand Haven 49417

Richard P. Heuschele, MD, 4911 Arboretum Drive, Saginaw 48603

Alvin N. Morris, MD, 1002 10th Ave., Port Huron 48060

John M. Jacobowitz, MD, 306 S. Lincoln Ave., Three Rivers 49093

Gerald L. Groat, MD, 47 Austin St., Sandusky 48471

Robert L. Roty, MD, 114 W. North, Owosso 48867

Mitchell Urban, MD, Caro State Hospital, Caro 48723

H. David Fenske, MD, 412 Phoenix St., South Haven 49090

Robert S. Ideson, II, MD, 2200 Vinewood Ave., Ann Arbor 48104

Ned I. Chalat, MD, 929 Fisher Bldg., Detroit 48202

George F. Wagoner, MD, 530 Cobb St., Cadillac 49601

Oakland society
taking an inner look

The Oakland County Medical Society has a new
committee to review the obligations and goals of
the society and to evaluate the society’s organiza-
tion.

Chairman of the committee is Fred W. Bryant,
MD, Royal Oak. He will lead the committee in ap-
praising the duties of the various officers and com-
mittees, and to help improve the society’s relations
with other medical organizations.

Saginaw physicians
planning art exhibit

The new Art Committee of the Saginaw County
Medical Society is announcing plans for a fall
exhibit of works of art by members and families
of the Saginaw medical, dental and osteopathic
professions and their families. The exhibit will
be under the direction of the medical auxiliary
and will be held at the Saginaw Museum in Sep-
tember. Categories will include oil painting, water
colors, photography, ceramics and sculpture.

558 MICHIGAN MEDICINE JUNE 1972

Couqty" s eerie s

Wayne Society

honors Beaumont lecturer,

E. S. Gurdjian, MD

E. S. Gurdjian, MD, Detroit, received a citation
from the Wayne County Medical Society at the
Beaumont Lecture which he presented this year.

IThe citation declared that the “Wayne County
Medical Society gratefully acknowledges the many
years of inspirational and dedicated teaching, de-
votion to his patients, and outstanding research in
the field of neurosurgery.”

The Beaumont lecture was about “Head Injuries
from Antiquity to the Present.” Doctor Gurdjian
also traced the development of seat belts, inflatable
bags and predicted that “the nation will have a
car that will protect the driver and passengers with
little or no injury after a bad accident in six to
eight years.”

The Beaumont Lecture usually features medical
authorities from other states, but occasionally hon-
ors such a nationally-known expert as Doctor Gurd-
jian.

Bay doctors
make $2,000 loan
to WSU med student

An initial loan of $2,000 has been made by the
Bay-Arenac-losco counties medical society to a
Wayne State University medical student, in hopes
that he will practice in Bay City on completion of
his medical training.

The loan is the first to be made by the Bay Coun-
ty Foundation for Medical Progress, established
with donations of Bay County citizens made during
the 1964 twin-dose sugar cube polio immunization.

The student recipient, who may obtain a max-
imum of $3,000 per year from the foundation, is
one of six medical students from around the state
who spent a day recently in Bay City meeting with
physicians and becoming acquainted with the area.

The Bay physicians first met the student at the
recent Michigan Community-Medical Student Day
at Wayne State University, when they interviewed
30 interested medical students.

The effort was led by the Bay county society’s
Medical Procurement Committee, chaired by Rich-
ard Bickham, MD.

Official Journal of the

as effective therapy.

American Fertility Society

(thyroid-androgen) tablets

Double-Blind Study and Type of Patient:

100 patients suffering from impotence. Of
the patients receiving the active medication
(Android) a favourable response was seen
in 78%. This compares with 40% on
placebo. Although psychotherapy is indi-
cated in patients suffering from functional
impotence the concomitant role of chemo-
therapy (Android) cannot be disputed.

The treatment of

impotence

\ due to androgenic deficiency in the American male.
The concept of chemotherapy plus the
physician’s psychological support is confirmed

The Treatment of Impotence
with Methyltestosterone Thyroid
(100 patients — Double Blind Study)
T. Jakobovits

Fertility and Sterility, January 1970

i

Choice of 4 strengths:

Android Android-HP

Each yellow tablet contains:
Methyl Testosterone ..2. 5 mg.
Thyroid Ext. (1/6 gr.) ..10 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 tablet 3 times daily.
Available:

Bottles of 100, 500, 1000.

HIGH POTENCY

Each red tablet contains:
Methyl Testosterone ..5.0 mg.
Thyroid Ext. (Va gr.) . . .30 mg.

Glutamic Acid . .50 mg.

Thiamine HCL 10 mg.

Dose: 1 tablet 3 times daily.
Available:

Bottles of 100, 500, 1000.

Android-X

EXTRA HIGH POTENCY

Each orange tablet contains:
Methyl Testosterone .12.5 mg.
Thyroid Ext. (1 gr.) ...64 mg.

Glutamic Acid 50 mg.

Thiamine HCL 10 mg.

Dose: 1 or 2 tablets daily.
Available:

Bottles of 60. 500.

Android-Plus

WITH HIGH POTENCY
B-C0MPLEX AND VITAMIN C

Each white tablet contains:
Methyl Testosterone ..2.5 mg.
Thyroid Ext. (V« gr.) ...15 mg.
Ascorbic Acid (Vit. C) .250 mg.

Thiamine HCL 25 mg.

Glutamic Acid 100 mg.

Pyridoxine HCL 5 mg.

Niacinamide 75 mg.

Calcium Pantothenate . 10 mg.

Vitamin B-12 2.5 meg.

Riboflavin 5 mg.

Dose: 2 tablets daily.
Available: Bottles of 60, 500.

Contraindications: Android is contraindicated in patients with prostatic carcinoma, severe cardiorenal
disease and severe persistent hypercalcemia, coronary heart disease and hyperthyroidism. Occasional
cases of jaundice with plugging biliary canaliculi have occurred with average doses of Methyl Testos-
terone. Thyroid is not to be used in heart disease and hypertension.

Warnings: Large dosages may cause anorexia, nausea, vomiting abdominal pain, diarrhea, headache,
dizziness, lethargy, paresthesia, skin eruptions, loss of libido in males, dysuria, edema, congestive heart
failure and mammary carcinoma in males.

Precautions: If hypothyroidism is accompanied by adrenal insufficiency the latter must be corrected prior
to and during thyroid administration.

Adverse Reactions: Since Androgens, in general, tend to promote retention of sodium and water, patients
receiving Methyl Testosterone, in particular elderly patients, should be observed for edema.
Hypercalcemia may occur, particularly in immobilized patients: use of Testosterone should be discontinued
as soon as hypercalcemia is detected.

References: 1. Montesano. P., and Evangelista, I. Methyltestosterone-thyroid treatment of sexua
impotence. Clin Med 12:69, 1966. 2. Dublin, M. F. Treatment of impotence with methyltestosterone
thyroid compound. West Med 5:67, 1964. 3. Titeff, A. S. Methyltestosterone-thyroid in treating impotence
Gen Prac 25:6, 1962. 4. Heilman, l.. Bradlow, H L., Zumoff. B.. Fukushima, D. K., and Gallagher, T. F
Thyroid-androgen interrelations and the hypocholesteremic effect of androsterone. J Clin Endocr 19:936
1959. 5. Farris, E. J., and Colton, S. W. Effects of L-thyroxine and liothyronine on spermatogenesis
J Urol 79:863, 1958 6. Osol, A., and Farrar, G. E. United States Dispensatory (ed. 25). lippincott, Philz
delphia. 1955, p. 1432. 7. Wershub, L. P. Sexual Impotence in the Male. Thomas, Springfield,

III., 1959, pp. 79-99.

Write lor literature and samples: fawoWJJfc THE BROWN PHARMACEUTICAL CO., INC. 2500 West 6th Street, Los Angeles, California 9005)

COUNTY SCENES/Continued

Problems

of health care delivery
tackled by Ingham MDs

The Ingham County Medical Society is making a
major effort to define and solve problems in the
delivery of health care to the Lansing area.

The society has a new Ad Hoc Committee on
Patient Care, which formed in September and in-
cludes representatives of the MSU College of Hu-
man Medicine and local practicing physicians. Area
osteopaths are also invited to take part.

In addition, Ingham Executive Director John B.
Kantner has invited the Lansing doctors to stopgap
local problems through a series of short-term serv-
ices. He suggests, in a box in The Ingham Bulletin,
that doctors accept an occasional new family as
patients, accept a specified number of new Medi-
caid and ADC patients, give a transient or tem-
porary resident shots for travel, give blood tests
for marriage licenses, give a physical examination
for a job, give a specified number of camp or
school physicals, volunteer for a two-hour period
one afternoon a week in the fall to cover junior
high football games.

“The problem is just not enough doctors,” Mr.
Kantner says. “But I hope to relieve the public’s
problems, if not by giving them a family doctor, at
least by giving them someone to help solve their
immediate problems.”

The ad hoc committee is working for more per-
manent solutions under the basic premises that the
university may participate in the full spectrum of
community care, that university participation be ac-
complished with the cooperation of local physi-
cians, and that multiple methods of medical prac-
tice should compete freely.

Children poisoned
by eating lead paint
treated by Genesee doctors

Flint children found by a recent survey to have
an unsafe blood lead count are being evaluated
and treated by members of the Genesee County
Medical Society, in cooperation with the local
health department and the C. S. Mott Children’s
Health Center.

Through a blood screening test delivered to 103
children late in October, those with possible lead
paint poisoning were identified. The tests were
given in 30 smaller cities around the country by a
HEW team, to determine the magnitude and geo-
graphic distribution of the lead paint hazard.

Pre-Sate ®

(chlorphentermine HCI)

CAUTION: Federal law prohibits dispensing without
prescription.

Indications: Pre-Sate (chlorphentermine hydrochlo-
ride) is indicated in exogenous obesity, as a short
term ( i.e ., several weeks) adjunct in a regimen of
weight reduction based upon caloric restriction.
Contraindications: Glaucoma, hyperthyroidism, phe-
ochromocytoma, hypersensitivity to sympathomi-
metic amines, and agitated states. Pre-Sate
(chlorphentermine hydrochloride) is also contrain-
dicated in patients with a history of drug abuse or
symptomatic cardiovascular disease of the following
types: advanced arteriosclerosis, severe coronary
artery disease, moderate to severe hypertension, or
cardiac conduction abnormalities with danger of ar-
rhythmias. The drug is also contraindicated during
or within 14 days following administration of mona-
mine oxidase inhibitors, since hypertensive crises
may result.

Warnings: When weight loss is unsatisfactory the
recommended dosage should not be increased in
an attempt to obtain increased anorexigenic effect;
discontinue the drug. Tolerance to the anorectic
effect may develop. Drowsiness or stimulation may
occur and may impair ability to engage in potenti-
ally hazardous activities such as operating ma-
chinery, driving a motor vehicle, or performing
tasks requiring precision work or critical judgment.
Therefore, such patients should be cautioned ac-
cordingly. Caution must be exercised if Pre-Sate
(chlorphentermine hydrochloride) is used concom-
itantly with other central nervous system stimu-
lants. There have been reports of pulmonary hyper-
tension in patients who received related drugs.
Drug Dependence: Drugs of this type have a poten-
tial for abuse. Patients have been known to increase
the intake of drugs of this type to many times the
dosages recommended. In long-term controlled
studies with high dosages of Pre-Sate, abrupt ces-
sation did not result in symptoms of withdrawal.
Usage In Pregnancy: The safety of Pre-Sate (chlor-
phentermine hydrochloride) in human pregnancy has
not yet been clearly established. The use of ano-
rectic agents by women who are or who may be-
come pregnant, and especially those in the first
trimester of pregnancy, requires that the potential
benefit be weighed against the possible hazard to
mother and child. Use of the drug during lactation
is not recommended. Mammalian reproductive and
teratogenic studies with high multiples of the human
dose have been negative.

Usage In Children: Not recommended for use in
children under 12 years of age.

Precautions: In patients with diabetes mellitus there
may be alteration of insulin requirements due to
dietary restrictions and weight loss. Pre-Sate (chlor-
phentermine hydrochloride) should be used with
caution when obesity complicates the management
of patients with mild to moderate cardiovascular
disease or diabetes mellitus, and only when dietary
restriction alone has been unsuccessful in achieving
desired weight reduction. In prescribing this drug
for obese patients in whom it is undesirable to in-
troduce CNS stimulation or pressor effect, the phy-
sician should be alert to the individual who may be
overly sensitive to this drug. Psychologic disturb-
ances have been reported in patients who concomi-
tantly receive an anorexic agent and a restrictive
dietary regimen.

Adverse Reactions: Central Nervous System: When
CNS side effects occur, they are most often mani-
fested as drowsiness or sedation or overstimulation
and restlessness. Insomnia, dizziness, headache,
euphoria, dysphoria, and tremor may also occur.
Psychotic episodes, although rare, have been noted
even at recommended doses. Cardiovascular: tachy-
cardia, palpitation, elevation of blood pressure.
Gastrointestinal: nausea and vomiting, diarrhea, un-
pleasant taste, constipation. Endocrine: changes
in libido, impotence. Autonomic: dryness of mouth,
sweating, mydriasis. Allergic: urticaria. Genitouri-
nary: diuresis and, rarely, difficulty in initiating
micturition Others: Paresthesias, sural spasms.
Dosage and Administration: The recommended adult
daily dose of Pre-Sate (chlorphentermine hydrochlo-
ride) is one tablet (equivalent to 65 mg chlorphen-
termine base) taken after the first meal of the day.
Use in children under 12 not recommended.
Overdosage: Manifestations: Restlessness, confu-
sion, assaultiveness, hallucinations, panic states,
and hyperpyrexia may be manifestations of acute in-
toxication with anorectic agents. Fatigue and de-
pression usually follow the central stimulation.
Cardiovascular effects include arrhythmias, hyper-
tension, or hypotension and circulatory collapse.
Gastrointestinal symptoms include nausea, vomiting,
diarrhea, and abdominal cramps. Fatal poisoning
usually terminates in convulsions and coma.
Management: Management of acute intoxication with
sympathomimetic amines is largely symptomatic and
supportive and often includes sedation with a bar-
biturate. If hypertension is marked, the use of a
nitrate or rapidly acting alpha-receptor blocking
agent should be considered. Experience with he-
modialysis or peritoneal dialysis is inadequate to
permit recommendations in this regard.

How Supplied: Each Pre-Sate (chlorphentermine
hydrochloride) tablet contains the equivalent of
65 mg chlorphentermine base; bottles of 100 and
1000 tablets.

Full information available on request.

WARNER-CHILCOTT

Division, Warner-Lambert Company
Morris Plains, New Jersey 07950

560 MICHIGAN MEDICINE JUNE 1972

Pre-Sate® (chlorphentermine HCl)...the increasingly practical appetite suppressant

Not a controlled drug under the Comprehensive
Drug Abuse Prevention and Control Act

♦ low potential for abuse

• less CNS stimulation than with d-amphetamine
or phenmetrazine

Effective anorectic adjunct to your program
of caloric restriction and diet re-education

* weight loss comparable to d-amphetamine and
phenmetrazine, superior to placebo

• convenient one- a- day dosage

When you select this familiar antibiotic for
IV infusion you have available a broad dosage range
that hospitalized patients may need.

In life-threatening situations as much
as 8 grams/day has been administered
intravenously to adults.

In usual IV doses, Lincocin (lincomycin
hydrochloride, Upjohn) should be
diluted in 250 ml or more of normal
saline solution or 5 % glucose in water.
But when 4 grams or more per day is
given, Lincocin should be diluted in not
less than 500 ml of either solution,
and the rate of administration should
not exceed 100 ml/hour. Too rapid
intravenous administration of doses
ceeding 4 grams may result in
tension or, in rare instances,
cardiopulmonary arrest.

Effective gram-positive antibiotic:

Lincocin IV is effective in respiratory
tract, skin and soft-tissue, and bone

Intravenous Lincocin (lincomycin
hydrochloride, Upjohn), with its 1.2 to
8 grams/ day dosage range, covers many
serious and even life-threatening
infections. Lincocin is effective in
infections due to susceptible strains of
streptococci, pneumococci, and
staphylococci. Lincocin IV therefore
can be as useful in your hospitalized
patients as its IM use has proved to be in
your office patients. As with all
antibiotics, in vitro susceptibility studies
should be performed.

1.2 to 8 grams/ day IV dosage

Most hospitalized patients with
uncomplicated pneumonias respond
satisfactorily to 1 .2 to 1 .8 grams/ day of
Lincocin IV. These doses may have to
be increased for more serious infections.

infections caused by susceptible strains
of pneumococci, streptococci, and
staphylococci, including penicillin-
resistant strains. Staphylococcal strains
resistant to Lincocin (lincomycin
hydrochloride, Upjohn) have been
recovered. Before initiating therapy,
culture and susceptibility studies should
be performed. Lincocin has proved
valuable in treating patients hyper-
sensitive to penicillin or cephalosporins,
since Lincocin does not share
antigenicity with these compounds.
However, hypersensitivity reactions
have been reported, some of these in
patients known to be sensitive to
penicillin.

Well tolerated at infusion site: Lincocin
; intravenous infusions have not
produced local irritation or phlebitis,
when given as recommended. Lincocin
is usually well tolerated in patients who
jj iare hypersensitive to other drugs.
v '(Nevertheless, Lincocin should be used
cautiously in patients with asthma or
significant allergies.

In patients with impaired renal function,
the recommended dose of Lincocin
■should be reduced to 25—30% of
is the dose for patients with normal
'kidney function. Its safety in
pregnant patients and in infants
less than one month of age has
not been established.

Lincocin may be used with other
antimicrobial agents: Since Lincocin
is stable over a wide pH range, it is
suitable for incorporation in

administered concomitantly with other
antimicrobial agents when indicated.
However, Lincocin should not be used
with erythromycin, as in vitro antagonism
has been reported.

Lincocin'

Sterile Solution (300 mg per ml)

(lincomycin hydrochloride, Upjohn)

For further prescribing information, please see following page.

I

I

(lincomycin hydrochloride, Upjohn)

Up to 8 grams per day by IV infusion for
hospitalized patients with life-threatening infections.

Lincocin is effective in infections due to
susceptible strains of streptococci, pneumococci,
and staphylococci. As with all antibiotics,
in vitro susceptibility studies should be performed.

Each Lincomycin

preparation hydrochloride

contains: monohydrate

equivalent to
lincomycin base

250 mg Pediatric Capsule 250 mg

500 mg Capsule 500 mg

*Sterile Solution per 1ml 300 mg

Syrup per 5 ml 250 mg

^Contains also: Benzyl Alcohol 9 mg; and,
Water for Injection — q.s.

Lincocin (lincomycin hydrochloride) is in-
dicated in infections due to susceptible strains
of staphylococci, pneumococci, and strepto-
cocci. In vitro susceptibility studies should
be performed. Cross resistance has not been
demonstrated with penicillin, ampicillin,
cephalosporins, chloramphenicol or the tet-
racyclines. Some cross resistance with eryth-
romycin has been reported. Studies indicate
that Lincocin does not share antigenicity
with penicillin compounds.

CONTRAINDICATIONS: History of prior
hypersensitivity to lincomycin or clindamy-
cin. Not indicated in the treatment of viral
or minor bacterial infections.

WARNINGS: CASES OF SEVERE AND
PERSISTENT DIARRHEA HAVE BEEN
REPORTED AND HAVE AT TIMES
NECESSITATED DISCONTINUANCE
OF THE DRUG. THIS DIARRHEA HAS
BEEN OCCASIONALLY ASSOCIATED
WITH BLOOD AND MUCUS IN THE
STOOLS AND HAS AT TIMES RE-
SULTED IN AN ACUTE COLITIS. THIS
SIDE EFFECT USUALLY HAS BEEN
ASSOCIATED WITH THE ORAL DOS-
AGE FORM BUT OCCASIONALLY HAS

BEEN REPORTED FOLLOWING PA-
RENTERAL THERAPY. A careful inquiry
should be made concerning previous sensi-
tivities to drugs or other allergens. Safety
for use in pregnancy has not been estab-
lished and Lincocin (lincomycin hydrochlo-
ride) is not indicated in the newborn. Reduce
dose 25 to 30% in patients with severe im-
pairment of renal function.

PRECAUTIONS: Like any drug, Lincocin
should be used with caution in patients
having a history of asthma or significant
allergies. Overgrowth of nonsusceptible or-
ganisms, particularly yeasts, may occur and
require appropriate measures. Patients with
pre-existing monilial infections requiring
Lincocin therapy should be given concomi-
tant antimoniHal treatment. During pro-
longed Lincocin therapy, periodic liver
function studies and blood counts should be
performed. Not recommended (inadequate
data) in patients with pre-existing liver dis-
ease unless special clinical circumstances in-
dicate. Continue treatment of /Themolytic
streptococci infections for 10 days to
diminish likelihood of rheumatic fever or
glomerulonephritis.

ADVERSE REACTIONS: Gastrointestinal
—Glossitis, stomatitis, nausea, vomiting. Per-
sistent diarrhea, enterocolitis, and pruritus
ani. Hemopoietic— Neutropenia, leukopenia,
agranulocytosis, and thrombocytopenic pur-
pura have been reported. Hypersensitivity
reactions— Hypersensitivity reactions such
as angioneurotic edema, serum sickness, and
anaphylaxis have been reported, sometimes
in patients sensitive to penicillin. If allergic
reaction occurs, discontinue drug. Have
epinephrine, corticosteroids, and antihista-

mines available for emergency treatment.
Skin and mucous membranes— Skin rashes
urticaria, vaginitis, and rare instances of ex-
foliative and vesiculobullous dermatitis have
been reported. Liver— Although no direct re
lationship to liver dysfunction is established,
jaundice and abnormal liver function tests
(particularly serum transaminase) have beer
observed in a few instances. Cardiovasculat
—Instances of hypotension following paren-
teral administration have been reported,
particularly after too rapid IV administra-
tion. Rare instances of cardiopulmonary ar-
rest have been reported after too rapid IV
administration. If 4.0 grams or more admin-
istered IV, dilute in 500 ml of fluid and
administer no faster than 100 ml per hour.
Special senses— Tinnitus and vertigo have
been reported occasionally. Local reactions
—Excellent local tolerance demonstrated tc
intramuscularly administered Lincocin
(lincomycin hydrochloride). Reports of pain
following injection have been infrequent
Intravenous administration of Lincocin ir
250 to 500 ml of 5% glucose in distilled
water or normal saline has produced nc
local irritation or phlebitis.

HOW SUPPLIED: 250 mg and 500 mg\
Capsules— bottles of 24 and 100. Sterile
Solution , 300 mg per ml— 2 and 10 ml viak
and 2 ml syringe. Syrup, 250 mg per 5 rn<
—60 ml and pint bottles.

For additional product information, consult
the package insert or see your Upjohn
representative.

MED B-6-S (KZL-7) JA71-1631

The Upjohn Company
Kalamazoo, Michigan 49001

lipjohn

140/90 is normal blood pressure. . . or is it?

An extensive study based on nearly 4 million
life insurance policies suggests that a blood pressure
reading of 140/90 requires close medical supervision.

Study Findings. Twelve years ago
the Society of Actuaries reported on
an extensive study based on the lives
and deaths represented by almost
4 million life insurance policies.
From this vast survey — "The Build
and Blood Pressure Study"1—
insurance experts concluded that:

• Blood pressure above 140/90 is
accompanied by increased morbid-
ity and requires close medical
attention.

• Even small increments in either
systolic or diastolic blood pressure
progressively and steeply shorten
life expectancy.

Other Studies. Studies conducted
with large numbers of patients since
that time have echoed the above
findings. Two studies published in
1970 — the VA Cooperative Study
Group on "Effects of Treatment on
Morbidity in Hypertension"2 and
the "Framingham Study"3— sug-
gest that treatment of even mild
hypertension may, over time, offer
significant benefits to the patient.

Another Point of View. Although a
growing body of studies suggests
that treatment of mild hypertension
is warranted, medical opinion is not
unanimous. Some clinicians recom-
mend that drug treatment for mild
hypertension be reserved for
patients with additional risk factors
such as smoking, high cholesterol

1. Society of Actuaries, The Build and Blood Pressure Study, 1959.

2. Veterans Administration Cooperative Study Group on Anti-
hypertensive Agents, "Effects of Treatment on Morbidity in
Hypertension," JAMA 213: 1143-1152, Aug. 17, 1970.

3. Kannel, William B., et nl. : "Epidemiologic Assessment of the
Role of Blood Pressure in Stroke — The Framingham Study,"
JAMA 274:301-310, Oct. 12, 1970.

4. Kirkendall, Walter M.: "What's With Hypertension These Days?"
Consultant, Jan. 1971.

levels, heart or kidney involve-
ment, or a family history of vas-
cular disease. Dr. Walter M.
Kirkendall stated this position
in his recent paper "Whaf s
With Hypertension These
Days?"4 Discussing the man-
agement of hypertension in
patients with a sustained dia-
stolic pressure up to 100 mm Hg,
he said: "Generally, I do not
recommend antihypertensive
therapy unless patient's blood
pressure approaches the upper
limit for the group and a number
of adverse factors exist, such as
male sex, family history of vascular
disease, youth, evidence of heart
or kidney involvement."

Drug Therapy for Hypertension.

Although opinion varies on when
to start drug therapy for mild hyper-
tension, many physicians agree
that treatment should start with
a thiazide diuretic such as
HydroDIURIL. For the adult patient,
the usual starting dosage is 50 mg
b.i.d. Dosage adjustments are recom-
mended as the patient responds to
treatment. The patient whose
therapy begins with HydroDIURIL
frequently can continue to benefit
from it, because HydroDIURIL
usually maintains its antihyperten-
sive effect even when M S D

therapy is prolonged. mercR

SHARft

DOHME

25- and 50-mg tablets

HydroDIURIL'

(Hydrochlorothiazide| MSD)
Therapy to Start With

For a brief summary of prescribing
information, please see next page.

25- and 50-mg tablets

HydroDIURIC

(Hydrochlorothiazide|MSD)
Therapy to Start With

Drug Therapy for Hypertension. Although opinion varies on when to start drug
therapy for mild hypertension, many physicians agree that treatment should start
with a thiazide diuretic such as HydroDIURIL. For the adult patient, the usual start-
ing dosage is 50 mg b.i.d. Dosage adjustments are recommended as the patient
responds to treatment. The patient whose therapy begins with HydroDIURIL
frequently can continue to benefit from it, because HydroDIURIL usually maintains
its antihypertensive effect even when therapy is prolonged.

CONTRAINDICATIONS: Anuria; increasing
azotemia and oliguria during treatment of severe pro-
gressive renal disease. Known sensitivity to this
compound. Nursing mothers; if use of drug is deemed
essential, patient should stop nursing.

WARNINGS: May precipitate or increase azotemia.
Use special caution in impaired renal function to avoid
cumulative or toxic effects. Minor alterations of fluid
and electrolyte balance may precipitate coma in hepatic
cirrhosis.

When used with other antihypertensive drugs, care-
ful observation for changes in blood pressure must be
made, especially during initial therapy. Dosage of
other antihypertensive agents, especially ganglion
blockers, must be reduced by at least 50% because
HydroDIURIL potentiates their action.

Stenosis and ulceration of the small bowel causing
obstruction, hemorrhage, and perforation have been
reported with the use of enteric-coated potassium tab-
lets, either alone or with nonenteric-coated thiazides.
Surgery was frequently required, and deaths have oc-
curred. Such formulations should be used only when
indicated and when dietary supplementation is im-
practical. Discontinue immediately if abdominal pain,
distention, nausea, vomiting, or gastrointestinal bleed-
ing occurs.

Thiazides cross placenta and appear in cord blood.
In women of childbearing age, potential benefits must
be weighed against possible hazards to fetus, such as
fetal or neonatal jaundice, thrombocytopenia, and pos-
sibly other adverse reactions which have occurred in
the adult.

The possibility of sensitivity reactions should be
considered in patients with a history of allergy or bron-
chial asthma. The possibility of exacerbation or activa-
tion of systemic lupus erythematosus has been
reported for sulfonamide derivatives, including
thiazides.

PRECAUTIONS: Check for signs of fluid and elec-
trolyte imbalance, particularly if vomiting is excessive
or patient is receiving parenteral fluids. Warning signs,
irrespective of cause, are dryness of mouth, thirst,
weakness, lethargy, drowsiness, restlessness, muscle
pains or cramps, muscular fatigue, hypotension,
oliguria, tachycardia, and gastrointestinal dis-
turbances Hypokalemia may develop (especially with
brisk diuresis) in severe cirrhosis; with concomitant
steroid or ACTH therapy; or with inadequate electro-
lyte intake. Digitalis therapy may exaggerate metabolic
effects of hypokalemia, especially with reference to

myocardial activity. Hypokalemia may be avoided or
treated by use of potassium chloride or giving foods |
with a high potassium content. Similarly, any chloride
deficit may be corrected by use of ammonium chloride
(except in patients with hepatic disease) and largely
prevented by a near normal salt intake. Hypochloremic
alkalosis occurs infrequently and is rarely severe. In
severely edematous patients with congestive failure or
renal disease, a low salt syndrome may occur if dietary I
salt is unduly restricted, especially during hot weather.

Thiazides may increase responsiveness to tubocu- i
rarine. The antihypertensive effect of the drug may be <
enhanced in the postsympathectomy patient. Arterial
responsiveness to norepinephrine is decreased, neces-
sitating care in surgical patients. Discontinue drug 48
hours before elective surgery. Orthostatic hypotension
may occur and may be potentiated by alcohol, barbit- 1
urates, or narcotics.

Pathological changes in the parathyroid glands with
hypercalcemia and hypophosphatemia have been seen
in a few patients on prolonged thiazide therapy. The
effect of discontinuing thiazide therapy on serum cal-
cium and phosphorus levels may be helpful in assess- I
ing the need for parathyroid surgery in such patients.
Parathyroidectomy has elicited subjective clinical im-
provement in most patients, but has no effect on
hypertension. Thiazide therapy may be resumed after
surgery. ■>

Use cautiously in hyperuricemic or gouty patients;
gout may be precipitated. May affect insulin require-
ments in diabetics; may induce hyperglycemia and
glycosuria in latent diabetics.

ADVERSE REACTIONS: Rare reactions include
thrombocytopenia, leukopenia, agranulocytosis, aplas-
tic anemia, cholestasis, and pericholangiolitic hepatitis.
Nausea, vomiting, diarrhea, dizziness, vertigo, pares-
thesias, transient blurred vision, sialadenitis, purpura,
rash, urticaria, photosensitivity, or other hypersensi-
tivity reactions may occur. Cutaneous vasculitis pre-
cipitated by thiazide diuretics has been reported in
elderly patients on repeated and continuing exposure
to several drugs. Scattered reports have linked
thiazides to pancreatitis, xanthopsia, neonatal throm-
bocytopenia, and neonatal jaundice. When adverse
reactions are moderate or severe, the dosage of
thiazides should be reduced or therapy withdrawn.

For more detailed information, consult your MSD MSD
Representative or see the Direction Circular. Merck
Sharp & Dohme, Division of Merck & Co., Inc., West SHARFV
Point, Pa. 19486 DOHME

Try Eutrorron a stubborn diastolic

pargyline hydrochloride 25 mg. and methyclothiazide 5 mg.

When you’re not satisfied with your patient’s diastolic
“end point’’ under present treatment , consider a trial of Eutron.
It will often bring further reduction of blood pressure ,
even in severe diastolic hypertension .

Special Characteristics of Eutron:

Course of therapy usually is smooth, with
blood pressure reducing gradually over one to
three weeks.

Around-the-clock effect from a single daily dose.

Provides diuresis when edema accompanies
hypertension.

Free of central depressant action.

Lower doses of pargyline hydrochloride are
made possible because of the methyclothiazide
component.

TM— Trademark

Special Restrictions (see back of page) :

Tyramine-containing foods (e.g. aged cheese)
should be avoided. (For further listing of foods,
see back of page.)

If alcohol is used, it should be used cautiously
and in reduced amounts.

Patients should be warned against the concurrent
use of non-prescription medications (particularly
cold preparations and antihistamines), or
prescription drugs without physician’s consent.

Discontinue Eutron at least two weeks prior to
elective surgery.

Before prescribing Eutron, see prescribing

information in package insert. A brief
summary appears on next page. 201353

Brief Summary
EUTRON”

pargyline hydrochloride and methyclothiazide

Filmtab3

INDICATIONS. EUTRON (pargyline hydrochloride and methyclothiazide) is indicated in the
treatment of patients with moderate to severe hypertension, especially those with severe
diastolic hypertension. It is not recommended for use in patients with mild or labile hypertension
amenable to therapy w th sedatives and I or thiazide diuretics alone.

Because of the potent diuretic properties of methyclothiazide, the combination is particularly
suited for use when congestive heart failure or other conditions requiring diuretic therapy
coexist with hypertension, or when edema attributable to antihypertensive therapy develops.

As discussed in regard to dosage and administration, it is desirable to establish the dosage
requirements for EUTRON by the administration of Eutonyl and Enduron separately.

CONTRAINDICATIONS. 1. Pargyline therapy is contraindicated in patients with pheo-
chromocytoma, paranoid schizophrenia, hyperthyroidism and advanced renal failure.

2. Pargyline should not be administered to those with malignant hypertension, or to children
under twelve years of age because significant clinical information concerning the use of the
drug in these conditions is not available.

3. In general, the following drugs or agents are contraindicated in patients receiving pargyline
hydrochloride:

a. Centrally acting sympathomimetic amines such as amphetamine and its derivatives (also
found in anorectic preparations).

Peripherally acting sympathomimetic drugs such as ephedrine and its derivatives (also
found in nasal decongestants, hay fever preparations and cold remedies).

b. Aged and natural cheese (e g , Cheddar, Camembert, and Stilton), and other foods (e g ,
pickled herring, Chianti wine, pods of broad beans, chicken livers, chocolate and yeast
products), which require the action of bacteria or molds for their preparation or preserva-
tion, because of the presence of pressor substances such as tyramine. Banana peels are
also contraindicated. Cream cheese, processed cheese, and cottage cheese can be allowed
in the diet during EUTRON therapy, since their tyramine content is inconsequential.

In some patients receiving EUTRON, tyramine may precipitate an abrupt rise in blood
pressure accompanied by some or all of the following: severe headache, chest pain, profuse
sweating, palpitation, tachycardia or bradycardia, visual disturbances, stertorous breath-
ing, coma, and intracranial bleeding (which could be fatal). A phenothiazine derivative or
phentolamine may be administered parenterally for treatment of such an acute hyper-
tensive reaction.

c. Parenteral administration of reserpine or guanethidine may cause hypertensive reactions
from sudden release of catecholamines. Parenteral use of these drugs is contraindicated
during, and for at least one week following, treatment with EUTRON.

d. Imipramine, amitriptyline, desipramine, nortriptyline, or their analogues should not be
used with pargyline. The use of these drugs with monoamine oxidase inhibitors has been
reported to cause vascular collapse and hyperthermia which may be fatal. A drug-free
interval (about two weeks) should separate therapy with EUTRON and use of these agents.

e. Methyldopa or dopamine, which may cause hyperexcitability in patients receiving pargyline,
should not be given.

f. Other monoamine oxidase inhibitors should not be added to a EUTRON regimen since
they may augment the effects of pargyline.

4. Methyclothiazide is contraindicated in patients with a known sensitivity to methyclothiazide
and/or other thiazide diuretics. It should not be used in patients with severe renal disease
(except nephrosis) or complete renal shutdown. Thiazide diuretics should not be used in the
presence of severe liver disease and/or impending hepatic coma. Hepatic coma has been
reported as a consequence of hypokalemia in patients receiving thiazide diuretics.

WARNINGS

A PATIENTS

1. PATIENTS SHOULD BE WARNED AGAINST THE USE OF ANY OVER-THE-COUNTER
PREPARATIONS, PARTICULARLY "COLD PREPARATIONS" AND ANTIHISTAMINES
OR PRESCRIPTION DRUGS WITHOUT THE KNOWLEDGE AND CONSENT OF THE
PHYSICIAN.

2. PATIENTS SHOULD BE CAUTIONED ON THE USE OF CHEESE (SEE CONTRAINDICA-
TIONS) AND ALCOHOLIC BEVERAGES IN ANY FORM.

3. PATIENTS SHOULD BE WARNED ABOUT THE LIKELIHOOD OF THE OCCURRENCE OF
ORTHOSTATIC HYPOTENSION.

4 PATIENTS SHOULD BE INSTRUCTED TO REPORT PROMPTLY THE OCCURRENCE OF
SEVERE HEADACHE OR OTHER UNUSUAL SYMPTOMS.

5. PATIENTS WITH ANGINA PECTORIS OR CORONARY ARTERY DISEASE SHOULD
BE ESPECIALLY WARNED NOT TO INCREASE THEIR PHYSICAL ACTIVITIES IN
RESPONSE TO A DIMINUTION IN ANGINAL SYMPTOMS OR AN INCREASE IN WELL-
BEING OCCURRING DURING TREATMENT WITH EUTRON

B. PHYSICIANS

1. WHEN INDICATED THE FOLLOWING SHOULD BE CAUTIOUSLY PRESCRIBED IN
REDUCED DOSAGES:

a. ANTIHISTAMINES

I). HYPNOTICS, SEDATIVES OR TRANQUILIZERS
c. NARCOTICS (MEPERIDINE SHOULD NOT BE USED)

2. DISCONTINUE EUTRON AT LEAST TWO WEEKS PRIOR TO ELECTIVE SURGERY.

3. IN EMERGENCY SURGERY THE DOSE OF NARCOTICS OR OTHER PREMEDICATIONS
SHOULD BE REDUCED TO 1/4 TO 1/5 THE USUAL AMOUNT. CLINICAL EXPERIENCE
HAS SHOWN THAT RESPONSE TO ALL ANESTHETIC AGENTS CAN BE EXAGGERATED
IN PATIENTS RECEIVING EUTRON. THEREFORE THE DOSE OF THE ANESTHETIC
SHOULD BE CAREFULLY ADJUSTED.

4. PARGYLINE HYDROCHLORIDE MAY INDUCE HYPOGLYCEMIA.

5. CARE SHOULD BE EXERCISED IN USING EUTRON IN PATIENTS WITH ADVANCED
RENAL FAILURE

The possibility of sensitivity reactions to methyclothiazide or pargyline should be considered
in patients with a history of allergy or bronchial asthma.

There have been several reports published and unpublished, concerning nonspecific small
bowel lesions consisting of stenosis with or without ulceration, associated with the administra-
tion of enteric-coated thiazides with potassium salts. These lesions may occur with enteric-
coated potassium tablets alone or when they are used with nonenteric-coated thiazides, or
certain other oral diuretics.

These small bowel lesions have caused obstruction, hemorrhage and perforation. Surgery
was frequently required and deaths have occurred.

Available information tends to implicate enteric-coated potassium salts although lesions
ol this type also occur spontaneously. Therefore, coated potassium-containing formulations
should be administered only when adequate dietary supplementation is not practical, and
should be discontinued immediately if abdominal pain, distention, nausea, vomiting or gas-
trointestinal bleeding occurs.

The possibility of exacerbation or activation of systemic lupus erythematosus has been
reported for sulfonamide derivatives, including thiazides.

EUTRON does not contain added potassium.

USE IN PREGNANCY

Pargyline Hydrochloride. Safe use of pargyline during pregnancy or lactation has not yet
been established. Before prescribing pargyline in pregnancy, in lactation, or in women of
childbearing age, the potential benefits of the drug should be weighed against its possible
hazard to mother and child.

Methyclothiazide. Thiazides should be used with caution in pregnant women and nursing
mothers since they cross the placental barrier and appear in cord blood and in breast milk.
The use of thiazides may result in fetal or neonatal jaundice, bone marrow depression and
thrombocytopenia, altered carbohydrate metabolism in newborn infants of mothers showing
decreased glucose tolerance, and possible other adverse reactions which have occurred in
the adult. When the drug is used in women of childbearing age, the potential benefits of the
drug should be weighed against the possible hazards to the fetus.

PRECAUTIONS

Pargyline Hydrochloride. The therapeutic response to a variety of drugs may be changed,
or exaggerated, in patients receiving a monoamine oxidase inhibitor such as pargyline hydro-
chloride. Caffeine, alcohol, antihistamines, barbiturates, chloral hydrate, and other hypnotics,
sedatives, tranquilizers and narcotics (meperidine should not be used), should be used
cautiously and at reduced dosage in patients who are taking pargyline.

Pargyline has not been shown to damage the kidney or liver. However, laboratory studies
including complete blood counts, urinalyses, and liver function tests should be performed
periodically. The drug should be used with caution in the presence of liver disease. All patients
with impaired circulation to vital organs from any cause including those with angina pectoris,
coronary artery disease, and cerebral arteriosclerosis should be closely observed for symptoms
of orthostatic hypotension. If hypotension develops in these patients, EUTRON dosage should
be reduced or therapy discontinued since severe and/or prolonged hypotension may precipitate
cerebral or coronary vessel thromboses.

The hypotensive effect of pargyline may be augmented by febrile illnesses. It may be advisa-
ble to withdraw the drug during such diseases.

Since pargyline is excreted primarily in the urine, patients with impaired renal function
may experience cumulative drug effects. Such patients should also be watched for elevations
of blood urea nitrogen and other evidence of progressive renal failure. If such alterations
should persist and progress, the drug should be discontinued.

An increased response to central depressants may be manifested by acute hypotension
and increased sedative effect. Pargyline also may augment the hypotensive effects of anesthetic
agents and surgery. For this reason, the drug should be discontinued from at least two weeks
prior to surgery.

In the event of emergency surgery smaller than usual doses (1/4 to 1/5) of narcotics,
analgesics, sedatives, and other premedications should be used. If severe hypotension should
occur, this can be controlled by small doses of a vasopressor agent such as levarterenol.

Pargyline therapy should not be used in individuals with hyperactive or hyperexcitable
personalities, as some of these patients show an undesirable increase in motor activity with
restlessness, confusion, agitation and disorientation. Clinical studies have shown that par-
gyline may unmask severe psychotic symptoms such as hallucinations or paranoid delusions
in some patients with pre-existing serious emotional problems. This can usually be controlled
by judicious administration of chlorpromazine intramuscularly, or other phenothiazines, the
patient remaining supine for one hour after administration.

Pargyline should be used with caution in patients with Parkinsonism, as it may increase
symptoms. In addition, great care is required if pargyline is administered in conjunction with
anti-parkinsonian agents.

In experience to date, pargyline has not been associated with eye changes or optic atrophy
as reported with the use of some hydrazine monoamine oxidase inhibitors. However, patients
receiving this drug for prolonged periods should be examined for any changes in color per-
ception, visual fields, fundi, and visual acuity.

Clinical reports state that certain individuals receiving pargyline for a prolonged period of
time are refractory to the nerve-blocking effects of local anesthetics, e g., lidocaine.
Methyclothiazide. Thiazide therapy should be used with caution in patients with severely
impaired renal function because of the possibility of cumulative effects. Caution is also nec-
essary in patients with severely impaired hepatic function or progressive liver disease.

Thiazide drugs may reduce response to levarterenol. Accordingly, the dosage of vasopressor
agents may need to be modified in surgical patients who have been receiving thiazide therapy.

Thiazide drugs may increase the responsiveness to tubocurarine.

The antihypertensive effect of the drug may be enhanced in the svmpathectomized patient.

All patients should be observed for clinical signs of fluid or electrolyte imbalance, including
hyponatremia ("low-salt” syndrome). These include thirst, dryness of the mouth, lethargy
and drowsiness.

Hypokalemia may occur during therapy with methyclothiazide. In such cases supplemental
potassium may be indicated. Potassium depletion can be hazardous in patients taking digitalis.
Myocardial sensitivity to digitalis is increased in the presence of reduced serum potassium
and signs of digitalis intoxication may be produced by formerly tolerated doses of digitalis.
Hypochloremic alkalosis may occur following intensive or prolonged thiazide therapy. Re-
placement of chloride may be indicated in such cases.

Thiazides may decrease serum P.B.I. levels without signs of thyroid disturbance.
ADVERSE REACTIONS. Generally side effects should not be severe or serious when the
recommended dosages are used, and necessary precautions are observed. If side effects
are severe or persist in spite of symptomatic treatment, the dosage should be reduced or the
drug withdrawn. See also Warnings and Precautions.

Pargyline Hydrochloride. The most frequently occurring side effects are those associated
with orthostatic hypotension (dizziness, weakness, palpitation, or fainting). These usually
respond to a reduction of dosage Patients should be warned against rising to a standing
position too quickly, especially when getting out of bed. Severe and persistent orthostatic
hypotension should be avoided by reduction in dosage and/or discontinuation of therapy.

Mild constipation, fluid retention with or without edema, dry mouth, sweating, increased
appetite, arthralgia, nausea and vomiting, headache, insomnia, difficulty in micturition night-
mares, impotence and delayed ejaculation, rash and purpura, have also been encountered.
Hyperexcitability, increased neuromuscular activity (muscle twitching) and other extra-pyra-
midal symptoms have been reported. Gain in weight may be due either to edema or increased
appetite. Drug fever is extremely rare In some patients reduction of blood sugar has been
noted. Although the significance of this has not been elucidated, the possibility of hypo-
glycemic effects should be borne in mind. Congestive heart failure has been reported in patients
with reduced cardiac reserve.

Methyclothiazide. Side effects that may accompany thiazide therapy include anorexia,
nausea, vomiting, diarrhea, headache, dizziness, paresthesias, weakness, skin rash, photo-
sensitivity. Jaundice and pancreatitis also have been reported.

Blood dyscrasias, including thrombocytopenia with purpura, agranulocytosis and aplastic
anemia, have been reported with thiazide drugs.

Thiazides have been reported, on rare occasions, to have elevated serum calcium to hyper-
calcemic levels. The serum calcium levels have returned to normal when the medication has
been stopped. This phenomenon may be related to the ability of the thiazide diuretics to
lower the amount of calcium excreted in the urine.

Elevations of blood urea nitrogen, serum uric acid, and blood sugar have occurred with the
use of thiazide drugs. Symptomatic gout may be induced.

Although not established as an adverse effect of methyclothiazide, it has been reported that
thiazide diuretics may produce a cutaneous vasculitis in elderly patients.

®F1LMTAB— Film-sealed tablets, Abbott. TM— Trademark

204364

Highlights

of April 26, 1972 meeting —
The MSMS Council

The MSMS Council on April 26

. . . APPROVED THE APPOINTMENT by Council
Chairman Masters of an ad hoc membership com-
mittee to develop guidelines for further efforts at
recruitment and retention of members.

. . . AGREED TO WRITE Michigan Association of
Regional Medical Programs and express The Coun-
cil’s opposition to further inroads by RMP into the
practice of medicine.

. . . VOTED TO CREATE an ad hoc task force to
work with AMA on educational project re national
health insurance.

. . . APPROVED GUIDELINES and procedures for
MSMS consideration of requests for endorsement
of National Health Service Corps applications.

. . . APPROVED A STATEMENT “that any system
of national health insurance should provide the
coverage for mental and emotional disorders to the
same degree and extent as for any other illness.”
This action was taken in response to a letter from
the Michigan Psychiatric Association asking for a
MSMS expression.

. . . AUTHORIZED A LETTER to the Michigan De-
partment of Health offering suggestions for con-
sideration in its development of proposed “Guide-
lines for Development of Health Care Delivery Or-
ganizations.” The Health Department has been or-
dered by legislation to develop such guidelines.

. . . TOOK THE FOLLOWING positions on several
Michigan bills, as recommended by the MSMS
Committee on Legal Affairs:

— SUPPORT HB 5886 — to “decriminalize” habit-
ual drunkenness and provide treatment and rehabil-
itation.

—SUPPORT HB 5084 and oppose HB 6106— to
provide birth control services to minors without
parental consent (to implement this position taken
by MSMS House of Delegates this spring) but to
involve parents in general health problems of
minors.

—OPPOSE HB 5882— to create a State Depart-
ment of Human Resources which would envelop
current Departments of Social Services, Mental
Health and Public Health and certain other com-
missions.

. . . APPROVED A MSMS POSITION on who could
dispense medications under certain circumstances,
reading: “The State of Michigan Board of Phar-

macy provisions be amended to allow registered
nurses, on written policies and procedures adopted
by the hospital pharmacy and/or therapeutics com-
mittee, to dispense medications ordered by a qual-
ified physician in the absence of a registered phar-
macist.”

. . . APPROVED A NEW service to offer auto leas-
ing to MSMS members at considerable savings.

. . . VOTED TO SEND MSMS Medigram to Mich-
igan medical and osteopathic students in another
effort to tell future doctors about efforts and con-
cerns of MSMS.

. . . VOTED TO REQUEST the MSMS professional
Insurance Plans Committee to explore the possibil-
ities for improving the scope of benefits to the
medical assistants so they are equal to those ben-
efits in the MSMS group policy for physicians. The
Executive Committee was instructed to act on the
recommendations of the committee before June 1.

. . . AUTHORIZED AN INCREASE in the advertis-
ing rates for Michigan Medicine to offset increases
in the costs of printing the MSMS journal.

And on April 26,

The Council heard reports

... by MSMS President Sidney Adler, MD, on re-
cent AMA Conference on Socio-Economics at Fort
Lauderdale;

... by MSMS President-Elect John J. Coury, MD,
and MDPAC Chairman Louis Zako, MD, on their
talks at the Legislative Workshop sponsored by the
state Woman’s Auxiliary;

... by MSMS Speaker Vernon V. Bass, MD, who
reviewed the spring House of Delegates meeting
and outlined preliminary plans for the fall meeting,
October 1-3 in Detroit, and

... by Chairman of the MSMS Delegation to the
AMA, Donald N. Sweeny, MD, who invited The
MSMS Council to present constructive, written crit-
icism to the AMA in connection with AMA hearing.

MICHIGAN MEDICINE JUNE 1972 569

c^Mictiigaii mediscerie

JUNE 6-8 — Fourth Annual Spring Meeting, Michigan
Chapter, American Academy of Pediatrics, Ot-
sego Ski Club, Gaylord, contact: Nathan S. Fire-
stone, MD, program chairman, 4791 Haddington
Drive, Bloomfield Hills, 48013
JUNE 7 — The Council, MSMS Headquarters, con-
tact: Warren F. Tryloff, director
JUNE 12-16 — Eighth Annual Northern Michigan
Summer Program, “Diagnosis and Treatment of
Some Common Medical Problems,” sponsored
by Department of Postgraduate Medical Educa-
tion, University of Michigan, at Shanty Creek
Lodge, Bellaire, contact: Neal A. Vanselow, MD,
acting chairman, U-M Department of PG Med-
icine, Towsley Center, Ann Arbor, 48104
JUNE 18-22 — Many Michigan physicians will at-
tend AMA Annual Convention in San Francisco.
JUNE 23-24 — Annual Meeting, Upper Peninsula
Medical Society, Holiday Inn, Marquette, con-
tact: Thomas B. Bolitho, MD, UPMS president,
1414 W. Fair Ave., Marquette, 49855
JUNE 25 — Board meeting, Michigan chapter, Amer-
ican Association of Medical Assistants, noon,
MSMS Headquarters, contact: Margaret Broad-

ayman real estate fund

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a Public Limited Partnership

NO SALESlCOMMISSION

OBJECTIVE: Tax Shelter, Cash Flow
and Capital Appreciation

THE FUND WILL SEEK ITS OBJECTIVES
BY INVESTING IN REAL ESTATE SUCH
AS: Apartments, Shopping Centers, Office
Buildings, etc.

$2,500 per Unit

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(OFFER LIMITED TO RESIDENTS OF
MICHIGAN ONLY AND NOT FOR
RESALE TO NON-RESIDENTS.)

THIS ADVERTISEMENT IS NEITHER
AN OFFER TO SELL NOR A SOLICITA-
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IS MADE ONLY BY THE PROSPECTUS.

/or details Call or
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17220 WEST 8 MILE ROAD
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Phone 313/353-0520

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well, 406 Professional Plaza, 3800 Woodward
Ave., Detroit, 48201

JUNE 26 — Statewide meeting to develop plan for
prevention, detection and treatment of kidney
disease, sponsored by Office of Comprehensive
Health Planning, at MSMS Headquarters, contact:
llze Koch, health planning consultant, State Of-
fice of Comprehensive Health Planning, Lewis
Cass Building, Lansing, 48913

JUNE 26-29 — International Symposium on Clinical
Aspects of Metabolic Bone Disease, Henry Ford
Hospital, contact: Boy Frame, MD, Henry Ford
Hospital, Detroit, 48202

JUNE 26-30 — American College of Physicians, Con-
ference on Medical Interviewing, Kellogg Center,
MSU, contact: Allen Enelow, MD, chairman, De-
partment of Psychiatry, MSU, East Lansing, 48823

JULY 15-16 — “Summer of 72” seminar weekend for
State of Michigan Medical Assistants, Schuss
Mountain, Mancelona, contact: Mrs. Audrie

Chute, chairman, 3600 W. 13 Mile Road, Royal
Oak, 48072

JULY 15-19 — 26th Annual Postgraduate Scientific
Assembly of Michigan Academy of Family Physi-
cians, Boyne Highlands, Harbor Springs, contact:
George Hoekstra, MD, chairman, 100 Maple St.,
Parchment, 49004

JULY 27-28 — Coller-Penberthy-Thirlby Conference,
Park Place Motor Inn, Traverse City, contact: L.
P. Skendzel, MD, Traverse City, chairman

AUG. 4-5 — Annual Midsummer meeting, MSMS
Council, Boyne Highlands, contact: Warren F.
Tryloff, MSMS director

AUG. 25-26 — Physician-Education Program, Mich-
igan Heart Association Stroke Council, Schuss
Mountain, Mancelona, contact: Harold Arnow, Di-
rector of Public Relations, MHA. 16310 W. Twelve
Mile Road, P.O. Box LV-160, Southfield, 48076

SEPT. 14 — Second Annual Research Forum, Mich-
igan Heart Association, at Michigan State Uni-
versity, contact: Harold Arnow, Director of Public
Relations, Michigan Heart Association, 16310 W.
Twelve Mile Road, P.O. Box LV-160, Southfield,
48076

SEPT. 16-17— Leadership Training Seminar, State
of Michigan Medical Assistants, Hospitality Inn,
Lansing, contact: Dorothy Brandis, 401 W. Green-
lawn, Lansing, 48910

SEPT. 21-24— Michigan Regional Meeting, American
College of Physicians and Michigan Society of
Internal Medicine, Otsego Ski Club, Gaylord, con-
tact: Muir Clapper, MD, ACP governor for Mich-
igan, Wayne State University School of Medicine,
540 E. Canfield, Detroit, 48201

OCT. 1 AND 4 — The Council, Sheraton-Cadillac
Hotel, Detroit, contact: Warren F. Tryloff, MSMS
director

OCT. 1-5— 107th Annual Session of the Michigan
State Medical Society, Sheraton-Cadillac Hotel,
Detroit, contact: Helen Schulte, MSMS Head-
quarters, for scientific information; Richard Cam-
pau, MSMS Headquarters for House of Delegates
information

OCT. 5— Annual Meeting, Michigan Division, Amer-
ican Cancer Society, Olds Plaza Hotel, Lansing,
contact: Arthur L. Crampton, executive vice presi-
dent, 1205 E. Saginaw St., Lansing, 48906

570 MICHIGAN MEDICINE JUNE 1972

zMSmS ill actioii

Medical Education
Foundation elects,
makes grants

The Michigan Foundation for Medical Education
has re-elected its entire slate of officers to serve
during the coming year and made its annual grants
to the following organizations in the indicated
amounts below.

Continuing to serve the foundation are Harry A.
Towsley, MD, Ann Arbor, president; Warren F. Try-
loff, East Lansing, secretary, and Herbert A. Gard-
ner, MD, treasurer. Trustees for three-year terms
are Daniel Cowan, MD, East Lansing, Robert J.
Mason, MD, Birmingham, and G. Thomas McKean,
MD, Detroit.

BRUCE FUND—

Central Hospital Council of Saginaw $ 150.00

University of Michigan 3,342.12

CENTRAL FUND—

Michigan Health Council 1,800.00

University of Michigan 2,400.00

Wayne State University 2,000.00

Michigan State University 1,400.00

TOTAL .$11,092.12

MS MS delegation
supports Doctor Sweeny
in AM A Council hid

The Michigan delegation to the American Med-
ical Association is firming resolutions and other
plans-of-action with the approach of the June 18-22
dates of the AMA annual convention in Chicago.

The 16 delegates and alternates from Michigan
are supporting the candidacy of Donald N. Sweeny,
Jr., MD, Detroit, chairman of the Michigan delega-
tion, for a seat on the AMA Council on Medical
Services.

Doctor Sweeny was nominated by the AMA
Board of Trustees at its May 9 meeting to fill the
vacancy left when George W. Slagle, MD, Battle
Creek, steps down at the convention. Doctor Slagle
has held the post for three terms, the maximum
allowed.

The Michigan delegation plans to submit to the
AMA a resolution that the AMA House “commend
the representatives of the AMA for their efforts and
urge that they continue and intensify their efforts to
resolve problems of adverse regulatory decisions
concerning Title XVIII and XIX.”

Beecham found it,
named it,

put it in your hands.

Prescribe

the discoverer’s brand

Totaciilin

(ampicillin trihydrate)

'capsules equivalent to 250 mg. and 500 mg.

ampicillin, for oral suspension equivalent
to 125 mg./5 cc. and 250 mg./5 cc. ampicillin.

roa

Beecham-Massengill Pharmaceuticals
Division of Beecham Inc. Bristol, Tennessee 37620

MSMS evaluating its PR program
in light of Phase II recommendations

By Thomas R. Berglund, MD, Chairman
MSMS Committee on Public Relations

The MSMS Committee on Public Relations is busy
evaluating the comments made by MSMS members
about communications in the Alexander Grant and
Company Phase II Survey.

The entire Phase II Report, which was sent to
MSMS delegates before the Spring meeting of the
House, has been referred to the MSMS Planning
and Priorities Committee for recommendations to
The Council and for consideration at the fall ses-
sion of the House. Appropriate committees also
will study the Report.

As a delegate, as secretary of the Kalamazoo
Academy of Medicine, and as chairman of the
MSMS Committee on Public Relations, I am keenly
interested in the opinions voiced by the members.

I have discussed several times various aspects of
the survey report with Herbert A. Auer, manager of
our MSMS Department of Communications and Pro-
fessional Information.

The Phase II Study, MSMS members will recall, was
authorized by the House to survey the opinions of
the members and to develop alternative forms of
organization that would be more responsive to the
needs of the members.

There were 7,913 questionnaires sent out and 2,227
responses. The 28 per cent response has been re-
garded as good and valid. The highest percentage
response was 38 per cent from Jackson County,
and the lowest of 21 percent was from Wayne
County members.

THE SURVEY FOUND that the “most valued serv-
ices and functions” are in this order:

Michigan Medicine
Professional and Ethical Standards
Public Relations
Professional Association work

Those seen as “less valuable” were Government
Relations, Group Insurance Programs, Medical Ec-
onomics, Annual Meeting, Scientific Information
and Training, Legal Services.

The survey asked, “How do you value the MSMS
Public Relations Work?” The responses were as
follows:

Of Substantial Value 9 per cent

Moderate Value 30 per cent

Occasional Value 35 per cent

Of No Value or No Opinion 26 per cent

With this kind of grading system it is good to find
that 3 of 4 doctors felt the public relations work
was of occasional, some, or substantial value.

The Department of Communications also is respon-
sible for Michigan Medicine which scored the high-
est. The replies there were:

Of Substantial Value
Of Moderate Value
Of Occasional Value
Of No Value or No Opinion

10 per cent
31 per cent
41 per cent
18 per cent

These figures can be interpreted to show that more
than 8 of 10 doctors felt the journal was of occa-
sional, some, or substantial value.

THE RESPONSES TO another survey question pro-
vide the PR Committee little definitive direction
about the PR approach that the members prefer.
The survey asked members what PR approach they
favored. The statistics can roughly be interpreted
like this:

Of 10 doctors surveyed, their first answers were
as follows:

1 had no opinion or didn’t answer
3 favored “aggressive methods”

3 favored “soft sell”

2 favored “long term education”

1 said “do good work”

Or it can be stated that three of 10 said “be ag-
gressive” (which is subject to many interpretations)
while six others disagreed and said “do good work,
depend on long-range education, and use soft-sell
methods.”

Two of the survey recommendations to a large de-
gree are related and can be considered together
as we think of possible action. One recommenda-
tion says the MSMS public relations program in
part “should be designed to improve the public’s
awareness regarding the objectives of professional
medicine.” This is done through MSMS projects
and conferences and statements. MSMS tells the
public about the concerns of doctors through news
conferences, news releases, the weekly radio pro-
gram, other radio and TV involvement and publica-
tions.

The other related recommendation is that the pub-
lic relations program “should if possible, be de-
signed to involve large numbers of physicians and
require participation by each component unit."

Certainly MSMS leaders and staff agree that PR
projects should involve as many units and doctors
as possible. There are various reasons why partici-
pation, or impact, has not been as great in the past
as desired.

These reasons can be cited: (1) Perhaps MSMS has
not had adequate workshops for component society

572 MICHIGAN MEDICINE JUNE 1972

leaders (this is being corrected); (2) Maybe some
projects have been poorly conceived; (3) MSMS
and AMA projects have been announced and pro-
moted too late without adequate time to be con-
sidered and implemented effectively.

In order to be more visible with effective public
service projects and in order to increase participa-
tion by MSMS members, the PR Committee is trying
to find a way to identify and develop two, three or
four major public information projects for 1973.

To try this, the PR Committee held a “hearing” at
its meeting May 24 as a new approach to MSMS
project planning in the public relations-public in-
formation area. The various MSMS committees, the
specialty societies, and the voluntary health asso-
ciations were invited to present proposals for major
MSMS public relations activities in 1973.

The PR Committee hopes that many good ideas will
be offered and several developed in detail for 1973.
Herb Auer and our committee members believe
such a new approach will permit MSMS to coor-
dinate various MSMS communications efforts in
major scheduled projects and to provide helpful
materials to the component societies so they will
also participate.

Proposals are asked to include clearly-defined ob-
jectives and suggest ways to reach the public and/
or the profession through the use of Michigan Med-
icine, MSMS conferences, or other means.

After the hearing, the PR Committee will present
its recommendation for 1973 PR projects to The
MSMS Council for consideration. These plans like-
ly will be reported to the 1972 House of Delegates
for information. Any resolutions there suggesting
PR projects could be measured against or incorpo-
rated into the already-developed proposals.

Thomas Payne, MD, Lansing, is chairman of the
task force for this PR Committee “Hearing.”

MANY OF THE SUGGESTIONS that grow out of
the study, as you might guess, are similar to sug-
gestions being developed by various committees
and staff members.

The Study suggests MSMS has two different needs
regarding communications. MSMS should clearly
define internal programs to reach the doctors and
MSMS needs ways to reach the public. As you
know, for the past several years, the MSMS Com-
munications Department has consisted of Mr. Auer
as manager; Judy Marr as managing editor of
Michigan Medicine, and one secretary. In October,
MSMS added Jeanne Smith, former Chicago news-
paper reporter and public relations specialist. She
has worked in all areas of MSMS communications
for six months and was then made responsible for
communications with the public under the super-
vision of Mr. Auer. By dividing the communications
work into external with Mrs. Smith, and internal
with Mr. Auer, the Public Relations Committee feels
planning, operations, and evaluation should be even
more effective.

Beecham found it,
named it,

put it in your hands.

Prescribe

the discoverer’s brand

Bactocili

(sodium oxacillin)

‘capsules equivalent to 250 mg. and 500 mg.
oxacillin and vials for injection equivalent to
500 mg. and 1 gm. oxacillin.

Beecham-Massengill Pharmaceuticals
Division of Beecham Inc. Bristol, Tennessee 37620

The 1972 Michigan Conference on Maternal
and Perinatal Health attracted a record at-
tendance of over 700 physicians, nurses and
students to the Olds Plaza hotel, Lansing.

Among the topics were amniocentesis, Rho-
gam, rubella, prostaglandins, genetic counsel-
ing, fetal monitoring and newborn care.

1972 Conference
for Maternal Health

Conference-goers submitted many
questions for further consideration
by the speakers following each talk
at the 1972 Michigan Conference
for Maternal and Perinatal Health.
Among the sponsors of the confer-
ence were Michigan pediatricians,
obstetricians and gynecologists, the
Ingham County Medical Society, the
Michigan Bureau of Maternal and
Child Health, pharmaceutical com-
panies and MSMS.

During a break between conference sessions,
small talk developed between, from left,
Richard T. Mel Ms, MD, Kalamazoo, chairman,
MSMS Committee on Maternal and Perinatal
Health; Lee S. Stevenson, MD, Farmington,
committee vice chairman, and Hermann Ziel,
Jr., MD, of the Michigan Department of Pub-
lic Health, Maternal and Child Health Bureau.

Conference chairman Joseph L. Sheets, MD,
left, Lansing, conferred with speakers Mahlon
S. Sharp, MD, center, Lansing obstetrician-
gynecologist, and Thomas H. Kirschbaum,
MD, chairman, MSU Department of OB/GYN
and Reproductive Biology.

574 MICHIGAN MEDICINE JUNE 1974

MSMS

in the headlines

It is interesting to note the different headlines
that appeared over the same Associated Press
story about the MSMS House of Delegates action
to organize a foundation for peer review.

Detroit News:

State Foundation Planned; Doctors to Review
Medical Services

Iron Mountain News:

Michigan Doctors Consider ‘True Peer Review’
Group

Pontiac Press:

Michigan Doctors Propose Their Own Board of
Review

Escanaba Daily Press:

Group to Keep Tab on Doctors’ Performances

Jackson Citizen Patriot:

Doctors Eye Self-Regulation

Benton Harbor News Palladium:

Michigan Doctors Considering Professional
Watchdog Group

Menominee Herald-Leader:

National Health Insurance Likely; Doctors
Weigh Policing Peers

Port Huron Times Herald:

State Doctors May Form Self-Policing Board
to Forestall Government Action

Flint Journal:

Michigan Doctors Consider Forming Own Re-
view Group

Dowagiac Daily News:

State Doctors May Form New Group for In-
spection

Owosso Argus Press:

Peer Review: Doctors Attempt to Head Off
Federal Controls

MSMS Judicial Commission
rules on use of word “clinic ”

An example of the continuing work of the MSMS
Judicial Commission is its recent decision that use
of the word “clinic” implies more than one physi-
cian rendering service and should not be used by
one physician to describe his facility, even though
he may employ paramedical personnel with him.

The commission was asked its opinion by a com-
ponent county medical society after one of^ its
members had displayed a sign announcing his eye
clinic,” though he was the only physician at that
location.

No legal rulings were found by MSMS legal
counsel governing the use of the word, but the
Judicial Commission presented its view in light of
the public view of its meaning.

Beecham found it,
named it,

put it in your hands.

»

Prescribe

the discoverer’s brand

Pyopen

(disodium carbenicillin)

*vials for injection equivalent to 1 gm.
and 5 gm. of carbenicillin.

HZIj

Beecham-Massengill Pharmaceuticals
Division of Beecham Inc. Bristol, Tennessee 37620

The touch-responsive cathode ray tube terminal is dis-
cussed by Robert M. Stow, MD, right, MSMS Computer
Committee chairman, and Park W. Willis, III, MD, Ann
Arbor, committee member, as they tour the East Lansing
center of Biomedical Computer Systems, Inc., of Edina,
Minn.

The Michigan State Medical Society’s new Com-
puter Committee, formed to keep abreast of de-
velopments in the field, is in action. The four-
member committee, established after passage of
a resolution by the 1971 MSMS House of Delegates,
held its first meeting April 19.

The committee discussed the health information
system as the core of community health services.

Special guest was Jerome A. Hilger, MD, president,

Biomedical Computer Services, Inc., St. Paul, Minn.

Robert Stow, MD, Lansing, sponsor of the
resolution passed by the House which established
the committee, is chairman. On the committee are
E. C. Heinmiller, MD, Saginaw; Charles G. Kramer,

MD, Midland, and consultants Frank Westervelt,

Wayne State University Computer Center; Al Her-
rell, William Beaumont Hospital, Royal Oak; N.

Doyle McGlaughlin, MD, Wyandotte, and Vergil N.

Slee, MD, Ann Arbor.

President of the Biomedical Computer Sys-
tems company, Jerome A. Hilger, MD, left,
of Minnesota, explains fine points of the East
Lansing system to N. Doyle Me Glaughlin,
MD, Wyandotte, consultant to the MSMS
committee.

MSMS

Computer Committee
learning its field

Taking a good look at the computer which will be part of the East
Lansing installation are, from left. Jack Hoard, of Biomedical Com-
puter Systems, Inc.; Richard Campau, manager, MSMS Department of
Operations and Economics, and E. Clifford Heinmiller, MD, Saginaw,
MSMS committee member.

I

I.

°Iil small doses

E. Marshall Goldberg, MD, Flint,

who has been interviewed by Michigan Medicine
several times about his program to boost Fayette,
Miss., medical staffs with Flint and Grand Rapids
physicians, is now the author of a novel. The
novel, “The Karamanov Equations,” was pub-
lished in March and is being considered for a
movie. The tale of international intrigue and med-
icine is already in its second printing.

Hilliard Jason, MD, East Lansing,

will step down from his administrative position
July 1 with Michigan State University’s College of
Human Medicine. Doctor Jason, who is director
of the Office of Medical Education Research and
Development (OMERAD) and has been a key
figure in the development of the new MSU med-
ical school, will remain at MSU to devote full
time to teaching and research. He plans a year’s
leave of absence to serve as an educational con-
sultant to the Lister Hill Center for Biomedical
Communication of the National Library of Med-
icine in Bethesda.

Kenneth L. Krabbenhoft, MD, Detroit,

is one of 23 members of the newly-created Na-
tional Cancer Advisory Board to the President.
Doctor Krabbenhoft is included because of his
membership on the National Advisory Cancer
Council, which is to be superseded by the board.
He will continue to serve until his council ap-
pointment expires in September 1973.

Donald C. Smith, MD, Ann Arbor,

professor of maternal and child health at the Uni-
versity of Michigan, has been appointed special
advisor on health and medical affairs to Gov.
William G. Milliken. Doctor Smith is to plan and
monitor health resources for the governor, as
well as advise him on current and long-range
policies leading to the development of a compre-
hensive state-wide health program for Michigan.

Tony J. Trapasso, MD, Sault Ste Marie,

is secretary-treasurer of the Canadian-American
Medical-Dental Association, founded in 1960 to
foster better rapport in all related MD and DDS
practices. The CAMDA held its 13th annual ses-
sion Feb. 24-March 3 in Vail, Colo.

Homer Weir, MD, Plymouth,

is the new superintendent of a proposed mental
retardation center to be located in Southgate. He
was transferred late in Marcn by E. Gordon Yu-
dashkin, MD, director, Michigan Department of
Mental Health. Doctor Weir has been superin-
tendent of the Plymouth State Home and Train-
ing School.

jpeciauzea, Service

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GRAND RAPIDS OFFICE: G. J. Haworth, Representative
422 Federal Square Building, Grand Rapids 49502 Telephone: 616-454-4477

MICHIGAN MEDICINE JUNE 1972 577

How physicians are affected
by price stabilization regulations

The following is the AMA’s interpreta-
tion of the U.S. Price Commissioner’ s rul-
ings on physicians’ fees and a few exam-
ples of how the ruling works. Further in-
formation on the rulings may be obtained
from the MSMS Bureau of Economic In-
formation.

Physicians are covered specifically by the Price
Stabilization regulations which govern “non-institu-
tional providers of health services” such as doc-
tors, dentists, medical laboratories, Christian Sci-
ence practitioners, etc.

As a non-institutional provider of health services
a physician may charge a price in excess of his
base price only to reflect allowable costs on No-
vember 14, 1971, and allowable cost increases be-
ing incurred after November 14, 1971, reduced to
reflect productivity gains, and only to the extent
that the increased price —

• Does not result in an increase in his profit
margin over that which prevailed during his
base period; and

• The aggregate of price increases does not ex-
ceed 2.5 percent per year.

These rules require the physician to justify any
increase in his fee for a particular service on the
basis of increased costs, subject to three limita-
tions —

1. The increase in cost in providing a particular
service must be reduced by “productivity
gains,” if any.

Example: Dr. X operates a medical labora-
tory. He incurs additional costs in the pur-
chase of a new diagnostic machine. The addi-
tional costs, however, are entirely offset by
the increased productivity of the new machine
as compared to the one it replaces. The new
machine, therefore, will not support an in-
crease in charges for the services for which
it is used.

2. Irrespective of increased costs of rent, wages,
malpractice insurance, etc., the physician can-
not increase his fees if the result will be an
increase in his profit margin over that which
prevailed during his base period.

Example: Dr. Y has been in solo practice for
four years. Each year his practice has grown,
requiring him to devote more time to it. Dur-
ing the base period his profit margin was 50
percent. Even though his overhead has in-

creased substantially, he cannot increase his
fees because his profit margin has remained
the same due to additional hours of work.

3. Fees may not be increased by more than 2.5
percent per year on average.

Example (a): Dr. Z increased his fee for a
particular service by 10 percent in order to
recoup his increased cost in rendering this
service. He is allowed to do this since
the result will not be to increase his profit
margin over the base period and his average
fee for the year will not be increased by more
than 2.5 percent. (Averages are to be calcu-
lated on the basis of percent of total revenue
per procedure.)

Example (b): Assume that Dr. Z increased
his fee for the service in January, 1972, and
a few months later his accountant advises
him that his profit margin for 1972 will exceed
that of his base period because he is seeing
more patients. Even though the increase in
profit margin is not due to the price increase
of the particular service in question, he will
have to roll back the price of the service.
Likewise, a roll back would be required if it
appears that the price increase of the service
will result in more than a 2.5 percent overall
increase in fees.

Example (c): Dr. X derives practically all of
his income from office calls for which he
charges $10.00 a visit. Because his lease ex-
pired, in January, 1972, he moves his office
to a new location at a very substantial in-
crease in rent. In addition, he has had sub-
stantial increases in cost because of higher
professional liability insurance premiums,
wages, etc. He figures that the additional
costs could be recouped by increasing fee
from $10.00 to $10.50. Applying the 2.5 per-
cent rule he could only increase fee to $10.25.
Dr. X could apply for an exception.

Example (d): Assume that Dr. X is reluctant
to increase his fee to $10.25 but inquires
whether he could raise his fee to $10.50 in
1973. There is nothing in the regulations
which would permit him to increase his av-
erage fee by more than 2.5 percent because
he did not implement an allowable increase
in a prior year.

Exceptions are made

In situations where the physician believes that

578 MICHIGAN MEDICINE JUNE 1972

the application of the price rules would work a
“serious hardship or gross inequity” as applied to
him, he may apply to the District Director of In-
ternal Revenue that an exception be made in his
case to permit specific increases in his fees. The
regulations do not state, however, what criteria will
be used in processing applications for exceptions.
Presumably an exception might be allowed in the
instance where a physician is able to show that his
fees are substantially lower than other physicians
in his community — or, if none, then in nearby com-
munities— and that as a consequence the total fees
derived from his practice are grossly inequitable
as compared to other physicians.

Another instance where an inequity may be rec-
ognized, possibly, is in the case where a physician
acquires board certification and desires to raise
his fees to those customarily charged by certified
specialists in his field.

A physician applying for an exception cannot
increase his fees until the exception has been ap-
proved.

A physician’s overhead consists of the costs he
incurs in providing services, such as increases in
rent, electricity, janitor service, and the wages of
his office employees. Other increases may be re-
lated only to specific services which he furnishes
as in the case of laboratory supplies used for cer-
tain diagnostic tests.

Increased fees for particular services may in-
clude overhead increases and the specific cost in-
creases applicable to furnishing those specific serv-
ices. As a practical matter the physician may not
want to raise his charges by penny amounts. If he
follows this practice he may forego allowable in-
creases because the fee for one service may not
be increased to cover additional costs for other
services.

Explanation of terms

“Allowable cost” means any cost, direct or in-
direct, unless disallowed by the Price Commission.

“Base period” means any two of the physician’s
last three fiscal years (your accounting year for tax
purposes) ending before August 15, 1971. General-
ly, the physician may select any two of the cal-
endar years 1968, 1969, and 1970 as his base
period. In determining a base period for the pur-
pose of computing a profit margin during a base
period, a weighted average of its profits during the
two years chosen shall be used.

“Base price” means the highest price permitted
for the sale of any service for the period beginning
August 16, 1971 and ending November 13, 1971. In
general, the base price for a particular service is
the highest price paid for that during the foregoing
period.

“Price increase” means an increase in the unit
price of a property or service or a decrease in the
quality of substantially the same property or serv-
ices.

Name —

Address

City State Zip

Barry Laboratories, Inc.,

461 N.E. 27th Street,
Pompano Beach, Fla. 33064

Since t 1928

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MIER6EJHCJXTBACTS

memoriam

Doctor Hull

Leroy W. Hull, MD
Brighton

Leroy Wetmore Hull, MD, past president of the
Michigan State Medical Society, died April 8 at the
age of 85. He also had served as president of the
Wayne County Medical Society.

Doctor Hull was a graduate of the University of
Michigan Medical School and specialized in urol-
ogy. He was chief of the department of urology at
Grace Hospital until his retirement in 1957 and had
been a staff member for nearly 50 years.

Doctor Hull was president of the WCMS in 1944-
45 and before that served as its information direc-
tor and a member of its medical economics com-
mission. He was named MSMS president in 1953
and served for two years. He also served the state
society as a councillor.

He was an outspoken critic of early government
health programs and in 1939 called socialized med-
icine a “political expedient — more associated with
politicians’ needs for votes than the need of the
poor for medical care.”

At that time Doctor Hull was sharply critical of a
proposed compulsory sickness insurance to be
financed by a “sickness tax,” and said in a speech
that the system would “wax fatter and fatter at the
expense of the citizen . . . until there are more
clerks than doctors and more of the insurance dol-
lar would go to administration and overhead than
to helping the sick.”

Doctor Hull was president of the Detroit branch,
American Urological Society, in 1940-41, and was
a founder of the Urological Surgical Service at Re-
ceiving Hospital.

R. Gordon Brain, MD
Flint

Doctor Brain was a graduate of Wayne State Uni-
versity School of Medicine and was in charge of
the new psychopathic ward at Hurley Hospital. He
was former city psychiatrist.

John E. Clifford, MD
Grosse Pointe Woods

John Edward Clifford, MD, Detroit-area obstetri-
cian-gynecologist since 1937, died April 22 at the
age of 61. Doctor Clifford was a life resident of the
Detroit area.

He was a graduate of Wayne State University
School of Medicine, and was affiliated with St.
John, Cottage, St. Joseph Mercy, Hutzel and De-
troit General hospitals. He was former chairman
of the Department of Ob-Gyn at St. John Hospital
and past president of the St. Joseph Mercy Hos-
pital staff.

Doctor Clifford was an instructor at Wayne State
University School of Medicine. He was affiliated
with the American College of Surgeons, the Cen-
tral Association and American College of Obstetri-
cians and Gynecologists, and was a long-time
treasurer of the Michigan Society of Obstetricians
and Gynecologists.

Ben Gaber, MD
Detroit

Pediatrician Ben Gaber, MD, of Detroit, died
April 1 at the age of 50.

Doctor Gaber was organizer and director of the
seizure clinic at Children’s Hospital of Michigan
and specialized in epilepsy and learning disorders.
He was a graduate of the University of Indiana
College of Medicine.

Doctor Gaber was born in Russia. He was a
member of the American Board of Pediatrics and
American Academy of Pediatrics.

Harold F. Grover, MD
Flint

Harold F. Grover, MD, Flint physician since 1928,
died April 8 at the age of 75. He was a life mem-
ber of the Genesee County Medical Society and
MSMS.

A general practitioner, Doctor Grover was affil-
iated with Hurley, McLaren General and St. Joseph
Hospitals in Flint. He was a graduate of the Uni-
versity of Indiana medical school.

Flint psychiatrist for more than 40 years, R. Gor-
don Brain, MD, died April 9 at the age of 78. Doc-
tor Brain was still in private practice and was an
active emeritus member of Flint’s Hurley Hospital
staff.

A life member of the Genesee County Medical
Society and MSMS, Doctor Brain had received the
MSMS 50-year award in 1967. He was a past presi-
dent of the Michigan Psychiatric Association and a
fellow of the American Psychiatric Association.

Louis Jaffe, MD

Detroit S

Louis Jaffe, MD, former chief of the department
of medicine at Highland Park General Hospital,
died April 20 at the age of 63.

Doctor Jaffe was affiliated with Harper Hospital
and was an associate professor of medicine at the
Wayne State University School of Medicine. He
(Continued on page 584)

580 MICHIGAN MEDICINE JUNE 1972

Travel Medical Seminar for ail Members and Families of

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MICHIGAN MEDICINE JUNE 1972 581

Classified Advertising

$5.00 per insertion of 50 words or less, with an additional 10 cents per word in excess of 50.

PROFESSIONAL INCORPORATION PROGRAMS:
estate planning, income tax reduction, HR- 10 retire-
ment plans, life insurance, disability, income, invest-
ment counsel, and practice management. If you want
the best in financial and practice counseling, phone
or write Phillip Fry and Associates, 14940 Plymouth
Road, Detroit, Michigan 48227. Phone (313) 499-9044.

LOCUM TENENS WANTED for the months of July,
August and September, general practitioner, offices
in hospital, excellent X-ray and laboratory facilities,
summer resort area in southern Michigan. Should be
equipped for emergency service. Contact: B. H.

Growt, M.D., P.O. Box 128, Addison, Michigan
49220.

HEALTH DEPARTMENT DIRECTOR: Single County
Health Dept, has position available on July 1, 1972
for a Director of a 63,000 population County. Fringe
benefits; hospitalization; retirement program; paid va-
cation; sick leave; 10 annual holidays. Qualifications
require an M.D. or D.O. physician; Michigan licen-
sure. Address: Shiawassee County Health Dept., 120
E. Mack St., Corunna, Michigan 48817.

PHYSICIAN WANTED to join two man Family Prac-
tice Group. Kalamazoo, Michigan. Two large open
staff hospitals with active teaching programs located
within two mile radius of modern office building.
Area noted for its recreational facilities including
lakes and rolling hills. Excellent school system en-
hanced by one university and three colleges with stu-
dent enrollment exceeding 25,000. Guaranteed salary
with percentage. Equal time off including five weeks
paid vacation per year. Call Collect: Roger J. Smith,
M.D., (616) 381-4381.

PHYSICIAN WANTED to join 2-man GP group, Kala-
mazoo, Mich. Two large open staff hospitals with ac-
tive teaching programs located within 2 mile radius
of modern office bldg. Guaranteed salary with per-
centage. 5 weeks paid vacation per year. Call Collect:
Roger J. Smith, MD, (616) 381-4381.

GENERAL SURGEON & FAMILY PHYSICIAN-Two
men to provide health services in new community
financed hospital in Jennings County, Indiana. No
other hospital in county of 22,000. Three other gen-
eral practitioners in county. New hospital equipped
to provide many health services. Hospital Board will
contract with the physicians for services. For further
details, call Cory SerVaas, MD, (317) 634-1100.

OFFICE SPACE FOR RENT: Macomb County: High
quality residential neighborhood. New building. For
Dental and Medical use. Open for inspection. 36380
Garfield, Clinton Township. Call Philip F. Pierce
(313) 792-0200.

IMMEDIATE OPENING for OB-GYN, Internal Medi-
cine, and Orthopedic specialties to establish successful
practice with 14 man multi-specialty group. Excellent
group benefits; pension plan; modern clinic facilities;
progressive community with excellent educational
system including two colleges; city population 35,000;
good recreational facilities; each specialty must be
board eligible or certified; young man with military
obligation completed. Contact: Business Manager,

The Manitowoc Clinic, 601 Reed Avenue, Manito-
woc, Wisconsin 54220.

PSYCHIATRIST-CHALLENGING OPPORTUNITY
TO practice progressive and innovative treatment
to wide variety of mental disorders; excellent facili-
ties and ancillary staff; comfort of small town living
with nearby city conveniences; excellent school sys-
tem; good climate; regular hours, 30 day vacation,
exc. retirement, life, health ins. plans; can pay
moving expenses; salary range $23,424-$29,848; any
state or DC license required; equal opp. employer.
Write: Chief of Staff, VA Hospital, Salisbury, N.C.
28144.

PHYSICIAN SUMMER PLACEMENT in Beautiful
Upper Peninsula. Hospital sixty (60) miles west of
Mackinac Bridge is seeking a physician with Mich-
igan license to provide partial coverage in Emer-
gency Room during summer months. References re-
quested with terms to be negotiated. Call or write:
Helen Newberry Joy Hospital, Newberry, Michigan.
(906) 293-5181, Jack Vantassel, Administrator.

LOCLIM TENENS for qualified Internist for month of
July 1972, Michigan License required. Excellent
boating, fishing, swimming in area located on Lake
Michigan. Associateship or Partnership Potential.
Contact: D. R. Boyd, M.D., 1735 Peck Street, Mus-
kegon, Michigan 49441.

GENERAL PRACTIONER or GP Surgeon needed for
rapidly growing family practice clinic in Michigan
town of 100,000. $40,000 first year guarantee, plus
fringe benefits. No investment. High potential. Reply
Box #4, 120 W. Saginaw Street, East Lansing, Mich-
igan 48823.

PHYSICIANS: Bd. Certified or eligible— two internists
with interest in cardiology or pulmonary diseases;
and one orthopedic surgeon. Also, physician for out-
patient unit. 229 bed hospital with coronary care and
soon to be activated respiratory care units. Hospital
in small community Michigan Upper Peninsula offer-
ing ideal family living, a superior school system, and
all seasons sports vacationland. Full staff of highly
qualified physicians, 80% Bd. Certified. Licensure,
any state. U.S. citizenship. Salary based on qualifica-
tions. Excellent fringe benefits. Non-discrimination in
employment. Contact Chief of Staff, VA Hospital,
Iron Mountain, Michigan 49801, (906) 774-3300.

582 MICHIGAN MEDICINE JUNE 1972

PSYCHIATRIC STAFF— Requirements of 3 years resi-
dency training to Board Certified. §26,000 to $36,300
depending on qualifications and experience. Excel-
lent Michigan Civil Service fringe benefits. Smog
free, peaceful, cultural summer-winter vacationland
community. College town, near Interlochen National
Music Camp. 1400 bed progressive psychiatric hos-
pital. J.C.A.H. approved. 3 year psychiatric residency
program. Contact M. Duane Sommerness, M.D.,
Room 323, Traverse City State Hospital, Traverse
City, Michigan 49684. An equal opportunity em-
ployer.

CLINICAL DIRECTOR (Psychiatry) . Milwaukee
County Mental Health Center. We are a community
orientated center providing out-patient, in-patient
and partial hospitalization for adults and children,
and also providing community psychiatric clinics lo-
cated in 6 catchment areas. Supervise psychiatric,
neurological, medical and related services. Required
completion of approved 3 year residency in psychi-
atry, eligibility for Wisconsin license and a total of 7
years’ experience or training in psychiatry. For fur-

ther information contact: George E. Currier, MD,
Asst. Director, Mental Health, 9191 Watertown Plank
Rd„ Milwaukee, Wis. 53226. (414) 258-2040, Ext.
3440.

LAKE PROPERTY FOR SALE: Ranch style year
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Lake near Alpena, buildings approx, three years old,
three bedrooms, two baths, large L-shaped kitchen
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full view of lake, remainder fully carpeted, double
fireplace between living room and enclosed porch
viewing lake, thermopane windows, aluminum siding
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insulated for electric heat, fully furnished. 263 ft. lake
frontage on Doctor’s Point, approx. li/2 acres wooded
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dock, shore station boat hoist, full year around use,
restricted area, non-commercial, private road. Full
price $85,000— minimum $40,000 down. For further
information call (313) 729-2580 or (313) 728-0298.

PROFESSIONAL
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FOR

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Administrators, Physicians,
Dept. Heads

PHYSICIANS— ALL SPECIALTIES

At no financial obligation, send us your resume
if you would like a fine full-time position with
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HOSPITALS: Full-time Chiefs of Services, Di-
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In addition to our service to Client organizations, we
assist physicians in considering relative merits of a va-
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time to the candidate. Appointments can be made as
much as a year or more in advance. Send complete
resume plus your professional objectives and geographic
preferences in confidence to Arthur A. Lepinot.

Advertisers in MICHIGAN MEDICINE are
friends of the profession. By accepting their adver-
tising we show confidence in them, their services
and products. They help make the journal a qual-
ity publication. Please familiarize yourself with
their services and products and let them know
that you see their advertising in MICHIGAN
MEDICINE.

INDEX TO ADVERTISERS

Abbott Laboratories

Barry Laboratories

Beecham-Massengill Pharm . . .

Brown Pharmaceuticals

Burroughs Wellcome & Co. . . .

Campbell Soup Co

Classified Advertising

Geigy Pharmaceuticals

Hayman Real Estate

Helen Newberry Joy Hospital

Hospital Planning, Inc

Import Motors Limited

Lilly, Eli & Co

Mead Johnson & Co

Medical Protective Co

Merck, Sharp & Dohme

Mercywood Hospital

Michigan State Medical Society
Pharmaceutical Mfg. Association

Roche Laboratories

Searle, G. D. & Co

Stratton, Ben P. Agency

Stuart Pharmaceuticals

Upjohn Co

Warner-Chilcott Laboratories . .
Winthrop

567, 56 8

579

571, 573, 575

559

514, 551

547

582, 583

513

570

584

583

517

522

556, 557

577

565, 566

555

581

519, 520, 521

Cover II, 509, Cover IV

548, 549, 550

Cover III

552, 553, 585

562, 563, 564

560, 561

586, 587, 588

MICHIGAN MEDICINE JUNE 1972 583

IN MEMOR I AM /Continued

was past president of the Detroit Medical Club and
former consultant to the Allen Park VA Hospital.
He was a member of the American College of Phy-
sicians and the American College of Chest Physi-
cians, and the American Diabetic Association and
the American College of Cardiology, for which he
had served as Michigan governor.

A graduate of the University of Michigan Med-
ical School, Doctor Jaffe was an internist. He prac-
ticed in Detroit his entire career.

John L. Law, MD
Seattle

John L. Law, MD, an Ann Arbor pediatrician for
34 years until his retirement in 1966, died April 5
at the age of 73. He had been living in Seattle, and
was a native of Atlanta, Ga.

Doctor Law earned his medical degree at Edin-
burgh University in Scotland and was head of Uni-
versity Hospital’s Department of Pediatrics in Ann
Arbor in the early 1930’s. He was instrumental in
setting up the first postgraduate medical program
at the U-M.

Doctor Law was a fellow of the Academy of In-
ternational Medicine and was a fellow, life member
and former board member of the American Acad-
emy of Pediatrics.

Loren E. Miller, MD
Grand Blanc

Loren Eugene Miller, MD, Flint-area physician
since 1944, died April 7 at the age of 61.

Doctor Miller was a graduate of the University

of Michigan Medical School and was on the staffs
of Hurley, McLaren General and St. Joseph hos-
pitals of Flint. He was a member of the American
Academy of General Practice.

S. G. Murphy, MD
Detroit

Scipio Glascoe Murphy, MD, Detroit pediatrician
for more than 35 years, died April 14 at the age of
71.

Doctor Murphy was one of the first pediatricians
at Children’s Hospital of Michigan and also was
affiliated with Parkside and Burton Mercy Hospitals
in Detroit. He was a graduate of Wayne State Uni-
versity School of Medicine.

Doctor Murphy had served as a delegate to the
MSMS House of Delegates, and was a member of
the Detroit Commission on Community Relations.
He was a member of the Detroit Pediatric Society.

Edgar R. Sherrin, MD
Detroit

Edgar R. Sherrin, MD, former chief of staff at
Mt. Carmel Mercy Hospital, died May 2 at the age
of 65. Doctor Sherrin also was a past president of
the Detroit Academy of Surgery.

Doctor Sherrin, a graduate of the University of
Western Ontario medical school, had practiced in
northwestern Detroit for over 35 years.

He was a fellow of the Detroit Academy of Sur-
gery, the American College of Surgeons and the
Royal Society of Medicine and was a member of
the American Geriatrics Society.

Coller - Penberthy -
Thirlby Conference
July 27-28

A distinguished faculty including several out-of-
state physicians will present the program at the
52nd annual Coller-Penberthy-Thirlby Medical Con-
ference scheduled for July 27-28 at Traverse City.

John A. Gronvall, MD, dean of the University of
Michigan Medical School and director of the Uni-
versity of Michigan Medical Center, will be the
toastmaster for the Thursday evening dinner when
Allan C. Barnes, MD, vice president, Rockefeller
Foundation, will speak.

Invited guests include Robert D. Coye, MD and
Andrew D. Hunt, Jr., MD, Deans, respectively, of
the medical schools at Wayne State University and
Michigan State University; Sidney Adler, MD,
president, MSMS; Carl E. Badgley, MD, Professor
Emeritus of Surgery, Section of Orthopedic Sur-
gery, the University of Michigan Medical Center;
Edgar A. Kahn, MD, Professor Emeritus of Surgery,

Section of Neurosurgery, the University of Michigan
Medical Center; Reed M. Nesbit, MD, Associate
Director of the Joint Commission on Accreditation
of Hospitals, Chicago, Illinois; Harry A. Towsley,
MD, Professor Emeritus of Pediatrics and Com-
municable Diseases, the University of Michigan
Medical Center and Mrs. Frederick A. Coller.

An estimated 350 physicians are expected.

Physician Summer Placement
in

Beautiful Upper Peninsula

Hospital sixty (60) miles east of Mackinac
Bridge is seeking a Physician with Mich-
igan license to provide partial coverage in
Emergency Room during summer months.
References requested with terms to be
negotiated.

Call or write:

Helen Newberry Joy Hospital
Newberry, Michigan
906-293-5181

Jack Vantassel, Administrator

584 MICHIGAN MEDICINE JUNE 1972

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Though Talwin® can be compared
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• Tolerance not a problem: tolerance to the analgesic
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1 Dependence rarely a problem: during three years of

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• Not subject to narcotic controls: convenient to
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Contraindications : Talwin, brand of pentazocine (as hydrochloride),
should not be administered to patients who are hypersensitive to it.
Warnings: Head Injury and Increased Intracranial Pressure. The
respiratory depressant effects of Talwin and its potential for ele-
vating cerebrospinal fluid pressure may be markedly exaggerated in
the presence of head injury, other intracranial lesions, or a pre-
existing increase in intracranial pressure. Furthermore, Talwin can
produce effects which may obscure the clinical course of patients
with head injuries. In such patients, Talwin must be used with ex-
treme caution and only if its use is deemed essential.

Usage in Pregnancy. Safe use of Talwin during pregnancy (other
than labor) has not been established. Animal reproduction studies
have not demonstrated teratogenic or embryotoxic effects. How-
ever, Talwin should be administered to pregnant patients (other
than labor) only when, in the judgment of the physician, the po-
tential benefits outweigh the possible hazards. Patients receiving
Talwin during labor have experienced no adverse effects other than'
those that occur with commonly used analgesics. Talwin should be
used with caution in women delivering premature infants.

Drug Dependence. There have been instances of psychological and
physical dependence on parenteral Talwin in patients with a history
of drug abuse and, rarely, in patients without such a history. Abrupt
discontinuance following the extended use of parenteral Talwin has
resulted in withdrawal symptoms. There have been a few reports of
dependence and of withdrawal symptoms with orally administered
Talwin. Patients with a history of drug dependence should be under
close supervision while receiving Talwin orally.

In prescribing Talwin for chronic use, the physician should take pre-
cautions to avoid increases in dose by the patient and to prevent the
use of the drug in anticipation of pain rather than for the relief of
pain.

Acute CNS Manifestations. Patients receiving therapeutic doses of
Talwin have experienced, in rare instances, hallucinations (usually
visual), disorientation, and confusion which have cleared spontane-
ously within a period of hours. The mechanism of this reaction is
not known. Such patients should be very closely observed and vital
signs checked. If the drug is reinstituted it should be done with cau-
tion since the acute CNS manifestations may recur.

Usage in Children. Because clinical experience in children under 12
years of age is limited, administration of Talwin in this age group is
not recommended.

Ambulatory Patients. Since sedation, dizziness, and occasional eu-
phoria have been noted, ambulatory patients should be warned not
to operate machinery, drive cars, or unnecessarily expose them-
selves to hazards.

chronic

pain

M. of moderate to severe intensity

of Talwin on the sphincter of Oddi, the drug should be used with
caution in patients about to undergo surgery of the biliary tract.
Patients Receiving Narcotics. Talwin is a mild narcotic antagonist.
Some patients previously receiving narcotics have experienced mild
withdrawal symptoms after receiving Talwin.

CNS Effect. Caution should be used when Talwin is administered
to patients prone to seizures; seizures have occurred in a few such
patients in association with the use of Talwin although no cause and
effect relationship has been established.

Adverse Reactions: Reactions reported after oral administration
of Talwin include gastrointestinal: nausea, vomiting; infrequently
constipation; and rarely abdominal distress, anorexia, diarrhea.
CNS effects: dizziness, lightheadedness, sedation, euphoria, head-
ache; infrequently weakness, disturbed dreams, insomnia, syncope,
visual blurring and focusing difficulty, hallucinations (see Acute
CNS Manifestations under WARNINGS); and rarely tremor, irri-
tability, excitement, tinnitus. Autonomic: sweating; infrequently
flushing; and rarely chills. Allergic: infrequently rash; and rarely
urticaria, edema of the face. Cardiovascular : infrequently decrease
in blood pressure, tachycardia. Other : rarely respiratory depression,
urinary retention.

Dosage and Administration: Adults. The usual initial adult dose is
1 tablet (50 mg.) every three or four hours. This may be increased
to 2 tablets (100 mg.) when needed. Total daily dosage should not
exceed GOO mg.

When antiinflammatory or antipyretic effects are desired in addi-
tion to analgesia, aspirin can be administered concomitantly with
Talwin.

Children Under 12 Years of Age. Since clinical experience in chil-
dren under 12 years of age is limited, administration of Talwin in
this age group is not recommended.

Duration of Therapy. Patients with chronic pain who have received
Talwin orally for prolonged periods have not experienced with-
drawal symptoms even when administration was abruptly discon-
tinued (see WARNINGS). No tolerance to the analgesic effect has
been observed. Laboratory tests of blood and urine and of liver and
kidney function have revealed no significant abnormalities after
prolonged administration of Talwin.

Overdosage: Manifestat ions. Clinical experience with Talwin over-
dosage has been insufficient to define the signs of this condition.
Treatment. Oxygen, intravenous fluids, vasopressors, and other
supportive measures should be employed as indicated. Assisted or
controlled ventilation should also be considered. Although nalor-
phine and levallorphan are not effective antidotes for respiratory
depression due to overdosage or unusual sensitivity to Talwin, par- j
enteral naloxone (Narean®, available through Endo Laboratories) is
a specific and effective antagonist. If naloxone is not available, par-
enteral administration of the analeptic, methylphenidate (Ritalin®), ;
may be of value if respiratory depression occurs.

Talwin is not subject to narcotic controls.

IIow Supplied : Tablets, peach color, scored. Each tablet contains
Talwin (brand of pentazocine) as hydrochloride equivalent to 50 mg.
base. Bottles of 100.

Precautions: Certain Respiratory Conditions. Although respiratory
depression has rarely been reported after oral administration of
Talwin, the drug should be administered with caution to patients
with respiratory depression from any cause, severe bronchial asth-
ma and other obstructive respiratory conditions, or cyanosis.
Impaired Renal or Hepatic Function. Decreased metabolism of the
drug by the liver in extensive liver disease may predispose to ac-
centuation of side effects. Although laboratory tests have not indi-
cated that Talwin causes or increases renal or hepatic impairment,
the drug should be administered with caution to patients with such
impairment.

Myocardial Infarction. As with all drugs, Talwin should be used
with caution in patients with myocardial infarction who have nau-
sea or vomiting.

Biliary Surgery. Until further experience is gained with the effects

| lAZ/rrY/rrop \ Winthrop Laboratories, New York, N. Y. 10016 (1583)

50 mg. Tablets

Talwin

brand of •

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^Souijd Off

Why should
/ pay my dues ?

Doctor Coury answers:

To: All MSMS Members

From: John J. Coury, MD,

MSMS President-Elect

One of the major efforts during my
stint in a leadership role tvill be in the
area of helping component society officers,
MSMS Council members, and MSMS
members answer the doctor who asks,
“What is MSMS or the AM A doing for
me ?”

This concern was outlined in my com-
ments to the spring meeting of the MSMS
House of Delegates.

In this connection, I would like to call
the following letter to your attention.
MSMS recently received a letter from a
member asking why he should continue
to pay his dues. This reply, I believe, is
positive and to the point. It lists some of
the many goals and concerns of MSMS.

May I respectfully urge you to read

it .. .

Dear Doctor:

You ask for some justification for continuing your
membership in MSMS, citing increasing government
control, inadequate payments from Blue Shield and
regional inequities in Blue Shield payment as rea-
sons to question your membership.

We welcome your letter.

Let me touch on several related matters before an-
swering those specific questions.

The tangible dollar-saving benefits of belonging
to MSMS are no doubt well known to you so I’ll
mention only a few in passing:

a. Group life insurance

b. Group disability insurance

c. Group umbrella liability insurance

Doctor Coury

d. Group rated medical/hospital insurance

The savings in these alone more than cover the
cost of MSMS membership dues. But, I think you
are seeking a deeper answer than mere dollars.

Medicine is organized in similar fashion to the rest
of society: From the individual, through county,
state and national levels. Each has certain respon-
sibilities which it can do best and which the in-
dividual probably could not do effectively.

The AMA directs its major concern to national
medical affairs and plays an important role in help-
ing to establish policy reflecting physician interest
and patient concern. Some physicians blame the
AMA because government involvement has in-
creased; but most realize that changes are in-
evitable. The AMA is working to make the changes
as acceptable to physicians as possible. If 50
states or 2,000 county medical societies took their
individual views to Congress, chaos would result.
United, the AMA can be heard.

This letter will now focus on MSMS. MSMS does
indeed address itself to the problems of doctors
throughout Michigan. Let’s discuss several:

1. Malpractice insurance — cost and availability.
Three years ago MSMS began an investigation
of a medical society sponsored plan. For rea-
sons valid at that time, we decided the time
was not appropriate. However, MSMS last sum-
mer authorized another study to bring to The
MSMS Council a plan which could be spon-
sored for its members. MSMS last spring de-
tailed the malpractice problem to 1) the State
Legislature and 2) the Insurance Commissioner.
As a result we have a House-Senate Study Com-
mittee with MD advisors. The State Insurance
Commissioner called a conference on the
problems February 28, at which MSMS par-
ticipated. MSMS believes this kind of leadership
is the only way to achieve statewide objectives
and to solve problems faced by individual doc-
tors.

2. In government relations, MSMS has continuing
contacts with congressional, legislative, state

MICHIGAN MEDICINE JUNE 1972 589

executive and departmental leadership. These
relationships do produce a variety of circum-
stances beneficial to medicine. MSMS tempers
the radical movement by keeping factual data
before prime decision makers. MSMS strength-
ens Medicine’s friends in government by pro-
viding rationale and rebuttals. MSMS makes
friends for Medicine by obtaining authentic in-
formation for lawmakers, who in turn promote
organized medicine’s second tenet, “to protect
the public health.”

Mostly, however, MSMS governmental activities
provide a coordination of efforts by component
societies, specialty societies and individual phy-
sicians to present to government a unified front.
This is accomplished through statewide com-
mittees such as Legal Affairs (legislation), Gov-
ernmental Medical Care Programs (government
medicine), Highway Injury, Public Health and
others, which refine the expressions of physi-
cians in Michigan into a cohesive State Society
policy.

The MSMS “Doctor-of-the-Week” program
brings volunteer doctors each week to the State
Capitol. No staff person can provide the same
first-hand experiences and comments, which all
work to erode an innate suspicion among pol-
iticians of doctors.

3. The new MSMS Bureau of Economic Informa-
tion is collecting data which MSMS never be-
fore possessed. The House of Delegates last
year created the Bureau with its own annual
budget. MSMS realized that we were handi-
capped in our dealings with governmental agen-
cies and Blue Shield because of lack of data
and statistics.

You are aware of the physician’s overhead cost
survey completed this summer and also our
statewide survey of fees. The survey results
showed that physician’s overhead had risen at a
rate faster than his income and, secondly, and
perhaps more importantly, showed that practice
costs were relatively constant throughout the
state.

On the other hand, our fee survey showed a
wide variation in charges by regions. These data
have been reviewed by The Council and we
have authorized a committee to meet with Blue
Shield in an attempt to eliminate any inequities
that may exist in the payment mechanism.

Further, using these data, MSMS expects to be
asked to play an advisory role or a bargaining
role in a statewide payment schedule which
may be adopted by the Department of Social
Services when it completes the take over of the
administration of Medicaid from the current fis-
cal administrator — Blue Shield this coming fall.

4. The work of the MSMS Relative Value Study is
currently being reviewed by the State Depart-
ment of Social Services for possible imple-
mentation in the Medicaid program.

5. One example of some significance that can only

have been achieved by the unified voice of
nearly 8,000 physicians was recently concluded.
Federal Law requires that physicians partici-
pating in Medicaid must sign a medical pro-
vider direct payment application/agreement if
they wish to participate. The proposed contract
submitted by the Michigan Department of Social
Services requested comments and suggestions.
The contract was found to be unacceptable in
both content and language.

MSMS succeeded in modifying the agreement
so that it will be better understood and more
acceptable to your colleagues. If MSMS or a
similar organization did not exist I doubt that
Social Services would have asked for the advice
of 8,000 fragmented, unorganized physicians.
What do you think?

6. MSMS is trying to find new ways to communi-
cate with the public and selected audiences the
concerns of the medical profession. In the area
of communications and public relations, the
staff is assisting the officers and committees so
MSMS can deal with vital issues. News releases
are issued, news conferences are held, speech-
es are made, etc., to drive home the points that
doctors want to make about better medical care.
Much of this can be done very effectively by
individual physicians as they inform themselves
and then discuss issues with neighbors, pa-
tients, their legislators, etc.

We hope this letter answers your questions about
the need for a strong Michigan State Medical So-
ciety. Our MSMS committees welcome your sug-
gestions and channels are open to the MSMS
House of Delegates for ideas you may have regard-
ing MSMS policies and projects. Your cooperation
is sincerely sought.

In short, Medicine needs your support and we urge
that you continue your membership. We sincerely
believe we are serving Medicine.

Let's examine
our feelings
about lawsuits

By Susan Adelman, MD
Detroit

A new medical syndrome, limited to physicians,
has reached epidemic proportions, especially in
large cities.

The usual predisposing condition is a conversa-
tion held by a physician with a dissatisfied patient
threatening a lawsuit. The doctor is seized with a
spasm.

But he can avert a lawsuit by regaining the con-
fidence of the patient, who is then meticulously

590 MICHIGAN MEDICINE JUNE 1972

taken care of and discharged as soon as possible.
However, if the patient decides to carry out the
suit, the illness enters a protracted phase. The
doctor makes speeches on the subject to everyone
who will listen. He is certain that everyone who
talks nearby is telling the tale.

Previous attempts at treatment of the “lawsuitis”
syndrome have emphasized the noble image of the
physician-scholar, dedicated to fighting disease
and relieving human suffering. The legal profession,
however, claims to see a different side: hostility,
lack of cooperation during trials, withholding of
medical information, and general reluctance to ex-
plain anything to any lawyer.

Every day we see things that should not be
done. In the event of a disastrous “mistake,” which
causes the lifelong disability or death of a patient,
is it morally justified to withhold information from
the inquiring relative? By so doing, we protect our-
selves while depriving the patient or family of the
chance for legal redress.

Our age has already judged that a sum of money
can to some extent compensate for the loss of a
limb or loved one. We ourselves accept a sum of
money in repayment of a legal wrong by someone.
How can we deny this to our patients and their
families?

Should we not look critically at why we are so
hostile toward malpractice lawsuits? Is it partly be-
cause so many are initiated by greedy families or
calculating lawyers? And what about the assault
on our professional pride? How shameful it is to be
dragged into court like a common thief! How dirty
the legal process! How unpleasant the lawyers!

These are not reasons to resent justifiable suits
brought by the families of needlessly deceased pa-
tients. The financial support of a whole family may
be at stake.

The fact is that every physician may commit
lethal errors, and places himself in the position of
being morally obligated to admit them. Any doctor
who has not been the subject of a malpractice suit
is either very young, very cowardly in his medical
practice, or deceitful.

The true professional
gives of himself,
earns respect

By Richard S. Youngs, DDS
President, Michigan Dental Association

To me, professionalism is closely aligned with
respect — respect and esteem from one’s peers,
from one’s family and from the community in which
one lives and works. Respect is an attribute which
must be earned. You aren’t born with it, you can-

Doctor Youngs

not buy it, and nobody will give it to you. It comes
when you deserve it; no sooner, no later.

How is it earned? By placing service to one’s
profession, one’s family, one’s community, one’s
country and one’s God above the pursuit of mon-
etary gain. And that, I guess, is what this talk is all
about. Service to the professional community.

I think it can be said without refutation that a
young man generally enters a profession for two
principal reasons: to provide a comfortable living
for himself and his family in a manner which will
give him some prestige, and to provide an oppor-
tunity to give something of himself to individuals
and the community. Let’s talk about the latter as it
relates to dentistry.

In providing dental services, a practitioner ac-
quires a deep sense of satisfaction by improving
the health of his patients and providing relief from
pain and misery. Many dentists are content to let
it rest there — assuming of course, that they are
earning satisfactory incomes. This type of man, in
my opinion, does not complete his professional
obligation.

We have heard a lot in recent years about a
dentist’s responsibilities to his community. This
conjures up thoughts about Community Chest ac-
tivity, participation in service clubs, devotion to
churches and even giving time to governmental af-
fairs. But what of his professional community?

A true professional man has an almost patholog-
ical desire to share his knowledge and expertise
with his fellow practitioners. It is only when he
gives of himself to his colleagues generously, free-
ly and gladly that he emerges as a complete pro-
fessional.

Let me tell you one thing right here: be good
to your profession and to your patients and they
will be good to you. Keep this in mind — rather
than the almighty dollar — at all times. Too often
the professional man has been associated with the
high income bracket. There is nothing against
making a good living, but the worst possible image
you can create for yourself or your profession is
to make it obvious that you border on being more
interested in your patients’ pocketbooks than their
teeth. The professions suffer somewhat from this
image in today’s society. Take care of your pa-
tients and the rewards undoubtedly will take care
of themselves.

MICHIGAN MEDICINE JUNE 1972 591

Your profession will be no better than the people
who enter it. I am certain you will earn the respect
you deserve.

(This article is reprinted, with permission, from
the April issue of the JOURNAL OF THE MICHIGAN
DENTAL ASSOCIATION. His remarks, part of an
address on professionalism given recently by Doc-
tor Youngs, are pertinent to physicians.)

% -

Doctor Stander

Are you ready
to become involved?

(Note: The following is a portion of the message
in the Saginaw County Medical Society Bulletin by
A. Carl Stander, MD, president, about drug abuse.)

A Drug Abuse Workshop, a three day event,
sponsored by the Saginaw Drug Abuse Council and
attended by a number of our medical society mem-
bers, is now a matter of record. As a participant, I
was impressed by the enthusiasm and sincerity of
those present.

At this meeting several other things were appar-
ent. The major drug problem is alcohol. Next came
the drug use and abuse of our drug oriented so-
ciety. The public, the physician, the drug industry,
self medication over the counter drugs, TV adver-
tising, the medicine chest, illicit drug distributors
were all implicated. Hallucinogens, stimulants, bar-
biturates, marijuana were all discussed. Edward
Lynn, MD, went in depth on a discussion of mari-
juana, pointing out it was not addictive, nor dan-
gerous, it did not alter reaction, time or alter driv-
ing ability, and had many good properties. He
stated the legal attitudes were unrealistic and
somewhat irrational.

Some change is inevitable. Community action
has begun here as in many communities. In a
democratic society, as dangers and threats to its
members become apparent, positive action can be
taken.

You are concerned — you are involved as pre-
scribing physicians whether you like it or not. All
society is involved. Are you ready to get involved
in the solution?

1. What is the best general approach to the patient who
has fainted?

2. What are the best strategies in the diagnosis and man-
agement of patients with recurrent chest pains?

3. What is the best treatment for the person with low back
pain?

4. How can the doctor best handle the neurophysiological
aspects of drug abuse?

5. What are national authorities saying now about the sur-
gical approaches to coronary disease?

For the answers to these questions and others, plan now to attend
the 107th Annual Session of the Michigan State Medical Society
October 1-5 at the Sheraton-Cadillac Hotel in Detroit. Block out
the dates now for this important medical event.

592 MICHIGAN MEDICINE JUNE 1972

MEDIGRAMS

LATE NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY

June 14, 1972, Volume 71, Number 18
Michigan State Medical Society
Reading Time: 2 Minutes, 40 Seconds

THE MSMS -SUPPORTED BILL TO REPEAL
AND FOREIGN-TRAINED DOCTORS FROM COMING TO
LEGISLATURE.

U. C. SAN

THE MSMS COUNCIL on June |||$^edf.&U
resolution praising the Michigan State
Legislature for such action. JUL101

The vote in the House was 96-6, with
passage in the Senate by a vote of
35-1. Governor Milliken is expected
to sign the bill into law, with
immediate effect, next week.

think it was you who asked me the other
day , ” What has MSMS done for me lately in
the legislative field?”

This article especially reports on a recent
MSMS accomplishment in our legislative work.

THE BASIC SCIENCE ACT WHICH HAS KEPT SOME CANADIAN
MICHIGAN HAS BEEN PASSED BY THE MICHIGAN

FRAiffiJSSO-

Curtis Bens on 3 MD3 Kalamazoo
From: John Coury3 MD3 MSMS President-Elect

In voting to compliment the legislature for passing HB5883, the MSMS Council author-
ized a letter to each of the lawmakers who concurred with the MSMS position. The
letters, from MSMS President Sidney Adler, MD , commended the legislators "who supported
this measure for statesmanship in careful and critical examination of an out-dated
measure and action reflecting responsiveness to present conditions and needs."

"Let us continue to work together for increases in the number of physicians serving
the growing population of the state," Doctor Adler urged.

The medical society supported the enactment of the original basic science requirement
in 1937 as a protection to the public. MSMS changed its position, and began working 20
years ago for repeal of the law when standards of medical education improved throughout
the world and because of the shortage of physicians in Michigan. Since 1964, MSMS has
sought outright repeal of the law.

In 1969, the Legislature amended the law to exempt graduates of U. S. accredited med-
ical schools from the basic science law.

IN RESPONSE TO REQUESTS from MSMS and others, the Michigan Highway Dept,
is taking steps to erect directional signs on freeways to help motorists
find hospitals with continuous emergency medical care. To qualify, the
requesting hospital must "be lo.cated within five miles of the interchange,
provide continuous service with emergency care, have a doctor on duty 24
hours per day and seven days per week, be licensed by the Michigan Dept,
of Public Health, and be located on the intersecting crossroad or be
trailblazed by other signs leading to the hospital."

JUNE 21 IS the deadline for Michigan physicians who wish to make contract
changes on their MSMS 94000 group Blue Cross and Blue Shield policies
during the annual BC-BS reopening. "The Blues" have made their second
mailing to all MSMS members asking them to contact the Blue Cross-Blue
Shield offices to make any desired changes. Physicians are being specially
urged now to add their medical assistants to the policy. Doctors also may
add Blue Shield to existing Blue Cross coverage, change to Blue Cross only,
add eligible dependents.

MSMS LEGAL COUNSEL Stewart Kerr reports that for the first time in several
years the Department of Justice seems to be refocusing on enforcement
against smaller businesses and trade associations, including professional
associations. The Antitrust Division recently announced its concern about
"codes of ethics" which have the effect of setting prices and/or otherwise
restricting competition.

THE MSMS COUNCIL ON JUNE 7, 1972 TOOK THE FOLLOWING ACTION: !

HEARD A REPORT that Governor Milliken had concurred in arguments of MSMS
and has asked the legislature to remove his recommendation for a 3% dis-
count in Medicaid reimbursement from his proposed budget.

AGREED TO WRITE the State Insurance Commissioner objecting to the increases
by Medical Protective Company in malpractice insurance rates effective June
1, raising questions about Phase II economic limitations.

ENDORSED THE PROPOSED NEW rules of the Department of Public Health governing
blood banks with one amendment. The new rules would no longer require that
a physician be present physically at blood banks — a change that MSMS has
sought for some time.

VOTED TO RESTATE the MSMS position supporting the 5-digit AMA Current Pro-
cedural Terminology to the Michigan Department of Social Services. The
Medical Advisory Committee to the MDSS has recommended the 4-digit code of
the National Association of Blue Shield Plans. Appeals that MSMS restate
the House of Delegates position were made by the Michigan Society of Interna
Medicine, Genesee County Medical Society, and several doctors.

APPROVED THE APPOINTMENT of a committee to implement the development of
the articles of incorporation and bylaws of Medical Programs, Inc. (the
foundation for peer review) .

ASKED THE CHAIRMAN to appoint a committee to further explore methods by
which physicians are paid for Medicaid services. House Bill 5305, which
would have provided for payments on a statewide uniform fee schedule, has
been stalled in the House of Representatives.

VOTED TO SUBMIT a MSMS statement to the AMA hearing in San Francisco June
17 when the AMA Council on Long-Range Planning will invite comments and
criticism. The five points to be made by MSMS will appear in "Medigram."

June 14, 1972 Vol. 71, No. 18

MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 5i /, 337-1351.

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

UNIVERSITY OF CAL
L I BRARY SCH OF MED
THIRD £ PARNASSUS AVE
SAN FRANCISCO CAL 94122

EDITOR: HERBERT A. AUER

^DIGRAMS

.ATE NEWS FROM THE MICHIGAN STATE MEDICAL SOCIETY MEDICO

JAN FRANCISCO REPORT: A Brief Summary of AMA Action

(Editor's Note: This summary of the AMA House of Delegates Annual Meeting covers

mly highlights and cannot be complete because of space limitations. A detailed report
7ill be made by the MSMS delegation in Michigan Medicine . Many articles also will appear
_n the AMA News - Herb Auer)

;HE MICHIGAN DELEGATES to the AMA convention in San Francisco were active in supporting
iiany matters aimed at better health care for the public and at stronger unity in the
siedical profession,

, . . and efforts to elect Donald N. Sweeny, Jr., MD, Detroit, to the AMA Council on
ledical Service were successful. Doctor Sweeny, highly regarded by AMA delegates as
m effective delegate and hard-working, experienced member of several AMA committees,
defeated a candidate from Texas and one from Ohio in a three-man race. Doctor Sweeny
7as elected to fill the Council seat being vacated by George W. Slagle, MD, Battle
Jreek, who had. served the maximum of two five-year terms. Doctor Slagle, an MSMS past
>resident, was lauded for his outstanding service.

’HE FULL COMPLEMENT of 8 Michigan delegates and 8 alternates plus two sectional dele-
gates from Michigan, participated actively in the affairs of the House, the reference
committees, the caucuses, the hospitality suite, etc. Sidney Adler, MD, Detroit,

[SMS president, attended and was seated with other state presidents on the stage for
he AMA installation services.

EADERS OF THE STATE Auxiliary to MSMS were prominent in the national Auxiliary con-
tention. The Auxiliary observed its 50th anniversary in San Francisco.

!N ADDITION to the work at the House of Delegates, 34 Michigan physicians were involved
in the scientific program, either presenting scientific papers or explaining their
scientific exhibits. Total registrations topped the 30,000-mark, with more than
1.5,000 physicians present.

jllCHIGAN-SPONSORED RESOLUTION was adopted by the AMA House instructing the AMA to
continue to work to remedy adverse regulatory decisions concerning Titles 18 and 19 .

?he Michigan resolution pointed out that "in too many instances agency regulations
lave resulted in limitations, denials and retroactive rejection for payment of services
:o the medically indigent." This resolution was introduced as instructed by the Spring
session of the MSMS House of Delegates.

:HE DELEGATES dealt with a number of social issues, such as gun controls, marijuana,
etc. A substitute resolution offered by Michigan was adopted after a long debate
iver a resolution about the illegal use of firearms. The Michigan approach was that
\MA "express its strong abhorrence and continued opposition to the use of a firearm
ir any weapon in the commission of a crime and that it urge the enforcement of strict
Penalties for such use."

IE: MARIJUANA, AMA House approved a proposal that would prohibit the public use of
rarijuana and also recommend that "personal possession of insignificant amounts of ^
narijuana be considered at most a misdemeanor with commensurate penalties applied.

The full resolution included a statement that the 'AMA does not condone the pro-
duction, sale, or use of marijuana."

SOME DELEGATES ANTICIPATED that AMA President Wesley Hall, MD, might be critical
again of various aspects of the AMA, but his annual address to the House was
positive and constructive. He was lauded for his "untiring and dedicated service
to medicine."

C. A. HOFFMAN, MD, West Virginia, the new AMA president, in his inaugural, observed
that doctors are threatened as never before by attacks on medical costs, medical
methods, and even their life styles. He underscored his opposition to government
medical programs.

SEVERAL CONSTITUTIONAL revisions were advanced by the delegates acting on the
recommendations of the House Reference Committee on Constitutions and Bylaws. Joseph
A. Witter, MD, Bloomfield Hills, served on that busy committee. AMA membership will
be available to medical students through county and state societies or directly with
the AMA if not available locally.

AMA HOUSE APPROVED a long report about ways to improve medical services in rural and
medically underserved areas. Robert Rice, MD, of Greenville, is a member of the
Commission on Rural Medical Service, and helped write Report Q. The AMA supported
legislation which would provide financial tax write-off incentives to attract doctors
to rural and inner-city areas.

THE HOUSE again opposed any MD draft to send doctors into such areas to provide civiliai
health care.

AMA REAFFIRMED its support of catastrophic health insurance coverage related to com-
prehensive health benefits, rather than as free standing programs.

THE RECENT AMA MEMBERSHIP poll was applauded. Opinions expressed by members and non-
members will be considered by the AMA in developing new projects and programs. There
was a 52.9 percent response — which is really outstanding as polls go.

THE DELEGATES were impressed with a detailed report by Ernest Howard, MD, executive
vice president of the AMA. The report effectively tells what the AMA is doing for
both the profession and the public. Interested members can write MSMS for a copy.

THE HOUSE VOTED TO ENCOURAGE individual physicians to continue to speak out on public
issues .

THE HOUSE ALSO approved a proposal to ballot at the next session on the question of
limiting the terms of members of the AMA Board of Trustees and approved a report on
the acceptance of osteopaths into residencies. A number of questions about developing
physician assistant programs was referred to the Council on Medical Education for study

THE MSMS DELEGATES are Doctor Sweeny, chairman, Detroit; Otto K. Engelke, MD, vice
chairman, Ann Arbor; John J. Coury, MD, Port Huron; Paul T. Lahti, MD, Royal Oak;

John W. Moses, MD , Detroit; Robert E. Rice, MD, Greenville; George W. Slagle, MD,

Battle Creek, and Joseph A. Witter, MD, Bloomfield Hills.

THE MSMS ALTERNATE DELEGATES are Donald T. Anderson, MD, Kingsford; Vernon V. Bass, MD,
Saginaw; James C. Danforth, Jr., MD, Grosse Pointe Woods; Brooker L. Masters, MD,
Fremont; Richard J. McMurray, MD, Flint; Marjorie Peebles Meyers, MD, Detroit; Robert
C. Prophater, MD, Bay City, and Frank B. Walker, II, MD, Grosse Pointe Park.

TWO DELEGATES FROM SPECIALTIES also are from Michigan. They are Harold F. Falls, MD,
representing Ophthalmology; and Chris Zarafonetis, MD, representing Clinical Pharma-
cology and Therapeutics, both of Ann Arbor. !j

PHYSICIAN PARTICIPATION IN MEDICAID (TITLE XIX)

AND CRIPPLED CHILDREN (TITLE V) PROGRAMS

The State advised physicians Jan. 28, 1972, that "the Michigan Departments of Social
Services and Public Health are in the final phases of implementing redesigned Medicaid
and Crippled Children fiscal and related claims processing systems." This new system
will replace Blue Shield as fiscal intermediary for claims payments. The scheduled
date for the final transition of these intermediary responsibilities with a test
group beginning on Aug. 1 is Oct. 1.

Physicians will receive a Medical Provider Direct Payment Application/Agreement
with Instruction Sheets for completing the forms. Physicians who enroll and receive
payment for services under the program must complete both the Application and Agree-
ment, sign the form and return it to Social Services. The physician’s name will then
be added to the master list of eligible providers and a Practitioner’s Manual and a
supply of invoices will be sent to him. The State and/or the physician may terminate
eligibility upon 60 days written notice.

3

]

i

Notice to Physicians Receiving

Medical Provider Direct Payment Application/Agreement

The front contains pertinent data relating to you as a provider to establish eligi-
bility. The back of the document is the Agreement setting forth conditions for
participation to fulfill Federal requirements. Only Clauses 1-7 and 12 apply to
physicians. Your decision to participate is voluntary, but you must enroll to
receive payment for treating eligibles.

The Michigan Department of Social Services will conduct Practitioner Seminars during
the month of July for the 10 percent test group to be converted in the Counties of
Ingham, Eaton and Genesee. Other Seminars will be conducted later throughout the
State to assist all enrolled providers to understand the procedures for filling out
invoices and billings. Physicians may find it more advantageous to send their medical
or office assistant to these Seminars - those employees responsible for eligibility,
billing and other paper work. These Seminars will not be policy or coverage sessions.

A Practitioner’s Manual will be sent you following receipt by Social Services of your
signed Appli cat ion /Agreement . Contents include: General Description, Recipient

Eligibility, Coverages and Limitations, Billing and Inquiry and Crippled Children
Program. Appendices and a glossary are also included. You and your office aide
should thoroughly review this material before attending a Seminar in order that your
questions can be answered at that time.

Doctors are protesting Department of Social Services requirement that provider
agreement for new Medicaid fiscal program must be signed before provider manual
v', and fee manual are given to them. It’s buying a pig-in-a-poke , doctors say,
to insist on agreement before receiving all information on the program.

t

MSMS Department of Government Relations staff reviewed this Manual and conveyed
objections to Social Services about certain portions. We protested the gratuitous
warning to physicians not to exploit, advertise or engage in fraudulent billings
and procedures.

Another portion, equally disturbing, notes that "a pharmacist will, with the obtained
consent of the prescribing physician, be allowed to exercise his professional judgment
in selecting the drug prescribed on a basis consistent with chemical equivalence, bio-7
availability and good economy." Later manuals may use the word "permission" instead
of "obtained consent." MSMS urges physicians to refuse to sign any form which would
authorize pharmacists to substitute. Ethical pharmacists will contact the physician
when a prescribed drug is not available. Substitution without the expressed author-
ization of the physician is illegal.

While enrollment into either program does not legally require a provider to render
services, all services rendered to an eligible recipient by an enrolled provider,
must be in compliance with the conditions of the provider agreement.

The MSMS Department of Government Relations solicits your comments and suggestions.

TWO HUNDRED FIFTEEN MORE MEDICAL STUDENTS are scheduled for Michigan#,
medical schools next fail under the higher education appropriations bill
passed by the Senate. Bill still faces floor action in the House. As
it stands now, MSU College of Human Medicine will increase by 54 students,
with a freshman class of 85; U-M will increase by 50, with a freshman class
of 237; Wayne State will increase by 111, with a freshman class of 240.
MSU's DO school will increase its enrollment by 64, with the entering
freshman class. Also programmed is the 1973-4 freshman class at WSU of
256, 16 more than planned for 1972-3.

MICHIGAN DEPARTMENT OF PUBLIC HEALTH will hold a public hearing on proposed
rules for cardiac care, intensive care and hemodialysis units in hospitals,

Thursday, July 13, in the auditorium of the Seven Story Office Building in
the Capitol Complex in Lansing. Copies of the proposed rules can be obtained
from Hermann Ziel, MD, Chief, Bureau of Health Facilities, MDPH, 3500 North
Logan, Lansing, Michigan 48914. Written statements filed with Doctor Ziel
prior to July 13 will be made part of the hearing record.

THE MSMS COMMITTEE ON MEDICAL SOCIO-ECONOMICS will meet with represent-
atives of Blue Shield July 12 to discuss Blue Shield's Usual, Customary
and Reasonable Fee Program and to explore possible inequities in the
program.

June 29, 1972 Vol. 71, No. 19

MICHIGAN STATE MEDICAL SOCIETY
Published three times each month and four times
in December and January, 38 issues, by the Michigan
State Medical Society as its official journal. Second
class postage paid at East Lansing, Mich, and at ad-
ditional mailing offices. Yearly subscription rate,
$9.00. Printed in USA. All communications should be
addressed to the Publications Committee, Michigan
State Medical Society, 120 West Saginaw Street, East
Lansing, Michigan 48823. © 1972 Michigan State
Medical Society. Phone: Area Code 517, 337-1351.

EDITOR: HERBERT A. AUER

Second Class Postage Paid at East Lansing, Mich,
and at additional mailing offices.

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>7! DAY

NOV 101972

RETURNE D

NOV - 8 1912

7 DAY

JUN 20 1973

returned

JUN 22 1973

7 DAY

JUL . 2 1973 _

^ *■""“** 4

IV- * -

JUL 11 "'973

15m-7,’72 (Q3551s4) 4315— A33-9